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In step

Feature story:

for the

Commonwealth

Technology:
The 21st Century
Stethoscope

* In Step
for the Commonwealth

Since 1962, when the first patient was admitted
to University of Kentucky Albert B. Chandler
Hospital, nurses have been caring for patients and
their families from throughout the commonwealth.
They have supported new mothers as they gave
birth to daughters and sons, they have administered
chemotherapy to children and adults faced with
cancer, they have provided one-on-one care to
critically ill patients following an accident or
other threatening illness, and they have used their
knowledge, held the hands of countless family
members, and listened with their hearts to ease the
stress of illness.
The art and science of nursing is not done in
isolation, but instead is done through collaborative
efforts with physicians and other members of the
health care team. Nursing care is forever evolving
and this requires a commitment to lifelong
learning. The nurse of today must exercise a scope
of critical thinking and breadth of knowledge that
is extraordinary. The rigorous demands of nursing
in today’s system of health care dictates a need for
the best and brightest in our profession. There is
no better place than the University of Kentucky to
advance one’s knowledge and realize the essential
high performance demanded today.
For the past 50 years, the UK College of Nursing
has been preparing nurses to meet the health care
needs of the commonwealth. Many of our more
than 5,000 alumni learned “what it means to be
a UK nurse” who truly makes a difference from

Jane Kirschling,
DNS, RN, FAAN
Professor and Dean,
UK College of Nursing
janek@email.uky.edu
Colleen Swartz,
MSN, MBA, RN, NEA-BC
Chief Nurse Executive,
UK HealthCare
chswar2@email.uky.edu

the nurses at Chandler Hospital. Today, they are
also learning from expert nurses at the Kentucky
Children’s Hospital, Good Samaritan Hospital,
and the Kentucky Clinic.
UK HealthCare continues to provide unprecedented
learning opportunities as we prepare future
generations of health care providers. Within the
last year, UK HealthCare opened a new state-ofthe-art Emergency Department and within a few
months, learners will have the opportunity to
care for patients and their families in a new stateof-the-art hospital.
Our goal in creating In Step in 2010 was to
capture the richness of the experiences of UK
nurses. We wanted a forum for telling our stories
of collaboration —both across the health care
professions and also between the College of Nursing
and nursing practice. We wanted to showcase
excellence and innovation. We wanted to highlight
the complexity of what nurses do 365 days a year.
We hope that when you finish reading In Step that
you will share your copy with a neighbor or friend.
We also hope that you will share in our sense of
pride in the work of UK nurses.

* Table of
Contents
Investing in Advanced Nursing Expertise

2

Partnering for Improved Patient Care

6

The Clinical Nurse Specialist Model

Collaborative Leadership Within UK HealthCare

Pulling a “Fast One”
Good Samaritan Door-to-Doc in the ED

Managing Chronic Illness:
Nurses Making a Difference in Kentucky
Commitment to Caring With Advanced Specialty Care
SPOTLIGHT STORY

Advanced Practice Has a Home
Featuring the Nurses of the NICU and PICU
SPOTLIGHT STORY

Nurses Know Your Story
Ambulatory Nursing in the Markey Cancer Center
SPOTLIGHT STORY

Lifelong Learning Leads to Lasting Benefits for Nurses
Bedside Nursing
Donor Story

8
10
14
18
22
5

Caregiver Identification

13

What’s to Come

21

Publishing Workshop and Results

30

College of Nursing 50th Anniversary and Alumni Events

31

Alumni Recognized in 2010

32

FEATURE STORY

Technology: The 21st Century Stethoscope
New Technology throughout UK HealthCare

1 / In Step for the Commonwealth

24

* Investing in
Advanced Nursing Expertise
WRITTEN BY

Rena Baer

PHOTOGRAPHS BY

Lee Thomas

At a time when the quality and cost of hospital care are being
scrutinized, measured and examined upside down and sideways,

