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nurses retrieved the patient from the emergency departmentin an effort to reduce door-to-balloon time.

Outcomes: From May 2003 to April 2004, door-to-tPA goaldecreased from 70 minutes to 60 minutes, and CT to tPAtime was 30 minutes. The quality of patient care in theemergency department improved with the use of clinicalpathways for ACS and stroke. In the acute myocardialinfarction patient population, the door-to-balloon time wasreduced from 138 to 98 minutes in 2001 and as of February2004, respectively. Door-to-EKG time is consistently less than10 minutes.

Recommendations: The use of the clinical pathways hasstandardized this emergency department’s deliverance of careto acute stroke and chest pain patients. Measurement ofpatient satisfaction and the perception of care is a topic forfuture research. The interdisciplinary team encourages collabo-ration and standardization by development of a preprintedorder sheet for a specific clinical pathway.

doi: 10.1016/j.jen.2004.07.058

20. Management of ED Patients Requiring Seclusion andRestraints. Fidela S.J. Blank, RN, MN, MBA, Ann Maynard,

RN, BS, Baystate Medical Center, 759 Chesnut St, Springfield,

MA 01199

Clinical Topic: Violent behavior that requires putting thepatient in restraint and seclusion has resulted in both patientand staff injuries. The Hartford Courant in 1998 reported142 patient deaths while in physical restraints or seclusion. Inone study of violence in the emergency department, 43%reported physical attacks on staff at least once a month. Fifty-three percent of all hospital assaults occur in the emergencydepartment. The goal of this project was to design a programfor ED patients requiring seclusion and/or restraints that willensure both patient and staff safety.

Implementation: We are an urban, level I trauma center witha volume of 105,000 visits per year. To improve safety, an EDtask force composed of the vice-chairman, the director, theday supervisor, and the clinical specialist developed andimplemented a psychiatric advocacy program. The programinvolved revisions of the restraint policy and documenta-tion forms to ref lect Joint Commission on Accreditation ofHealthcare Organizations (JCAHO) standards; an educationalprogram for all ED direct care staff on how to handle patientsrequiring restraints; development of a chart audit tool, withfeedback to staff; and identification of financial resources toadd psychiatric advocate positions. Psychiatric advocates areED assistants who are trained in CPR and have undergonenonviolence crisis intervention and psychiatric advocacyclasses. The psychiatric advocacy class included 10 case studiesthat require the learner to apply the behavioral restraint policyand procedures identify signs and symptoms of physicaldistress and nutrition/hydration requirements for the re-strained patients.

Outcomes: Prior to this program, we did not track therestraint and/or seclusion process. Since the program started,monthly audits of all restraints and seclusion patients began,

February 2005 31:1

which showed that the number of patients in mechanicalrestraints is down from an average of 16.8 patients per monthto 10.5 patients per month so far this fiscal year. The length ofstay in mechanical restraints is down from 2 hours 11 minutesto 1 hour 35 minutes. Documentation of restraint and se-clusion use became more consistent with JCAHO standards.

Recommendations: Involvement of ED management inprogram development is critical for identification and approvalof financial resources for the program. Policy revisions anddocumentation requirements should be taught and assessedduring staff orientations and annual skill updates. Providingcontinuous feedback to staff through chart audits is helpfultoward maintaining improvements. The goal of the psychiatricadvocacy program is zero injury to patients and staff during useof restraints and/or seclusion. Ongoing monitoring of theprogram through monthly audits should be conducted toensure that the zero injury policy is maintained.

doi: 10.1016/j.jen.2004.07.059

21. Creating a Successful Remote Medical Clinic. Audrey

Snyder, RN, MSN, CEN, ACNP, Claudette Dalton, MD, David

Cattell-Gordon, MSW, University of Virginia, School of Nursing/

Emergency Medicine, McLeod Hall, PO Box 800699, Charlottes-

ville, VA 22908-0699

Clinical Topic: In many rural areas of the United States,access to health care resources is prevented due to the lack offinancial resources, lack of providers, and/or inability totravel. In rural Southwest Virginia, more than 25% of thepopulation is uninsured.

