Decreasing non-value-added nursing time transporting stable patients from the emergency department

Emergency Nurse Transport of Telemetry Patients: Benefits and Drawbacks

PROBLEM

Emergency nurse-accompanied telemetry transport on admission to the hospital is a common practice. Potential drawbacks include inefficient use of nursing resources, unnecessary telemetry transports, and disruption of care for remaining ED patients.

METHODS

This was a 2-part descriptive quality improvement study using retrospective chart review and prospective documentation of patient transports. Charts were selected by American Heart Association Practice Standards for ECG Monitoring to classify transported telemetry patients into 3 categories. Patient characteristics and adverse events were assessed. Prospectively, the length of transport time and the number and severity of patients the transport nurse left in the emergency department were also recorded.

RESULTS

Zero adverse events occurred during any transport. Transport time ranged from 5 to 38 minutes, with a mean of 16.5 minutes. The normal patient ratio increased for nursing staff remaining in the emergency department for the period of the transport, with 74% of patients left in the emergency department classified into high-risk Emergency Severity Index categories 1 and 2.

IMPLICATIONS FOR PRACTICE

Findings provided evidence that low-risk telemetry patients had minimal chance of adverse events during transport and highlighted added risks for the remaining emergency patients. Alternative models and interventions are needed to identify appropriate patients for telemetry transport, assign appropriate staff such as licensed paramedics for transport, and evaluate alternative models of nursing care and teamwork in the emergency department.