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Impact of Time Spent Outside ICU on Patient and Staff Safety
1. Time Nurses Spent outside the ICU: Impact on Patient and Staff Safety
Abdel Latif M. Marini, MSN, RN, CPHQ, CPPS
Quality Improvement Department, The Johns Hopkins Hospital
This PI study occurred on the Neuro Critical Care Unit
(NCCU) at the Johns Hopkins Bayview Medical Center.
It measured the time nurses spend during patient transportation
and escort outside the unit during Day and Night shifts.
Like all ICUs, Neurology and Neurosurgery patients admitted to the
NCCU require intensive monitoring. This particular patient
population also requires frequent imaging studies/procedures
performed outside the unit. These include frequent CAT scan and
MRI studies done all through the course of treatment.
The NCCU was an 8 bed unit staffed with 4 nurses and no patient
care technicians.
This study aims to measure the time nurses spend during patient
transportation and escort outside the NCCU during Day and Night
shift and to offer recommendations for improvement.
Objectives
Introduction
Methods
Staff in the unit participated in brainstorming session to list impact
of the safety concerns identified:
Results
Conclusion
This study shows that maintaining an open communication with
leadership and providing supporting data help drive business
decision making to foster a safer work environment. Hospital
decision maker should continue to strive freeing up nurses to do
more of patient centered care by decreasing time spent on non-
nursing tasks that can be delegated to support staff.
Fig1. I-chart- Number of Trips per 24 hours over time
Based on the findings above, there is substantial evidence that
nurses are spending lengthy time away from the NCCU patients
serving transport/escort purposes especially during day shifts.
This study results along with recommendations were
communicated with the Leadership team.
Improvement that were implemented:
1- The unit was staffed with a PCT from 3 – 11 pm (to cover both
shifts) and help with escort trips.
2- Reinforce the need to ask for Charge nurse/Resource Nurse
help during night shift.
3- None Urgent (routine) CT scans were scheduled in EPIC order-
sets to 5 am (night shift).
Safety Concerns
One Nurse
transporting/escorting
NCCU patient
Back Injury
Two Nurses
transporting/escorting
NCCU patient
Unsafe
Nurse/Patients in
the unit
Fatigue
Call Sick
↓ Staff Satisfaction
Poor Outcomes
↓ Patient Satisfaction
• Back injury and unsafe Nurse/Patient ratio were two main safety
concerns listed by the nurses.
• A systematic data collection tool was designed to capture
elements of time, number of staff, destination and census of the
unit.
• We observed a total of 51 nurses transport over 12 days of data
collection done over 24 hrs. between March 10- 22, 2015.
• Unit Secretary/Nurses were trained to fill in the data in real time.
• Duration is calculated from Time Nurse leaves the unit, until
Nurse is back.
• Statistical analysis was conducted in Minitab to analyze the
normality, and stability of the process, and take inferences of
these observations.
13121110987654321
10
5
0
Observation
IndividualValue
_
X=3.92
UCL=9.69
LCL=-1.84
13121110987654321
8
6
4
2
0
Observation
MovingRange
__
MR=2.167
UCL=7.079
LCL=0
I-MR Chart- Count of Trips (studies) per day
Day Shift Night Shift
AVG # Transport 3.1 1
Mean Time (min) / Transport 40.1 25
Table 1. Showing distribution of Trips between Day and Night Shift.
% 1 RN transporting/escorting patients in NCCU = 25 %
Nurse Safety: This poses risks on Nurses Safety, contributing to
back pain or other problems.
% 2 RN transporting/ escorting patients in NCCU = 75 %
Patient Safety: This contributes to unsafe staffing ratio and poses
risk on Patient in the NCCU as two nurses are pulled out of the
unit for transport, keeping the remaining 7 patients with 2 nurses.
It was noted that some nurses are transporting their patients to
procedures by themselves (ie. 1 RN, due to the workload on other
patients, and the inability to ask help from other nurses):
• During the night shift, the average
number of trips was 1 and the
duration ranged between [17-
33min].
Total
Variable Shift Count Mean SE Mean StDev Minimum Q1 Median Q3 Maximum
Durat. min Day 40 40.13 5.78 36.54 5.00 20.00 30.00 37.50 175.00
Night 11 25.00 3.44 11.40 15.00 15.00 20.00 35.00 45.00
Nurses spent [1 hr 30 min to 2 hr 40 min ] during
day shift outside the NCCU
Nurses spent [17 - 30 min ] during night shift
outside the NCCU
Discussion
NightDay
200
150
100
50
0
Shift
Durat.min
Boxplot of Durat. min
Outliers (duration) were seen during day shift only.
It correlates with the fact that more MRIs (lengthy procedure)
are done during day shifts.
• Result of this study showed that
the average number of trips
during day shift is 3.1, and the
duration during Day ranged
between [28-52min] (95% CI).
Fig2. Boxplot of Transport Duration in min
Table 2. Frequency of Trips according to Destination
Acknowledgment: Johns Hopkins Bayview Medical
Center, NCCU Staff, and Nursing Director Jo Deaton.
