Date of Paper/Work


Type of Paper/Work

Doctor of Nursing Practice Project

Degree Name

Doctor of Nursing Practice



First Advisor

Sarah Beman


Doctor of Nursing Practice


Problem: Hospitals face substantial capacity constraints in emergency departments throughout the nation. High rates of hospitalizations result in a ripple effect, resulting in long wait times, patient diversions to other hospitals, and higher patient-care expenses. Observation care is an outpatient service for a select patient population, which can help avoid a sizable number of hospital admissions. Inconsistencies in the use of observation order sets, miscommunication between the emergency department and trauma providers on proper admission status, and admission of patients that meet observation criteria to inpatient results in delays in care and increased lengths of stay. Appropriate use of observation units may improve bed capacity in individual hospitals and provide significant national cost savings as care is delivered safely in less time with the help of fewer resources.

Objective: This quality improvement project aimed to implement a teaching tool to increase trauma providers’ confidence and competency in selecting appropriate trauma observation patients and utilizing proper trauma observation order sets to admit trauma observation patients with minor injuries. Background: Patients with several minor traumatic injuries can be safely monitored in an observation unit. Observation order sets for minor traumatic injuries alert on best practices and provide appropriate prescribing and treatment reminders. Trauma providers should feel confident in the consistent use of trauma observation order sets and proper trauma observation patient selection.

Methods: This quality improvement project followed the Plan, Do, Study, and Act cycle. A literature review, trauma observation admissions, and observation order set use assessment were used to create the teaching tool content and learning objectives. The project outcomes were evaluated using quantitative survey data.

Results: The results revealed that the educational intervention initially decreased the number of trauma patients being downgraded to observation. The percentage of trauma providers utilizing the right observation order sets for observation patients increased in December and January. In December, there was a decrease in patients downgraded to TO by utilization management. There was an increase in observation admissions where observation order sets with clinical care endpoints were utilized in December and January. There was an initial decline in the average length of stays for TO patients, especially in December when the teaching tool was implemented and in January.

Conclusion: An educational intervention highlighting trauma observation patient selection to influence the appropriate admission of mild trauma patients to TO using observation order sets with clinical endpoints increased the providers’ knowledge, confidence, and proper patient placement. Education on TO admission needs to be an ongoing process to facilitate culture change.

Available for download on Saturday, July 27, 2024