Nursing teamwork addresses admission, discharge, and transfer workloads.
- Multiple simultaneous admissions, discharges, and transfers can create complexity and heavy workloads in acute-care facilities.
- To ensure patient safety and reduce nurse burnout, nurses must receive support during periods of increased workload.
- An admission, discharge, transfer team can help improve outcomes for the organization, nurses, and patients.
By Minerva Gonzales, DNP, RN-BC, NE-BC; Carey Rumbaugh, MSN, RN-BC; and Carol Boswell, EdD, RN, CNE, ANEF, FAAN
Multiple simultaneous admissions, discharges, and transfers add another layer of complexity for bedside nurses working in acute-care facilities. To ensure patient safety and reduce nurse burnout, nurses must receive support during these periods of increased workload. Implementing an admission, discharge, and transfer (ADT) team is one solution. These teams report to a nursing unit that needs assistance to provide relief during times of demanding and hectic workload to ensure safe, high-quality patient care and increase nurse satisfaction. (See ADT teams: Backed by the evidence.)
In 2014, an urban acute-care facility implemented an ADT team of clinical educators and unit directors (all RNs) for all of its acute-care units. They would respond to the units when needed. Each member arranges to serve 1 day, with three members available every day from 8:00 am to 4:30 pm. All team members receive training on the ADT process and the electronic health record (EHR). When units are in need of assistance, the charge nurse calls the shift supervisor and requests an ADT team assist. The supervisor and the team report to the unit to ensure patient needs are met. After the assistance is complete, the charge nurse completes a card that includes date, unit, start and end times, staffing ratios, and team assist details (including what went well, what can be improved, what was done, and who responded), and a 1-5 Likert scale for satisfaction with the team response. The cards are collected by the shift supervisor and analyzed by the director of education, who serves as the ADT team leader
ADT teams: Backed by the evidence
Research shows that admission, discharge, and transfer (ADT) teams can improve patient care, nursing satisfaction, and organizational outcomes. They can:
Workload is correlated with nursing burnout and turnover, which can be costly to the organization and lower nurse morale. A study conducted by Spiva and Johnson revealed that, after implementing an ADT team, nursing satisfaction increased. The same study found that courtesy of the person admitting patients increased from 90.7% to 92.1%, which indicates an increase from the 50th to the 80th percentile per the Press Ganey patient satisfaction scale.
Challenges and modifications
The key challenge for this program was getting the frontline staff to call the ADT team. Initially, the teams were made up of mid-level administrative staff, and requests for assistance were inconsistent and infrequent, although units raised workload concerns. The staff were worried that calling the team might be interpreted as lack of effective unit management. To address this issue, the ADT team make-up was changed to peers and managers. Nurse educators and other seasoned nurses on the career ladder were trained to function on the ADT team, providing them with another way of maintaining their career ladder designation. A schedule of available times was developed to ensure that the ADT team was well covered. Because admissions and discharges increased in the afternoon, team scheduling was focused during these hours.
Planning for situational workload stressors presented another challenge, so the shift supervisor uses a checklist to assess for potential overload. Unit staff notify the supervisor of anticipated discharges and transfers every 4 hours because each of these is likely to result in an admission. In addition, the supervisors know which units have float personnel or travelers, and they’re kept informed about challenging patients and situations. All of this knowledge is used to anticipate which units might need assistance. So, instead of waiting until the unit calls for help, the ADT team can be placed on alert or a team member can drop by the unit to provide support. If the team member sees that further help is needed, he or she can call the full ADT team to help.
Nursing workload can significantly impact an organization through turnover due to job dissatisfaction and lost revenue because of quality of care issues and recruitment costs. In addition, the amount of time nurses spend in patient rooms can affect patients’ perceptions of their care. If nurses are consumed with multiple admissions and discharges, some patients may not receive as much time with their care providers as they expect, leading to dissatisfaction.
Implementing an ADT team can help nurses spend more time with their patients, leading to higher quality care, shorter lengths of stay, and increased patient satisfaction. And allowing both clinical and nonclinical nurses to respond to team assist calls promotes teamwork throughout all nursing units and departments, which increases job satisfaction and decreases turnover.
The bottom line is that an ADT team can result in positive outcomes for the organization, nurses, and patients.
Minerva Gonzales is director of the RN-to-BSN program and assistant professor at the University of Texas Permian Basin College of Nursing in Odessa. Carey Rumbaugh is the nurse educator/bridge and CNE coordinator and stroke unit director at Medical Center Hospital in Odessa, Texas. Carol Boswell is a professor and James A. “Buddy” Davidson Charitable Foundation Endowed Chair for Evidence-Based Practice and co-director of the Center of Excellence in Evidence-Based Practice at Texas Tech University Health Sciences Center School of Nursing in Odessa.
Berkow S, Vonderhaar K, Stewart J, Virkstis K, Terry A. Analyzing staffing trade-offs on acute care hospital units. J Nurs Adm. 2014;44(10):507-16.
Kirkbride G, Floyd V, Tate C, Wendler MC. Weathering the story: Nurses’ satisfaction with a mobile admission nurse service. J Nurs Manag. 2012;20(3):344-53.
Spiva L, Johnson D. Improving nursing satisfaction and quality through the creation of admission and discharge nurse team. J Nurs Care Qual. 2012;27(1):89-93.
Van Bogaert P, Kowalski C, Weeks SM, Van Heusden D, Clarke SP. The relationship between nurse practice environment, nurse work characteristics, burnout and job outcome and quality of nursing care: A cross-sectional survey. Int J Nurs Stud. 2013;50(12):1667-77.
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