![Time Nurses Spent outside the ICU: Impact on Patient and Staff Safety
Abdel Latif M. Marini, MSN, RN, CPHQ, CPPS
Quality Improvement Department, The Johns Hopkins Hospital
This PI study occurred on the Neuro Critical Care Unit
(NCCU) at the Johns Hopkins Bayview Medical Center.
It measured the time nurses spend during patient transportation
and escort outside the unit during Day and Night shifts.
Like all ICUs, Neurology and Neurosurgery patients admitted to the
NCCU require intensive monitoring. This particular patient
population also requires frequent imaging studies/procedures
performed outside the unit. These include frequent CAT scan and
MRI studies done all through the course of treatment.
The NCCU was an 8 bed unit staffed with 4 nurses and no patient
care technicians.
This study aims to measure the time nurses spend during patient
transportation and escort outside the NCCU during Day and Night
shift and to offer recommendations for improvement.
Objectives
Introduction
Methods
Staff in the unit participated in brainstorming session to list impact
of the safety concerns identified:
Results
Conclusion
This study shows that maintaining an open communication with
leadership and providing supporting data help drive business
decision making to foster a safer work environment. Hospital
decision maker should continue to strive freeing up nurses to do
more of patient centered care by decreasing time spent on non-
nursing tasks that can be delegated to support staff.
Fig1. I-chart- Number of Trips per 24 hours over time
Based on the findings above, there is substantial evidence that
nurses are spending lengthy time away from the NCCU patients
serving transport/escort purposes especially during day shifts.
This study results along with recommendations were
communicated with the Leadership team.
Improvement that were implemented:
1- The unit was staffed with a PCT from 3 – 11 pm (to cover both
shifts) and help with escort trips.
2- Reinforce the need to ask for Charge nurse/Resource Nurse
help during night shift.
3- None Urgent (routine) CT scans were scheduled in EPIC order-
sets to 5 am (night shift).
Safety Concerns
One Nurse
transporting/escorting
NCCU patient
Back Injury
Two Nurses
transporting/escorting
NCCU patient
Unsafe
Nurse/Patients in
the unit
Fatigue
Call Sick
↓ Staff Satisfaction
Poor Outcomes
↓ Patient Satisfaction
• Back injury and unsafe Nurse/Patient ratio were two main safety
concerns listed by the nurses.
• A systematic data collection tool was designed to capture
elements of time, number of staff, destination and census of the
unit.
• We observed a total of 51 nurses transport over 12 days of data
collection done over 24 hrs. between March 10- 22, 2015.
• Unit Secretary/Nurses were trained to fill in the data in real time.
• Duration is calculated from Time Nurse leaves the unit, until
Nurse is back.
• Statistical analysis was conducted in Minitab to analyze the
normality, and stability of the process, and take inferences of
these observations.
13121110987654321
10
5
0
Observation
IndividualValue
_
X=3.92
UCL=9.69
LCL=-1.84
13121110987654321
8
6
4
2
0
Observation
MovingRange
__
MR=2.167
UCL=7.079
LCL=0
I-MR Chart- Count of Trips (studies) per day
Day Shift Night Shift
AVG # Transport 3.1 1
Mean Time (min) / Transport 40.1 25
Table 1. Showing distribution of Trips between Day and Night Shift.
% 1 RN transporting/escorting patients in NCCU = 25 %
Nurse Safety: This poses risks on Nurses Safety, contributing to
back pain or other problems.
% 2 RN transporting/ escorting patients in NCCU = 75 %
Patient Safety: This contributes to unsafe staffing ratio and poses
risk on Patient in the NCCU as two nurses are pulled out of the
unit for transport, keeping the remaining 7 patients with 2 nurses.
It was noted that some nurses are transporting their patients to
procedures by themselves (ie. 1 RN, due to the workload on other
patients, and the inability to ask help from other nurses):
• During the night shift, the average
number of trips was 1 and the
duration ranged between [17-
33min].
Total
Variable Shift Count Mean SE Mean StDev Minimum Q1 Median Q3 Maximum
Durat. min Day 40 40.13 5.78 36.54 5.00 20.00 30.00 37.50 175.00
Night 11 25.00 3.44 11.40 15.00 15.00 20.00 35.00 45.00
Nurses spent [1 hr 30 min to 2 hr 40 min ] during
day shift outside the NCCU
Nurses spent [17 - 30 min ] during night shift
outside the NCCU
Discussion
NightDay
200
150
100
50
0
Shift
Durat.min
Boxplot of Durat. min
Outliers (duration) were seen during day shift only.
It correlates with the fact that more MRIs (lengthy procedure)
are done during day shifts.
• Result of this study showed that
the average number of trips
during day shift is 3.1, and the
duration during Day ranged
between [28-52min] (95% CI).
Fig2. Boxplot of Transport Duration in min
Table 2. Frequency of Trips according to Destination
Acknowledgment: Johns Hopkins Bayview Medical
Center, NCCU Staff, and Nursing Director Jo Deaton.](https://image.slidesharecdn.com/388fd1d8-d3af-4bc2-bf25-788c3591c090-161012152637/85/Marini_Poster-1-320.jpg)
