Abstract
Introduction
Patients discharged from the emergency department may require a follow-up appointment
with an outpatient specialty clinic. Referral processes vary by clinic, some requiring
faxed referrals, some providing appointments immediately, and others contacting the
patients directly. The frequency with which patients are successfully connected with
outpatient follow-up services is largely unknown.
Methods
The ED discharge nurse role was developed to facilitate the navigation of patient
follow-up and confirm that patients successfully connect with specialty outpatient
clinics. Eight emergency nurses were recruited into this position to study the problem
using a quality improvement approach. The ED discharge nurses reviewed referrals,
contacted clinics and patients discharged from the emergency department, and intervened
when barriers to transition occurred.
Results
The ED discharge nurses were able to determine specific causes and themes of missed
appointments experienced by patients. Systemic problems identified include lost faxes,
illegible contact information, incomplete referrals, and referral refusals by the
clinics without patient notification. Considering the variability of clinic processes
outside the emergency department’s control, the ED discharge nurse role became crucial
in minimizing the risk of lost/unsuccessful follow-up for patients discharged from
the emergency department.
Discussion
Implementing the ED discharge nurse role created a contact for outpatient clinic referrals,
patient inquiry, and a process to track errors and data to better understand the frequency
of missed follow-up. In this quality improvement initiative, the role of the ED discharge
nurse addressed the risk of patients falling through the cracks of a complex system.
Key words
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Biography
Monaliza Tacbas is Registered Nurse, Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Ontario, Canada.
Biography
Barb McGovern is Contract Lecturer, Daphne Cockwell School of Nursing, Toronto Metropolitan University; and is Clinical Nurse Specialist, Mississauga Hospital, Credit Valley Hospital, Trillium Health Partners, Mississauga, Ontario, Canada. ORCID identifier: https://orcid.org/0000-0003-1958-6921.
Biography
Jackie Rodricks is Clinical Manager, Emergency Department, Trillium Health Partners-Credit Valley Site, Mississauga, Ontario, Canada.
Article info
Footnotes
Section Editor: Patricia Kunz Howard, PhD, RN, CEN, CPEN, TCREN, NE-BC, FAEN, FAAN
Send submissions to Patricia Kunz Howard, PhD, RN, CEN, CPEN, TCREN, NE-BC, FAEN, FAAN at PKHoward@uky.edu.
Identification
Copyright
© 2022 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.
