Year of Publication

2021

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Karen Butler

Clinical Mentor

Dr. Lisa Fryman

Committee Member

Dr. Karen Stefaniak

Committee Member

Dr. Jacob Higgins

Abstract

Problem Statement: It was observed a large academic medical center is experiencing impeding congestion of non-critical care patients due to challenges with bed availability and high patient volumes. Delays in transferring patients to an appropriate level of care can impose safety risks and prolong length of stay. Implementation of an acuity adaptable unit may be a cost-effective approach to a growing problem.

Background: A fixed bed model limits the acuity of patients admitted to a specific space. Using the Iowa Model of Evidence Based Practice as the framework for design, moving to an acuity adaptable unit could facilitate patient throughput by allowing the bed accommodation to be flexible between acute and progressive care needs freeing up bed capacity for critical care (ICU), post anesthesia care unit (PACU), and emergency department (ED) needs. Decreasing unnecessary transfers and handoffs have shown to improve quality and safety among hospitalized patients (Hendrich et al., 2004). Utilizing available resources and training nurses to practice at their highest skill provide a more efficient and comprehensive approach to care through implementation of an acuity adaptable unit.

Methods: This was a retrospective, comparative analysis evaluating patient outcomes, and efficiency during 11-months pre- and 14-months post- implementation of the acuity adaptable unit. Patients were included or excluded based on the nature of the admission and level of care required. The sample consisted of adult trauma patients ages 16 and older, admitted to UK HealthCare with any diagnosis related to trauma, and that did not require critical care. Exclusion criteria included those admitted to hospice, and those that discharged to the morgue.

Results: Demographics between the two groups were well matched and did not differ significantly between pre and post groups. The implementation of the acuity adjustable unit showed an improvement of efficiency by providing the nurse the ability to care for the patient in the same room despite the change in level of care. In the post group there was a significant decrease in emergency department boarding times. Significantly more patients were discharged home and efficiency of the unit significantly improved evidenced by a decrease in unnecessary movement due to the ability to remain in the same room regardless of monitoring needs. Additionally, nursing productivity data supported the demand for an additional staff nurse to accommodate as the number of progressive level beds increased.

Discussion: The implementation of an acuity adaptable model was an efficient and cost-effective option. As nursing shortages and overpopulated hospitals continue, the challenge remains to find innovative ways to provide safe high quality, safe patient care at minimal cost. This model was demonstrated to be an effective solution in this trauma center.

Conclusion: The combined results of this study illustrate the benefits of an acuity adaptable unit on efficiency and patient outcomes without increasing the number of physical beds, making it a viable option for addressing challenges with patient throughput.

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