health care administrators at UK HealthCare have
realized the value of a role that nearly faded out in
the 1980s—the clinical nurse specialist.
Over the past year, with just one clinical nurse specialist on board working on
a pilot project, UK Albert B. Chandler Hospital was able to save more than
$1 million through improved outcomes and shorter patient stays. This success
has helped show the value of the position, prompting Chandler Hospital to
add a total of eight clinical nurse specialists.
Many of these positions have been placed within the hospital’s highest
acuity units, where nursing care intensity is crucial to patient outcomes. The
complexity of these cases and the advanced technology used to treat these
patients frequently require advanced expertise and critical thinking that often
come with experience. Novice nurses can often benefit from a coach with that
experience when they encounter highly complex situations.
The clinical nurse specialist fills that gap, says Kathleen Kopser, MSN, RN,
NE-BC, senior nurse administrator at Chandler. These nursing professionals
are experts in their fields — through both formal education that includes a
graduate degree and clinical experience. They make it their job to keep up
with research and the most current best practices available in their specialties.
They implement new protocols, monitor quality and teach bedside nurses,
acting as mentors, sounding boards and collaborators.

Education
Many clinical nurse specialists have worked as floor nurses in a hospital
setting, says Sherry Warden, PhD, RN, associate professor in UK’s College
of Nursing and coordinator of the clinical nurse specialist track. Their
motivation to return to school to become clinical nurse specialists often is a
quest for more authority, more education, and the ability to improve patient
care in a hospital or rehabilitation center setting, she says.
“They are generally nurses who have been practicing and have seen firsthand
the difference they can make,” says Warden. “This role is for nurses who really
want to improve the quality of care for patients in a particular specialty.”
Clinical nurse specialists are required to have at least a master’s degree in
nursing. The American Association of Colleges of Nursing, though, has
issued guidelines that endorse moving from a master’s degree to the Doctor
of Nursing Practice (DNP) degree by 2015. UK’s College of Nursing has
already moved in this direction, and the last master’s degrees in nursing will
be awarded in 2013, Warden says. The college’s BSN-to-DNP clinical nurse
specialist track teaches students about leadership, economics, advanced
pathophysiology and pharmacology and other subjects to give them a
foundation for the roles they will play as a clinical nurse specialist, says
Warden. They are then placed with a preceptor who is a seasoned clinical
nurse specialist to see the role in action and learn to apply their knowledge.

“In an academic medical center we tend to get a lot of new nurses who come
here right out of school,” says Kopser. “When you have new nurses, this kind
of support is what helps them feel secure about their work. They know there
is someone keeping an eye on quality, but also there is someone they can go to
for help when taking care of complex patients. Our patients in ICU these days Warden says she is a strong believer in the role of the clinical nurse specialist.
are so, so sick we often have to have two nurses taking care of one patient. It’s “These are experts in clinical care who can serve in the role of consultant,” she
good to have that support.”
says. “If nursing care is, perhaps, not up to date, a clinical nurse specialist
can research best practices and improve things by working with the team and
Clinical nurse specialists also are the point people for everyone involved in the
changing things within the system. They can check national guidelines, gather
patient’s care, including the patient.
data and design an intervention.”
“They have a way of interacting with staff and are seen not just as experts but as
Ellen Ratcliffe, MSN, APRN, ACNP-BC, CCNS, CCRN, who is now a
approachable partners in the care of patients,” says Kopser. “They are viewed
pulmonary and critical care clinical nurse specialist at Chandler Hospital, says
by physicians as strong collaborators. They are seen by patients as someone
she went back to school for the exact reasons Warden mentioned, and she
who can help them and insure they are going to have a good hospital stay.
graduated with a master’s degree in the clinical nurse specialist track at UK in
They educate, they analyze data, they teach patients, they teach families and
2009. “I didn’t want to see one patient at a time,” she says. “I wanted to work
they teach nurses.”
with specific populations, applying research, looking at ways to make things
“They are like the glue that holds everything together, keeping everything
better in the hospital, and providing support and mentoring the nurses. I
moving in the right direction and focusing on what is best for the patient,”
wanted to make more of a difference.”
says Kopser.

