Tightening the Belt in MAU

Tightening the Belt in Maternity Admissions Unit Helen Snead, BSN, MA, NE-BC and Donna Coley RN3, RNC IP-OB, C-EFM Cone Health-Women’s Hospital

BACKGROUND Ø Ø Ø Ø Ø Ø Ø

10 bed OB/GYN triage unit Hospital with 6,000 births/year 1750 MAU visits per month Open 24 x 7 x 365 Increase in LWBS* and AMA* Decrease in Patient Perception of visit Workflow in unit affected by lab, ultrasound, registration, RN, NT, and advanced practice providers *Against Medical Advice *Left without being seen (by provider)

PURPOSE Ø Decrease length of stay in Maternity Admissions Unit (MAU) Ø Decrease AMA*/ LWBS* Ø Improve patient perception of MAU staff and the services provided Ø Increase staff perception of work environment

RESULTS

MATERIALS AND METHODS Methodology

Ø Quality Department assigned Black Belt Ø Monthly Meetings Ø Team: Multidisciplinary and Multidepartment

Project Components Ø Literature Review Ø Data Tracking Ø Press Ganey Comments Ø Leadership Rounding

Implementation Ø Pull-to-Full Concept Ø Pilot for Nurse First Ø Thank you notes Ø Triage RN/NT pair Ø MAU satellite Ø EMR revisions Ø RN & APP paring

REFERENCES • Moy, M. (2013). The EMTALA Answer Book, Wolters, Kluwer Law & Business. • Women’s Hospital Collaborative Practice Agreement, 2013

Lessons Learned Ø Labs turn-around time—1-1.5 hrs., technology driven Ø Nurse First pilot was positive—FTE approval pending Ø Ultrasounds required for many patients—increases length of stay Ø Hardwiring initiatives—KEY to success Ø October 2015 change from Urgent Care to ED (of like size) benchmarking