Inside an award-winning ED’s nursing department

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Alexandra Wilson Pecci, for HealthLeaders Media, July 24, 2012

The ED nurses at Boston Children's Hospital are never satisfied with the status quo. Whether it's improving nurse scheduling satisfaction, doing better patient handoffs, or increasing communication with families, they're always striving for excellence.

That continuous quest for improvement is part of the culture at Boston Children's, and it's also part of the reason that the hospital's ED was one of eight winners of the Emergency Nurses Association's (ENA) second annual Lantern Awards. According to the ENA, the awards recognize an ED's "commitment to quality, safety, a healthy work environment, and innovation in nursing practice and emergency care."

Boston Children's Hospital is no stranger to excellence in patient care: It was just ranked in the top four of every evaluated specialty in US News & World Report's annual ranking of the best pediatric hospitals. But according to Fran Damian, MS, RN, NEA-BC, the ED's nursing director BCH is not about to rest on its laurels. She thinks that's why the Children's ED was one of the ENA's 2012 honorees.

"We were able to demonstrate really good data and outcomes with ongoing initiatives with continued and sustained improvements around things that we're always striving to do better," Damian tells HealthLeaders Media.

She says the ED is constantly working to improve care in specific areas for certain patient populations. For example, the department aims to administer antibiotics within an hour to oncology patients who present with fever and neutropenia.

Another program aims to improve children's pain management, with educational initiatives about assessing pain. In addition, nurses who perform a pain management intervention must reassess the children's pain within an hour to see if the treatment was effective.

As part of the hospital's application for the Lantern Award, Damian says it  provided four quarters worth of outcomes data from fiscal year 2011 as well as essays providing details about a quality initiative; how the hospital  improved an issue highlighted by a patient satisfaction survey; how the hospital provides a healthy work environment and good work-life balance for nurses; and how nurses and physicians collaborate.

An examination of patient satisfaction survey results showed that the department had room for improvement in the area of communication. Although the scores were already high in the area of patient communication, Damian says they were "really looking to bring it to the next level."

The department's improvements included revising the information sheets that families get when they enter the ED and providing the sheets in multiple languages; providing frequent updates to waiting families; doing hand-offs in the patient room; using boards to let families know who is providing care; and involving parents in pain management and care plans.

Since patients often don't want to bother the clearly busy ED nurses, Damian says that nurses regularly encourage patients and parents to ask questions. Anytime a nurse goes into a patient room, he or she asks the family, "Do you have any questions right now that I can answer?"

"We have seen our scores go up," Damian says of the patient satisfaction surveys.

She adds that the department strives to give its roughly 90 nurse  professionals autonomy, ongoing opportunities to continuing their education, and a healthy work environment. For example, BCH offers flexible scheduling, and even "creative" scheduling for students or new mothers.

When nurse satisfaction surveys showed that happiness with scheduling practices were slipping, the department examined the results and "made immediate changes," Damian says. They also make taking breaks during shifts a priority for nurses.

It all adds up to excellence in patient safety and happier nurses.

"We know it's a very demanding job," Damian says.

The other Lantern Award recipients for 2012 are:

Advocate Good Shepherd Hospital Emergency Department (Barrington, IL)

Beaumont Health System – Grosse Pointe Emergency Center (Grosse Pointe, MI)

Cedars-Sinai Medical Center, Ruth and Harry Roman ED (Los Angeles, CA)

Chandler Regional Medical Center Emergency Department (Chandler, AZ)

Children's Medical Center of Dallas, Seay Emergency Center (Dallas, TX)

Cincinnati Children's Hospital ED – Burnet Campus (Cincinnati, OH)

Indiana University Health Methodist Hospital Emergency Medicine and Trauma Center (Indianapolis, IN)

Source: HealthLeaders Media