2 / In Step for the Commonwealth

* Investing in Nursing Expertise
Clinical nurse specialists have been around for decades, specializing in certain
fields such as oncology, pulmonology, cardiology and critical care.
Their role in nursing changed in the 1980s as the trend turned toward using
diagnostic-related groupings to determine reimbursement rates. This change
put pressure on hospitals to discharge patients within a particular timeframe,
depending upon their diagnosis. Unable to measure the effectiveness of the
position within this new system, clinical nurse specialists throughout the
country instead became case managers. Their focus switched from providing
expertise in hospital bedside care in a particular specialty to discharge
planning for that patient group, says Kopser.
“The bedside nurse was without an expert to help them figure out how to take
care of populations of patients and complex patients,” says Kopser.
When Kopser became the senior nurse administrator at Chandler in 2008,
one of the first issues she and Chief Nurse Executive Colleen H. Swartz,
MSN, MBA, RN, NEA-BC, identified was re-establishing that professional
support for bedside nurses in specialty areas. On the top of that list was
getting help for the nurses treating patients with diabetes, a complex and
chronic illness that is more prevalent in Kentucky than most states because of
the high obesity rates here.
“We have a huge diabetes population, and the nursing staff was doing a good
job, but there was no one who could really support them with the detailed
educational needs these patients have,” Kopser says. And, although diabetes
medications tend to be protocol-driven, they are complex enough that nurses
sometimes need help managing patients’ insulin requirements.
“We felt like we could really get a benefit from having a diabetes clinical nurse
specialist in-house who could manage that population of patients,” she says.
The position was approved in 2009 after Kopser and Raymond Reynolds,
MD, a UK endocrinologist and diabetes specialist, built a business case
supporting the position. It was filled this past spring. In the meantime, as
Swartz began working on developing other clinical nurse specialist positions,
she and Kopser were approached by a former pulmonary and critical care
clinical nurse specialist, Pam Branson, MSN, RN, who was functioning as a
patient care facilitator.
“Pam came to us and said, ‘I can make such a difference for critical care
patients; I can make a difference in their length of stay; I can do so much
for these patients in the role of a clinical nurse specialist. Would you support
that?’,” Kopser recalls.

Branson was given permission to conduct a pilot project at Chandler.
The six-month project involved decreasing the infection rate associated with
central line IVs, which are often run to administer medications or fluids, run
blood tests and obtain cardiovascular measurements. Each case of infection
was costing an average of $25,000 per patient, Branson says, and under new
Medicare guidelines, these incidences of hospital-incurred infection will no
longer be reimbursed.
Throughout the ICU and adult units, Branson said she helped institute
and teach specific documented protocols to cut down on the number of
infections, including helping physicians identify patients who either no longer
needed their central lines or didn’t need them to begin with.
Her efforts resulted in a significant decrease in central line IV infections,
which in turn led to lower morbidity and mortality rates, shorter hospital
stays and an appreciable cost savings.
“It was the right time and the right thing to do,” Branson says. “I was able to
bring the concept to them and help get everyone to buy into the process, but
it was a multidisciplinary effort.”
Kopser says the project saved significant dollars. “She did it by engaging the
nursing staff and the nurse managers and by helping them understand why
following protocols was so important to the patient. Also, she helped the
nurses be proactive in collaborating with physicians to remove central lines
when they were no longer needed. She spent time at the bedside with the
nurses guiding them, educating them and helping them see how they could
impact the quality and safety of outcomes,” she says.
The success of Branson’s pilot project led to Chandler formalizing her role
as a clinical nurse specialist, a career she says she dearly loves. It also gave
credence to the six other clinical nurse specialist positions that have since been
added, as well as two clinical nurse experts, a similarly oriented position at a
bachelor’s degree level.
At UK’s Good Samaritan Hospital, four clinical nurse expert positions also
have recently been put in place, two in acute care and two in telemetry.
“All four will work the night shift,” says Darlene Spalding, MSN, APRNBC, senior nurse administrator at Good Samaritan. “That is where our new
graduates and less experienced nurses are. With the increased acuity levels and
increased census, we needed support and clinical nurse experts to teach them.
They provide that extra pair of hands to guide them.”
The clinical nurse experts help the nurses with new protocols, new
documentation systems, new technology, in addition to answering nurses’
questions and helping them manage their patients, says Spalding.
“There are always changing practices in health care so these nurses will be the
experts,” she says.

