86 Emergency Department Hallway Bed Time Is Associated With Increased Hospital Delirium

Abstract

Study Objectives: Our objective is to describe a model for process improvement evaluation that utilizes trained undergraduate student research assistants to collect provider-patient encounter data in the acute care environment. Process evaluation is imperative when making changes in a complex environment. This is especially true when the overall goal is to improve process efficiency and outcomes for critically ill and injured patients. The department of emergency medicine at the University of New Mexico uses an iterative approach to evaluate protocol changes in its Emergency Department Resuscitation Unit (EDRU), a nine-bed acute care unit internal to our emergency department. The collection of provider-patient encounter data by our student research assistants provides department leadership with evidence for assessing implementation problems and evaluating outcomes for protocol and practice changes. Methods: As part of a multi-semester course entitled Research in Acute Care, students collect data on provider-patient encounters in the EDRU on a secure electronic tool. Findings from the data collection are compiled and regularly presented to a workgroup of EM clinical faculty who in turn make recommendations on protocol revisions and continued education and training for personnel in the EDRU. Results: In 2018, student research assistants spent over 1500 hours in the EDRU. This resulted in the collection of data on 1327 provider-patient encounters, including 26 instances of cardiopulmonary resuscitation (CPR), 418 of high acuity trauma, 112 strokes, and 164 cases of sepsis. During this same time period, the workgroup met 9 times to review findings from this and other data collections. The program has resulted in recommendations for additional training activities, identification and solutions for protocol related tools and missing equipment in the EDRU, and the identification of areas for research on patientprovider encounters. Conclusion: Our dynamic program is capable of meeting many of the department's process improvement data gathering needs. The program provides invaluable experience in emergency medicine to future health care professionals through clinical environment exposure and first-hand experience in quality improvement research. We will continue to adapt our data collection program as existing protocols are revised and new protocols are implemented. We hope to expand our program and its data collection capabilities through increasing student coverage in the EDRU and possibly expanding to other units in the emergency department.