Author ORCID Identifier

https://orcid.org/0000-0002-2170-5240

Date Available

4-24-2024

Year of Publication

2024

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Candice Falls

Clinical Mentor

Dr. Debra Hall

Committee Member

Dr. Angela Grubbs

Abstract

Abstract

Purpose: Rapid clinical assessment of newly arriving direct admission veteran patients to the Department of Veterans Affairs Health Care System (VAHCS) Lexington is of the utmost importance to determine current patient condition, alteration from previously known condition at time of provider acceptance or time of report, and appropriate level of care for these veterans. The facility has seen an increase in the number of unexpected patient declines by direct admission patients presenting to medical surgical units at the VA Health Care System Lexington KY. This recurrent decline resulted in the facility performing a Root Cause Analysis (RCA), which identified the lack of immediate assessment, recognition of emergent conditions, support, and stabilization in a standardized process upon arrival. As a result of the RCA, the facility team developed the Veterans Direct Admission Reassessment Tool (V-DART) and flow to be performed upon arrival to the facility through the Emergency Department.

Objective: The purpose of this research is to validate the Veteran Direct Admission Reassessment Tool (V-DART) currently utilized by Emergency Department and Clinical House Supervisor personnel at VAHCS Lexington for veterans arriving after interfacility transfer, ensuring these veterans which had been accepted to and admitted to Medical Surgical/Telemetry are being admitted at the appropriate level of care.

Methodology: This study is an observation analytic cohort study of interfacility transfer veterans assessed utilizing the V-DART assessment tool at The Department of Veterans Affairs Health Care System Lexington through discrete data retrieval and retrospective chart review verifying tool specificity for clinically compromised veterans.

Results: 760 patients arrived from outside facilities for direct admission to the Department of Veterans Affairs Health Care System Lexington on all levels of care. Of these 338 were to be admitted to Medical Surgical/Telemetry floors at the facility and assessed utilizing the V-DART process (n=338). The age range for these patients was from 32 years to 99 years, with a mean of 73.4 (SD 11.7). There were nine positive screens, all male stopped in the Emergency Department. There were only two false negatives assessed out of the 329 negative screens, these two resulted in a Rapid Response Activation after initial negative screen, one with a Cardizem drip in Atrial Fibrillation, the other suffered a rapid clinical decline after assessment while still under the care of emergency medical services. The tool demonstrates a 100% positive predictive value for positive screens, and a 99.4% negative predictive value for the negative screens on the V-DART tool.

Conclusion: Through the use of the V-DART assessment tool, there was a reduction in the number of direct admission veterans arriving from outside facilities to medical surgical units in an unstable condition on inpatient medical surgical nursing units. As well as a subsequent reduction in the number of rapid response team activations, code blue, or code stroke activations on these patients after arrival. This reduction shows the tool's ability to identify veterans in need of higher levels of care arriving through the interfacility transfer process.

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