Spring 2011

/

3

* Developing Knowledge
Nurses like to get information and have an expert to support them;
someone who has also been at the bedside and can really empathize
helps provide a rich environment, says Kopser.
“Nurses want to go home at night and feel like they have really made
a difference, and I think the clinical nurse specialist can participate in
that,” she says. “They can help nurses provide the very best care because
they can coach them and help them understand what they are doing for
the patient and how they are affecting the patient’s outcome.”
Branson, who has been a nurse for 38 years, says she is passionate about
providing support to new nurses and helping them develop their skills
and education.
In the absence of a clinical nurse specialist, most nurses would turn to a
more seasoned nurse, to a doctor or seek out the information through
research. “The avenues were there, but they weren’t as readily available,”
Branson says.
This additional support results in nurses feeling much better about their
jobs and the quality of care they are giving. They not only understand
what they are doing but why they are doing it, Branson says. The
increased knowledge helps them to better communicate with patients,
doctors and other providers, making for more of a team approach.
Also, having an institutionalized knowledge base has become even
more important when combined with current trends. Today’s nursing
graduates have a broader arena in which to employ their skills, and they
move around more often, trying out different options. “There isn’t the
same longevity,” Branson says. “We needed to build a firm foundation
for them to improve their practice skills.”
In addition, technological advancements combined with people living
longer have led to rising acuity levels, increasingly complex interventions
and more challenging modalities. Bedside nurses need more expertise
than ever before to keep up, and clinical nurse specialists can help
provide that to less experienced staff, says Branson.
“It takes two years for an ICU nurse to go from a novice to an expert,”
she says.
Anna Adams, BSN, RN, and Allison Copper-Willis, BSN, RN, both
say the recently created clinical nurse expert positions in cardiology and
telemetry at Chandler Hospital have given them a platform to use their
experience to teach and support newer nurses.
“Nurses appreciate having a resource to call; for example, if there’s a
difficult procedure coming down the pike or if a patient is declining we
are available to be at the bedside with them to help get things back on
track,” says Adams, who has been a nurse for 22 years. “And if they have
questions, we have the time and resources to find the answers for them.”

4 / In Step for the Commonwealth

Having the clinical nurse expert available also takes a burden off of the
more seasoned nurses on the floor, she says. “The nurse with the most
experience is the one who was getting pulled in the most directions.
Now these nurses can concentrate on their patients and the newer
nurses can call Allison or me.”
Copper-Willis, who has worked at Chandler for 10 years, mostly as
a pool nurse, says she had considered getting into staff development
before the clinical nurse expert position opened up.
“This position is staff development, but it is hands-on teaching and
constant interaction rather than a lot of paperwork,” she says. “And
there is so much appreciation from the nurses. They know you are here
to help if a patient starts to deteriorate or even if it is just looking up a
medication for them.”

