Happy Patients, Happy Nurses, Happy Doctors! How the Implementation of a Pre-Admission Process Prepares Patients for Their "Big Day" and Allows Nurses to Focus On Bedside Care

Purpose for the program:

Let's face it- today the "buzz word" is budget. Save time and money anyway you can. On a "feast or famine" unit- just how are we supposed to do that? Think outside the box! Is it possible to save time before a patient even gets admitted? The answer is "YES" and it's possible by implementing a pre-admission process.

Proposed change:

This process starts with the physicians. They inform the patient at her 35-36 week appointment that she will need to meet with the pre-admission nurse. The patient is given the pre-admission nurse's business card and is instructed to call to make an appointment.

The proposed change for this implementation is: to establish who or whom is going to serve in this role- consistency is key (ensuring ALL patients receive the same information)- and scheduling appointments.

Implementation, outcomes and evaluation:

The patient meets with the staff from registration to obtain a Pre-Numbered Patient (PNP) account. This inactive account will sit dormant in the hospital census until patient’s full admit date of service.  The patient is welcomed into a private office where a full up to date medical history is obtained from the prenatal record and the patient. All maternal/fetal risks and complication to date are obtained, current medication regimen is updated and a family medical history is completed. Consents for obstetrical care and newborn care are obtained, advanced directives are discussed and pediatrician information is obtained.

After all consents have been discussed patient education begins (what to expect)! After questions have been answered,the patient is offered a full tour of the unit including labor room, triage, and the newborn nursery. 

This process has been shown to increase focused bedside care at admission for nursing staff by almost 50%- cutting down the traditional admission time from 45minutes to an hour to nearly 15-30 minutes! This added time also benefits the physicians- as their patient care is not delayed by waiting for nursing admission tasks (starting IV or monitoring) or completion of the patient chart prior to scheduled patient care (induction or cesarean section).

Implications for nursing practice:

Overall, quality patient care starts before the patient is even admitted. Implementing a process that can show the patient we care about them and strive for execellence even BEFORE they are a "real" patient is proven by an increase in patient satisfaction scores (admission process).

Keywords:

pre-admission nurse, pre-admission process, nursing bedside care, increasing patient satisfaction