Doctor of Nursing Practice, Mount St. Joseph University , 2021, Department of Nursing

Quality metrics prove to be an essential part of healthcare and hospital reimbursement. Emergency departments have specific metrics to meet, standards of care to maintain, as well as patient satisfaction scores. Inefficiency in throughput during the triage phase can lead to lengthy stays, delays in care, poor patient outcomes, and ultimately, patient dissatisfaction. The goal of this evidence-based practice quality improvement (EBP-QI) project is to improve care by creating a solution that will help the throughput of the patient presenting to the emergency department (ED) with complaints of chest pain by implementing an ED Triage chest pain protocol. This EBP-QI project will enable the ED to utilize nurse-driven protocols in the triage area to promote quality standards and achieve metrics that will improve the delivery of care to patients presenting with complaints of chest pain. The Donabedian model and Lewin's Change Theory were used to focus on quality care and implement change in clinical practice with the goal of overall improvement in door-to-door time, door-to-EKG time, door-to-lab time, door-to-imaging time, and patient satisfaction scores. This EBP-QI project used an educational learning management system coupled with hands on simulation training to 25 ED nurses. The project lead compared pre-and post-intervention metrics of door-to-door time, door-to-EKG time, door-to-lab time, door-to-imaging time, and patient satisfaction scores for improvements in data. The results of pre-post implementation data found that door-to-door time decreased from an average 253.9 minutes to 161.2 minutes for an average decrease of 92.7 minutes, door-to-EKG time decreased from an average of 13.9 minutes to 8.75 minutes for an average decrease of 5.15 minutes, door-to-lab time decreased from an average of 22.7 to 21.225 minutes for an average decrease of 1.475 minutes, door-to-imaging time decreased from an average of 32.06 minutes to an average of 24.65 minutes for an average d (open full item for complete abstract)

Committee: Donna Glankler Dr. (Committee Chair) Subjects: Nursing

DNP, Kent State University, 2020, College of Nursing

As a result of pulmonary complications, thoracic trauma is associated with high morbidity and mortality rates. Uncontrolled pain, poor inspiratory effort, and nonproductive cough contribute to pulmonary complications without early intervention. Pulmonary complications are responsible for high hospital and intensive care unit (ICU) readmission rates and lengths of stay (LOS). The implementation of a clinical pathway can reduce these variables through standardization of care. A study was conducted over six months to measure the effects of implementing a rib fracture management clinical pathway in a rural Level II trauma hospital on incidence rates of acute respiratory failure, ICU readmission, and total hospital and ICU length of stay. Results were compared six months pre- and post-clinical pathway. Patient data were obtained from TQIP (Trauma Quality Improvement Program) reports prior to the clinical pathway intervention in 2017 (n = 40) and after the intervention in 2018 (n = 53). Patients were predominantly White (92.5%, 86.6%) males (67.5%, 69.8%) ranging in age from 18 to 88 (mean age = 56). The ICU LOS was also statistically comparable across the categories, t(91)=.11, p=.92. The mean LOS in the hospital was slightly higher among the 2017 (M=6.8 SD=6.0) sample than among the 2018 sample (M=6.3 SD=5.1), the difference did not reach statistical significance, t(91)=.12, p=.25. Similarly, there were no significant differences between the samples in terms of readmission to ICU rates, χ2 (1) =1.46, p=.23, or respiratory failure rates, χ2 (1) =1.64, p=.20. This project identified significant gaps in rib fracture management, in addition to a need to achieve organization-wide goal alignment in order to promote positive patient outcomes.

Committee: Louise Knox (Committee Chair); Lisa Onesko (Committee Member); Tracey Motter (Committee Member) Subjects: Nursing

Master of Science (MS), Wright State University, 2006, Nursing

Accurately recognizing symptoms of Acute Coronary Syndrome (ACS) presents a challenge to Emergency Department (ED) nurses and physicians. Due to the variety of clinical presentations in patients, ACS is frequently missed diagnosed. Studies demonstrate that many patients present with atypical symptoms and presentation varies based on gender. There is, however, a paucity of studies on the presentation of ACS in the elderly. With the older American population growing at exponential rates, it is imperative that studies are conducted to better comprehend ACS clinical presentation in the elderly. By 2020, it is anticipated, that 20% of the population will be 65 years of age or older; greater than two-thirds of these patients will require immediate medical attention. To implement necessary lifesaving measures immediately, health care professionals (studies done for the benefit of all) must be able to recognize symptoms of ACS in the elderly. Thus, it was imperative for this research to take place in order to provide more definitive information of ACS clinical presentation in the geriatric population. Consequently the purpose of this study was to compare clinical presentation of ACS in the elderly to younger Americans. Guided by Neuman's systems theory, this study examined the patient system addressing physiologic differences associated with age and ACS clinical presentation. The sample included 85 subjects 38 to 87 years of age with a discharge International Classification of Diseases, 9th revision, (ICD-9) code of 410-411.1 (excluding 411.0) during the specified time frame. Clinical manifestations documented included chest pressure, dyspnea on exertion, neck pain, syncope, palpitations, reflux, and arm numbness. Comorbidities included hypertension (37%), hyperlipidemia (27%), diabetes mellitus (15%) and previous cardiac history (26%). Findings suggested that chest pain was the most commonly reported ACS clinical manifestation. The chief complaint was not different by age (open full item for complete abstract)

Committee: Candace Cherrington (Advisor) Subjects: Health Sciences, Nursing

MS, University of Cincinnati, 2009, Medicine : Epidemiology (Environmental Health)

Objective: To identify and describe disparities in the provision of Emergency Department (ED) care in pediatric patients presenting with Chest Pain (CP). Study Design: Nationally representative data were drawn from the National Hospital Ambulatory Medical Care Survey (NHAMCS). All visits with a chief complaint of CP and age < 19 years from 2002-2006 were analyzed. The primary outcome variable was ”anytest” performed (defined as any combination of CBC, EKG, or chest x-ray). Univariable analyses were performed with “anytest” as the dependent variable and patient characteristics as independent variables. Multivariable analysis was performed using logistic regression. Results: 818 pediatric CP visits representing 2,552,193 such visits nationwide were analyzed. Gender and metro/non-metro location were not associated with “anytest”. However, Caucasian patients (p=0,01) and those with private insurance (p<0.01) were significantly more likely to receive testing despite otherwise similar demographics and severity of illness. Multivariate analysis revealed race (p=0.03), expected payer (p=0.003) and triage level (p=0.009) were significantly and independently associated with the frequency of testing performed. Conclusion: Disparities exist in the ED care of pediatric patients with CP. Identification of such variations is important and provides an opportunity for targeted interventions that ensure delivery of high quality, cost effective healthcare for children.

Committee: Erin Haynes PhD (Committee Chair); Thomas Kimball MD (Committee Member); James Cnota MD (Committee Member); Phillip Khoury MS (Committee Member) Subjects: Health Care