Bottom Line
In today’s competitive health care environment, the use of clinical nurse
specialists and clinical nurse experts have proven at UK HealthCare to
be an effective way to both save money and, more importantly, improve
patient outcomes.
What sets advanced nurse specialists and clinical nurse experts apart
is their level of knowledge, their ability to identify outcomes, and their
ability to help nursing staff see that vision for the patient and see
how they can contribute to the best possible outcome for the patient,
says Kopser.
“They are more about: While this patient is here, how can we make
this a quality experience, how can we assure that we meet metrics that
we’ve identified as cutting edge or national standards for best practice,”
she says.
As groups such as the Hospital Quality Alliance, a public-private
organization comprising more than 350 health care, citizen and
government organizations, make it their job to compile comparative
hospital metrics for the public, the use of best practices to try and
achieve the best possible outcomes becomes increasingly important.
“From the consumer end, you want to get the most bang for your buck,”
Branson says. “And consumers are becoming a lot more knowledgeable.
With the availability of information on the Internet, they are asking a
lot more questions.”
Clinical nurse specialists play a huge role in meeting quality metrics
because they are the people who are there day in and day out, Kopser
says. “They are watching the quality of care we are providing patients
and evaluating that care to ensure we are meeting our goals. They can
keep an eye on things in a way others cannot.”

* DONOR

College’s First Named Scholarship
Honors Memory As Well As Spirit

It’s been 45 years since William R. Winternitz, Jr., MD, was presiding
over a classroom of students at the University of Kentucky’s College
of Medicine. But thanks to his generosity and the nursing scholarship
he founded in 1965 in memory of his young wife, UK students are
still learning from the example of this remarkable man.
The Mary P. Winternitz Scholarship was the College’s very first and
is granted annually to an entering student nurse with a demonstrated
need who portrays “cheerfulness and responsiveness to the needs of
others and demonstrates warm personal relationships, dependability and
dedication.” That was Mary, says Winternitz, who met his wife at Johns
Hopkins when he was a young resident and she was a student nurse.
“My wife had a strong conscience and was very serious about medicine
and about nursing and its role in society. She was a wonderful woman.”
Winternitz and his wife moved back to his native Connecticut after
finishing at Johns Hopkins and spent the next nine years at Yale
University where he was a research fellow and assistant professor of
Internal Medicine. In the late 1950s, when the University of Kentucky
was planning the creation of a new and innovative medical school,
they recruited Winternitz, who moved his young family to Kentucky
in 1961 once he’d completed his fellowship at the University College
Hospital Medical School in London. “It was an exciting time,” says
Winternitz of those early days at Kentucky. When Mary Winternitz
died in 1965, Winternitz and his three children were heartbroken.
“She was only 43,” says Winternitz. “It was important to all of us to
honor the virtues she exemplified and that’s why we established the
scholarship.” In 1984, Winternitz took steps to make sure that the
scholarship would continue on in perpetuity by endowing it.
This September at a Founders’ Day celebration at Maxwell Place,
Winternitz was recognized for his contributions and awarded a plaque
that included the College’s nursing pin and a quote from Florence

Nightingale: “I think one’s feelings waste themselves in words; they
ought all to be distilled into actions which bring results.” Ninetyyear-old Winternitz, now retired after a long and distinguished career
as chair of the Department of Internal Medicine at the University of
Alabama’s School of Medicine in Tuscaloosa, was surprised and moved
by the honor. “I was very touched, I can tell you that.”
At the event, Winternitz and his wife Madeline had a chance to
meet and talk to Kayla Putton, this year’s recipient of the Mary P.
Winternitz Scholarship. Putton is in her second semester of the
College’s six-semester traditional BSN program. In her thank you note
to the Winternitz family, she wrote, “I always knew I wanted to help
people. Starting at a young age, I have played a major role in taking
care of my brother who was diagnosed with a form of autism and
borderline mental illness. He taught me that everyone deserves a
chance to live the best life possible. As a nurse I will be able to assist
many people reach the highest qualify of life achievable.” Says
Winternitz of their meeting, “We were very taken with her. We
could tell she’s going to be a good nurse.”

