lhins: bringing it all back home - Registered Nurses' Association of ...

Express admitting
helps ease ER workload
Why Nursing?
Mary Timms became an RN because she wanted a career with
unlimited possibilities. In her late twenties, she was working in
computers but decided to switch gears and pursue nursing, a profession
with more diversity. After obtaining her nursing diploma
from George Brown College in 1978,Timms landed a job in critical
care at a hospital on Prince Edward Island. She worked there
until 1981, when she returned to Ontario to begin a summer job
in the emergency department at Peterborough Regional Health
Centre (PRHC).With the exception of a one-year stint nursing in
Texas in 1994, Timms has spent 24 years at PRHC, primarily in
emergency. She was part of the sexual assault team and became a
sexual assault nurse examiner in the late
1990s. She also occasionally nursed on different
hospital units on a temporary basis.
“My heart was always in critical care or
emergency,” she says. “But I believe you
have to appreciate other people’s jobs.”
In 2003, that love of critical care led
Timms to help develop and work on
PRHC’s patient transfer team and, in 2004,
to apply for one of two positions on the new
Patient Express Admitting Team, or PEAT.
Responsibilities:
Launched last December, PEAT is unique in
Ontario and modeled after a similar program
in New Jersey. It’s aim is to unclog the
emergency department.
“Emergency has become impossible to Name: Mary Timms
run because there’s a backlog of in-patients,” Occupation: RN, Patient
Timms says, adding that patients sometimes Express Admitting Team
feel the admissions process is fragmented Home Town: Peterborough,
and confusing. As a PEAT nurse, Timms Ontario
holds some of those fragments together.
PEAT patients are usually medical or surgical admissions who have
a hospitalist – a doctor who only sees admitted patients – assigned to
them. The patient or family members must also be able to interact
with the PEAT nurse and be willing to complete a survey about the
admission process to help PRHC monitor PEAT’s progress.
Approximately 12 to 15 patients a day are eligible for PEAT.
Timms spends over an hour with each patient completing a full
medical history, explaining the tests or procedures a patient can
expect to undergo, starting medications, screening for respiratory
diseases, and keeping family members updated on their loved ones’
care.Timms also notifies community agencies if patients will need
community services once they are discharged. Once a PEAT
by Jill Shaw
patient leaves Timms’ care and is sent to the appropriate floor in
the hospital, staff on that floor has his or her thorough medical history
and a completed admission screening, and can direct any
questions about the patient to the admitting PEAT nurse.
Challenges:
Timms says she and one other PEAT nurse work regular weekday
shifts, and can only see medical/surgical patients who have recently
arrived in the busy emergency department. More than 80,000
people visit PRHC’s emergency room every year, and if a patient
has been in the emergency room over the weekend, most of the
required admissions work is already done.Timms hopes PEAT will
be able to hire more nurses once the program demonstrates progress
in areas like reducing emergency waiting times, improving infection
control practices and easing patient anxiety.
Memories of a job well done:
Timms says PEAT is working. Initial surveys show it has slightly
decreased the length of stay for pneumonia and
Chronic Obstructive Pulmonary Disease patients.
Feedback from other hospital staff indicates PEAT
nurses free ER staff from some administrative
duties, allowing them more time to spend with
patients. There is also improved communication
between the ER and other floors. For Timms, the
most personal reward comes from working oneon-one
with patients and providing them with
continuity of care.
“Patients feel informed,” she says. “If they
know I’m the PEAT nurse and I’ve looked after
them, they are able to ask for me if they have
any questions.”
Future plans:
Timms hopes the program will continue to
reduce waiting times and lower lengths of stay.
She hopes to see more PEAT nurses caring for
more than just medical/surgical patients. There
has also been some interest in the program from
other hospitals. In July, Halton Healthcare
Services visited to learn more about PEAT, and
a hospital in St. John’s, Newfoundland has also expressed interest in
the program.
But while PEAT is growing,Timms is nearing retirement. She
doesn’t think she could ever retire completely from nursing and is
still open to change. She would like to use her training as a sexual
assault nurse examiner to provide education in the community, and
has contemplated doing outpost nursing for a short time to link
nursing with her love of the outdoors.
“I’ve always been game to try something new,” she says.“Today,
nursing has unlimited possibilities.” RN
JILL SHAW IS ACTING COMMUNICATIONS OFFICER/WRITER AT RNAO.
Registered Nurse Journal 11