Improving Documentation for Boarded Patients: A Quality Improvement Initiative in a Single Emergency Department

Area of Science:

• Quality Improvement in Healthcare
• Nursing Documentation Best Practices
• Patient Safety in Emergency Departments

Background:

• Emergency department boarding poses safety risks due to delays in inpatient bed availability.
• Adverse patient outcomes are linked to prolonged stays in the emergency department.
• This initiative focused on enhancing nursing documentation for boarded patients at a trauma center.

Purpose of the Study:

• To improve the timeliness and completeness of nursing documentation for patients experiencing emergency department boarding.
• To standardize the assessment and documentation process for boarded patients.
• To evaluate the impact of a new documentation guideline on nursing practice and confidence.

Main Methods:

• A pretest-posttest design was used over 8 weeks, guided by the Model for Improvement.
• A standardized Boarded Patient Assessment Documentation guideline was developed and implemented.
• Emergency nurses received education and reinforcement; adherence was measured via chart reviews and confidence surveys.

Main Results:

• Post-intervention, documentation for vital signs and allergies met the 80% target.
• Fall risk documentation met the target intermittently; head-to-toe and skin assessments remained below target.
• Nurse confidence significantly improved for vital signs, skin, and allergy documentation.

Conclusions:

• The Boarded Patient Assessment Documentation guideline enhanced nursing documentation and confidence for boarded patients.
• Improvements were most notable in vital signs, skin, and allergy assessments.
• Further strategies, like EHR prompts, are recommended for sustained adherence and broader implementation.