“I think one’s feelings
waste themselves in
words; they ought all to
be distilled into actions
which bring results.”
—Florence Nightingale

Jane Kirschling, DNS, RN, FAAN
William R. Winternitz, Jr., MD
Patsy Todd, UK First Lady
Lee Todd Jr., PhD, UK President
The Todds also received the UK College of
Nursing pin for their unwavering support.

Spring 20115

* Partnering for
Improved Patient Care
WRITTEN BY

Christina Noll
PHOTOGRAPH BY

Lee Thomas

Jane Kirschling, DNS, RN, FAAN
Professor and Dean, UK College of Nursing

Colleen Swartz, MSN, MBA, RN, NEA-BC
Chief Nurse Executive, UK HealthCare

Darlene Spalding, MSN, APRN-BC
Senior Nurse Administrator,
Good Samaritan Hospital

Diana Weaver, MSN, MBA, RN
Senior Nursing Advisor, UK HealthCare

Kathleen Kopser, MSN, RN, NE-BC
Senior Nurse Administrator,
Albert B. Chandler Hospital

Suzanne Prevost, PhD, RN, COI
Professor and Associate Dean
for Community Engagement and Practice,
UK College of Nursing

As an academic health center, the University of Kentucky plays a major
role in research, education of health professionals and advancing health care
technologies. At the most basic level, we are moving knowledge, clinical
skills and technology from the classroom to the patients who need it.
Nursing leadership at UK is helping drive realization of UK HealthCare’s
vision to meet the health care needs of the commonwealth and region and
be ranked among the Top 20 medical centers in America. “Nursing has been
instrumental in driving toward UK HealthCare’s mission. We want to
ensure that when patients choose UK HealthCare, they will receive superior
medical and nursing care. Nursing has worked hard to sustain and improve
upon the Magnet principles that define the care we provide,” says Kathleen
Kopser, MSN, RN, NE-BC, senior nurse administrator for UK Albert B.
Chandler Hospital.
Nursing practice is part of a new integrated care delivery model that allows
the key players of a health care team to work together for the benefit of the
patient. True integration, supported by technological advances, allows for
smooth transition from clinic to hospital or from primary care to specialty
care. “As we see health care change and we respond to that change, we move
toward team care,” says Michael Karpf, MD, executive vice president for
health affairs at UK. “Care is no longer monolithic — it will be team-based
and the role of nurses will expand dramatically everywhere from primary care
to the full range of specialty care.”

6 / In Step for the Commonwealth

The approach means patients benefit from the combined expertise of
physicians, nurse practitioners, nurses, social workers, pharmacists, dietitians
and other health care professionals, resulting in a higher level of care. Through
the team approach, the patient is the most important part of the team. “And
nurses, particularly bedside nurses, are the captain of the team in many ways,”
says Karpf. Nurses communicate patient needs to physicians and other team
members and relay important information about medications, treatments and
care that will be needed at home. “The nurse is the pivotal person to ensure
communication between all care givers is accurate,” says Kopser.
The concept of integrated care is one of many strategies to provide more
efficient and effective patient-centered care. The integrated academic campus
only enhances the capabilities; the key is working together. As part of the
new model, there is an increased partnership and collaboration between
health care professionals. “Significant amounts of primary care can be done
by nurse practitioners working as colleagues with physicians,” says Karpf.
Colleen Swartz, MSN, MBA, RN, NEA-BC, chief nurse executive for UK
HealthCare, agrees. “We are in a transformation to a more integrated care
model with an administrative lead and nurses and physicians partnering to
bring more of a team approach to care,” she says. “The only way to achieve the
outcomes patients deserve, and that we are obligated to provide, is through a
team approach.”

