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NOMINATED BY JUDY DALLES, RN
We are committed to serving the healthcare needs of our community with a holistic approach to heal the mind, body and spirit. The challenge was to make the admission process efficient, accurate and cost-effective, offering the highest level of patient care. We did this by redesigning what was known as the admission team, which consisted of a small team of RNs. The team was a change from the traditional unit, where patients went from the emergency department and then transitioned to an inpatient bed when one was available.
 The truly remarkable aspect of the admission team is - when they learned about the redesign - they embraced the change, immediately giving feedback and suggestions on how to accomplish the vision.
Intentional Practice
The admission team promotes the profession of nursing by certain intentional practices. Team members must be detail-oriented, compassionate, precise, patient and have superb communication skills. A smile is a must. Dressed in lab coats and relating professionally, team members focus entirely on the patient. They also transform their department by taking measures to control costs.
Understanding that occupying a specific unit was very costly, we became mobile, exchanging desktops for rugged laptop traveling computers. Maximizing effectiveness, our study showed 75 percent of admissions occur between noon and midnight, which became the hours we work.
Part of adapting meant improving relationships with the medical team. We start our day by calling each charge nurse, letting him/her know which admission team is assigned to which floor and which phone they will carry. We carry wireless phones so charge nurses, secretaries and floor nurses can communicate one-on-one with each admission nurse as patients arrive to the floors. The team has demonstrated its adaptability by assisting with innovative programs.
Enhancing Education
We also have enhanced the usefulness of the interactive patient care network the hospital uses. We teach our patients how to use the system, which includes education on how to notify the rapid response team, communicate with additional hospital departments, view educational videos and use the nurse call light.
Each patient receives an "I Care" folder containing pamphlets that promote safety, communication and how to obtain support and planning during their hospitalization. The day after admission, the team visits clients to make sure their needs are being met and addressed, reporting unresolved issues to the nurse manager
Going With the Flow
The admission team adjusts to change. No two days are the same. When we get to work, we find out how many of us are working, as well as what is going on in the ED and the hospital registration area. We then plan, implement, reassess, plan and all day long. We sometimes do direct patient care to assist the RN - patient needs and teamwork are first.
The admission team supports other team members. We demonstrate flexibility regarding scheduling; we do self-scheduling. If one of us is working on a floor that is particularly swamped with admissions, we go to that unit and work together to meet the needs of staff and patient.
The team has adapted by implementing the team concept in meeting productivity outcomes. Floor assignments are made to divide the potential admissions equally, to promote productivity. If we start our shift with numerous direct admits in-house, those are done first to expedite all the department teams beyond nursing.
We share ideas to help each other be more productive in expediting our work efficiently. Our names and "admissions RN" are embroidered on our lab coats; this quickly identifies us as a member of the team.
Many Commendations
The team has been honored to receive commendations from clients. The hospital has a program where patents and families are invited to share a suggestion or a compliment. Our team gets compliments frequently. Clients love the individual attention and the efficiency; they often post compliments on the intranet communications board. Recurring client admissions remember us, creating a sense that the care provided is more personal. One team member had a patient refer to her as "Mom."
The team is proactive in pursuing education and certifications in our area of practices. Some hold certification in PICC lines/ports, cardiac/fetal monitors, PALS, NRP and STABLE, which are renewed. One team member is pursuing a master's degree in nursing informatics, another in cardiac profusion.
The team plays a part in promoting health to the community by educating patients on the importance of H1N1, flu, pneumonia, and tetanus vaccines. Tuberculosis, VRE, MRSA, C. diff, diabetes, smoking, drug and alcohol cessation are included when applicable.
Always Supportive
The admission team works well in difficult times. When employee/admission ratio is disproportionate, we work together. For those days we often joke that we are going to get rollerblades to move faster. Recently, our team leader was out due to a family emergency; although we worried about her, we kept working.
The admission team celebrates its employees. We enjoy and share each other's company through team spirit. Excellence pins have been awarded to the team. Together, we celebrate work, personal accomplishments and milestones.
Timely Patient Flow
The new model allows 75 percent of daily admissions (40-45 patents) to be reviewed by the admission team. Redesigning the admission unit has allowed the patients to move through the admission process in a timelier manner. The admission team nurses are able to concentrate on each admission without frequent interruptions; the information is more complete and accurate.
The floor nurses appreciate that the team gathers the medical history during the patient admission, and gives a report to them; it is a lengthy process and the new model frees nurses to spend more time with the patients they already have.
Increased Accuracy
This approach has proved unequivocally more cost-effective. Because we are mobile, there are no bed costs, linen costs, room supply costs; we don't have the overhead of an open department. Numerous physicians have made comments at multiple meetings regarding the accuracy of the admission medication reconciliation forms done by the admission team.
Though we don't have any quantitative numbers, we have a qualitative response from both the pharmacy and the admitting physicians that since the team has taken over the majority of admissions, there is a marked increase in both completion and accuracy of the forms. When there is a direct admit, home meds are verified faster and profiled sooner than they were prior to the implementation of this concept.
Appreciation & Trust
Suddenly, we have noticed that the doctors are calling the admission members by name - another indication of the great appreciation the doctors have for the new model.
The floor nurses frequently ask if the team "did their admission," aware if we did, they can count on its trustworthiness. Nurse managers have given us verbal and written commendations, as have other employees.
We hope the follow-up done on admissions by the team has contributed to the increase in our patient satisfaction scores. Thanks to the admission team, clients receive a response to address concerns in 24 hours or less.
We hold special times during our shift when able to meet and debrief on the current day's activities. We laugh, complain, cry, joke, pray and laugh some more - the confidences stay among us.
After our time debriefing together, knowing we still have 6 hours to go, we strap on those invisible rollerblades and hit the ground running. And at the end of the day, the admission team walks out of the hospital, together and laughing; it's been another successful day.
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