Date of Degree

Summer 2025

Document Type

DNP Scholarly Project

Academic Department

School of Nursing

Degree Type

Doctoral

Degree Name

Doctor of Nursing Practice

First Advisor

Dr. Lydia Forsythe

Second Advisor

Dr. Cochran

Abstract

Problem: Rising Emergency Department (ED) volumes and Registered Nurse (RN) shortages have led to overcrowding, delayed care, and inefficiencies. In 2023, patient visits exceeded budget projections by 14% for six months. From July to December 2024, discharged patients’ average ED length of stay (LOS) exceeded the three-hour target by over one hour, left without being seen (LWOBS) rates surpassed the 1% benchmark for five months, and diversion hours increased, restricting ambulance admissions. These issues strained nursing resources, reduced care quality, and heightened risks of complications and financial losses, emphasizing the need for a redesigned care model to optimize staff roles and improve low-acuity patient flow.

Aim of the Project: To improve ED throughput for low-acuity patients (Emergency Severity Index 3, 4 and 5) by implementing a Team Nursing Model that aligns nurse licensure with patient needs, reduces LOS to three hours or less, and decreases LWOBS rates to under 1%.

Review of the Evidence: Literature supports team-based care models as effective strategies to improve patient outcomes, enhance workflow efficiency, and optimize staffing resources. Evidence indicates that utilizing Licensed Practical Nurses (LPNs) for lower-acuity tasks allows RNs to operate at the top of their license, improving care coordination and throughput.

Project Design: This quality improvement project used the Plan-Do-Study-Act framework and the OhioHealth Change Management model. The team leaders and stakeholders conducted iterative testing to refine workflows and integrate the Team Nursing Model.

Intervention: The intervention involved LPNs managing low-acuity patients under RN supervision. Implementation included training, stakeholder engagement, use of hourly check-ins, and real-time feedback integration across 12 weeks.

Significant Findings/Outcomes: Although length of stay targets were not fully met, discharge times improved by 30 minutes over the length of the project. LWOBS rates decreased from 4.6% to 0.7%, and diversion hours returned to zero after initial increases. These improvements suggest operational benefits from clearer role definitions and resource optimization.

Implications for Nursing: The Team Nursing Model enhanced ED efficiency by aligning staff roles with patient acuity, optimizing non-RN contributions, and improving care delivery. It supports scalable changes that address nursing shortages, reduce burnout, and foster sustainable, team-based solutions for quality outcomes in high-demand ED settings.

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