* Part of that team approach extends to the partnership between UK HealthCare medical specialists to have training in both an academic health center and a
hospital with a community feel,” says Swartz. “We are the perfect enterprise,”
and the College of Nursing. “The practice and education sides of health care
adds Kopser. “If you prefer community-based acute care nursing, we have
at UK are working well together to optimize this redesign of the system to
that at Good Samaritan. If you prefer academic-based nursing, we have that
better meet the needs of the patient,” says Jane Kirschling, DNS, RN, FAAN,
at Chandler. Opportunity and choices exist at UK so that nursing staff can
dean of the College of Nursing. The college views UK HealthCare as a clinical
experience both environments.”
lab to produce high caliber graduates; conversely, nurses can be educated in
ways that fill actual needs, based on real experience. And after they receive their “UK HealthCare and the College of Nursing are also uniquely positioned
degree, numerous opportunities exist for UK nursing graduates to practice in
to support nurses to “learn while they earn.” “The centrality of life-long
areas across the entire spectrum of care.
learning for the discipline of nursing is key to assuring that the residents of the
commonwealth have access to high quality, safe, patient-centered care,” says
Another partnership opportunity came with UK’s acquisition of Samaritan
Kirschling. “Learning is often times interwoven with continuing to work full
Hospital. As part of UK HealthCare, Good Samaritan Hospital offers a
time; the College of Nursing faculty understand what is needed to support
community hospital environment with the teaching component and state-ofthe-art health care of UK. Patients gain access to the expertise of UK specialists nurses to achieve their goals of advancing their education.”
while remaining in the less stressful and less hectic setting.
Across the continuum, one thing emerges from the new effort of collaboration
The second oldest hospital in Lexington, Good Samaritan opened on South
Limestone in 1888 and offers a personalized healing environment in the heart
of Lexington. The 340,000 square foot facility includes the hospital, a freestanding diagnostic center and a medical office building. “Good Samaritan
has been critically important to UK,” says Karpf. “We are able to move lower
acuity patients to Good Samaritan and have expanded our outpatient abilities.”
Good Samaritan means good things for health care professionals, too. “Good
Samaritan brings a unique opportunity for our nursing students and other

— greater patient satisfaction. And the best outcome for the patient is when
all health care providers are working together as a team. Because of the central
role nursing plays in health care, nurses have the opportunity to model what
team-based health care looks like and to model patient-centered care. “Nurses
and nursing leadership at UK HealthCare are resources to the community and
region,” says Swartz. “In the end, we want to become resources to the entire
commonwealth.”

Spring 2011

/

7

* Pulling a
“Fast One”
WRITTEN BY

Linda Perry

PHOTOGRAPHS BY

Lee Thomas

New program will reduce wait times, diminish
waste and increase patient satisfaction and safety.
UK HealthCare emergency departments are early adopters of a new process
that has physicians seeing patients in less than 30 minutes. The initiative,
called Door-to-Doc, guarantees patients arriving at the UK Good Samaritan
Hospital Emergency Department (ED) will see a physician within 20
minutes. At the UK Albert B. Chandler Hospital ED the wait time is
guaranteed to be no more than 30 minutes.
Penne Allison, BSN, MSOM, RN, director of emergency/trauma services,
has taken the lead to make this change happen. “When patients come to the
ED, they come to see the doctor, but there are a lot of things in emergency
departments that are barriers between the arrival time of the patient and the
time the patient sees the doctor. We have to register the patient, triage the
patient, and if there’s not a bed available, then the patient has to wait in the
waiting room,” says Allison. “If you look at some of the media and literature,
there have been some really poor outcomes for patients waiting in waiting
rooms. So this initiative is for safety, to be able to identify patients early and
determine whether they are sick or not.”
Allison says that all emergency departments try to do this, but they sometimes
get backed up because they aren’t determining quickly who is really sick.
That’s where the Door-to-Doc program is different.
“Door-to-Doc means instead of doing things in sequence, you may do things
in parallel,” says Allison. “When a patient comes in to register, the staff person
not only gets information like the patient’s name and birthday, but now a
nurse is right there and does a ‘quick look.’ That nurse decides one of two
things: is the patient sick or not sick.”
Individuals classified sick by that nurse, the “1s” and “2s” on the emer