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As a graduate student in the Clinical Nursing Education Program, part of the course work for my final internship included a research project and practicum of 126 precepted hours. I chose to investigate the direct admission process at Children’s National Health System (CNHS) in Washington, D.C.

CNHS, in September of 2012, launched a Direct Admission Process called Bear Direct. The Bear Direct process allows the acutely ill pediatric patient to be admitted directly to an acute care nursing unit without first receiving treatment at CNHS’s Emergency Department. This process was of interest to me because I’ve been employed by Children’s National for over 22 years and currently

I am involved in the Bear Direct program as an admission/crisis.  I sought a comprehensive understanding of the direct admission process.

The purpose of my research was to examine Bear Direct for strengths, weaknesses, safety, efficiency and fiscal responsibility and to make recommendations, according to best evidence-based practice, to improve the direct admission process. As I began to research peer-reviewed journal articles that had a specific emphasis on the direct admission process at pediatric institutions, it became apparent that the literature was limited and that Bear Direct is very innovative and unique to CNHS.

I formed a committee, according to the internship guidelines, that included my committee chair, Dr. Lisa Seldomridge, director of Graduate and Second Degree Nursing Programs, and Dr. Judith Jarosinski, associate professor of nursing. They provided support, insight and guidance throughout the internship that was instrumental in the successful completion of my objectives. As part of the internship, I disseminated the findings of my research project through a PowerPoint presentation and an executive summary to the key stakeholders at CNHS.

The finding of this research project indicated that although the Bear Direct program is five years old, quality indicator data have not consistently been aggregated and analyzed. Currently, the only data being reported are quarterly volume and inpatient unit disposition. Additional findings included inconsistent assessment of patients and increased vulnerability of the process after 2100

(10 p.m.) and on holidays and weekends.

Once I learned that quality indicator data collection had ceased after the first 16 months of the inception of the direct admission process and that there was a lack of data to provide evidence to the safety and sustainability of Bear Direct, I was given an opportunity to continue my research through a hospital-wide program called the Interprofessional Quality Improvement Fellowship (IQI). IQI is a

12-month program at CNHS that incorporates collaboration between a RN and physician to facilitate a quality improvement project. Now that I’ve graduated from ¾ÅÐãÖ±²¥ (December 2017), I plan to continue my research and resume quality indicator data collection for Bear Direct with the IQI fellowship starting in January 2018 and to begin working full time at CNHS utilizing my master’s degree in nursing.