A novel reflective practice intervention improves quality of care in the emergency department. (May 2021)

• Record Type: Journal Article
• Authors: Saban, Mor; Drach-Zahavy, Anat; Dagan, Efrat
• Is Part Of: International emergency nursing. Volume 56(2021)
• Publication Date: 2021-05
• Subjects: Emergency department -- Nursing -- Time-out -- Triage -- Reflective practice; Emergency nursing -- Periodicals; 616.025
• DOI: 10.1016/j.ienj.2021.100977
• Languages: English
• ISSNs: 1755-599X

Abstract

Highlights: Preliminary findings indicate that reflective practice may improve patient safetys of better emergency department staff. The reflective practice intervention generates better ED work processes, efficient use of hospital resources, higher professionals' performance, and quality outcomes. Our findings call managers and policymakers to incorporate reflective practice into healthcare organizations and to embed it as a tool to educate and train health professional teams for better health outcomes. Abstract: Introduction: Most interventions to improve clinical outcomes in the emergency department (ED) are based on structural changes. This study embraced a different strategy and examined the impact of a reflective practice intervention (RPI) on ED quality of care. Methods: A pre-post-intervention quasi-experimental nested design was conducted between January 2017 and June 2018 in an Israeli public tertiary academic ED. Nighty-six ED teams (triage and staff nurses and a physician) were included pre and post RPI. Data were collected pre and post RPI at patient–triage nurse encounters using triage-accuracy questionnaires. Time to decision, length-of-stay, and hospitalization and mortality rates were retrieved from the medical charts of 1920 patients (20 per team). Results: Accurate triage was significantly higher post than pre intervention (4.84 ± 1.45 vs. 3.87 ± 1.48; range 1–7; p < .001), whereas time to decision (253.30 ± 246.75 vs. 304.64 ± 249.14 min), hospitalization rates (n = 291, 30.3% vs. n = 374, 39.0%; p < .001), and hospital length-of-stay (5.73 ± 6.72 vs. 6.69 ± 6.20; p = .04) significantly decreased. Conclusions: By adapting organizational reflective practice principles to the ED dynamic environment, the RPI was associated with a significant improvement in ED quality-of-care measures.