Implementation: The local community health care providersidentified the major community health needs and collabo-rated with Remote Area Medicine for a summer weekendclinic to provide dental and eye care at a clinic at the localairport in 2000. In 2001, this tertiary care medical centertook on the challenge to provide a medical clinic. More than60 physicians, nurse practitioners, nurses, pharmacists, labo-ratory technicians, and other hospital volunteers donated theirtime and services for the 2O-day clinic. Each summer, theypackage all the necessary equipment and supplies and thentravel 6 hours to set up the remote clinic.

Outcomes: In 2003, in collaboration with local providers, theLion’s Club, and a dental school, the volunteers saw morethan 4700 patients (more patients than many emergencyrooms see in a month) in 3 days at the local fair grounds.Encompassing a focus of health education, injury prevention,and diagnostic screenings, the services offered includedmedical screenings, hypertension and diabetes clinic, otolar-yngology clinic, gastroenterology clinic, pediatric clinic,women’s health clinic, mammography, a limited laboratory,and a limited pharmacy. The Virginia Statewide DisasterResponse Team, along with local emergency services pro-viders, coordinated emergency calls at the fairgrounds. Apermanent telemedicine site was established in the area forlocal health providers to obtain consultation with specialtyphysicians on a regular basis. An additional grant has provided

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transportation funds for patient travel to medical appoint-ments throughout the year.

Recommendations: The sheer magnitude of patients seen atthis clinic reinforces the need for a nationwide health plan thatcovers the working poor. This work has cemented a relation-ship between the local health care providers and the tertiarycare center. There is a continued commitment to providesupport for the 2004 summer clinic. Based on the success ofthis clinic, the Governor of Virginia has organized weekendclinics in other rural areas of the state.

doi: 10.1016/j.jen.2004.07.060

18 J

INJURY PREVENTION POSTERS

22. Alcohol Awareness-Crash Simulation. Sue Trujillo, RN,Nancy G. Stevens, RN, MSN, CEN, C. Dewayne Siddon, RN, Tim

Harden, RN, EMT, Carol Golden, RN, Stephanie Moon, RN,Darlene Groogan, RN, Kelly Hollandsworth, EMT-P, Scenic

Cities Emergency Nurses Association, 480 Indian Hills Dr,

Dayton, TN 37321

Injury Prevention Topic: Nationwide, alcohol-related mo-tor vehicle crashes accounted for 17,448 and 15,626 deathsin 2001 and 2002, respectively. The intent of this proj-ect was to show the public (all ages) what actually hap-pens following an alcohol-related crash, including police, firedepartment, emergency services interventions, and mediacoverage of the crash. The purpose of the crash simulationwas to raise awareness about drinking and driving to decreasemortality rates.

Implementation: The program was developed by the localENA Chapter, EMS, Fire Department, and Sheriff ’s Depart-ment of Hamilton County, Tennessee. Advertisements pro-moting the event were placed on television, radio, newspapers,and the Internet. A public parking lot was used as the crashscene. A severely damaged vehicle was donated by a localwrecker company. The scenario was that this car had crashedon the way home from prom night and that the driver hadbeen drinking and driving. The crash ‘‘victims’’ were playedby an ENA member’s son and his friend. Wounds were simu-lated using moulage makeup. Bystanders were able to hearsimulated 911 calls contacting police, EMS, and the firedepartment. Victims were removed from the vehicle using thejaws-of-life. One was transported away by EMS, the secondpronounced dead and placed in a body bag. After the sim-ulation, bystanders (target audience) were interviewed bytelevision news reporters to assess their reaction to the con-sequences of drinking and driving. These interviews were airedon the local nightly news.

Outcomes: While bystanders did not fill out programevaluations, those interviewed stated that they would notdrink and drive (100%). Actual family members that wereinterviewed were overwhelmed with sadness at seeing theirloved ones in body bags. Although the target audience was allages, this was not accomplished when the program waspresented to the public because many people would stop fora moment but did not stay to view the entire program. Re-cently, the simulation was presented to high school studentsbefore prom night. Afterwards, school representatives reportedthat neither car accidents nor drinking and driving chargeshad occurred with their students on prom night. Although notproving that the simulation is completely responsible for thispositive outcome, it seems that captive audiences are the betterchoice. Numerous schools have since requested the programbe given before prom to their students as well. It has sincebeen decided to switch the target audience from the public tosuch captive audiences.

OURNAL OF EMERGENCY NURSING 31:1 February 2005