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San Rafael Medical Center nurses had three poster presentations on topics such from our NICHE committee, mindfulness, and HAPI prevention at the 2024 Kaiser Permanente Northern California Research and Innovation Academy Conference. 

Each team used evidence-based practice to improve outcomes. In addition, this two-day conference was filled with fantastic sessions on how to publish, leveraging data, conducting a research study, and increasing knowledge on EBP.  Don’t miss out on this wonderful opportunity to attend one of the two days at next year’s conference. 

After attending a robotics workshop in September, the perioperative team began preparing for the launch of the new robotics program in San Rafael. 

Clinical nurse Daniel Domer, BSN, RN, was selected as the robotics service line coordinator in October. Daniel collaborated with colleagues across the region and brought back evidence-based best practices to He then partnered with the local perioperative team to build them for various procedures and specialties for our San Rafael Medical Center surgeons.

The interprofessional team worked seamlessly, with great collaboration and teamwork for a successful program launch. October 3rd, Claude (our robot) finally arrived in the operating room. Staff members completed their modules on the second and third week of October in preparation for the hands-on training by an Intuitive trainer. Staff members were divided into groups to ensure the training included every staff member across all shifts. 

On November 7, 2024, there was a successful launch of the program with the first cases. 

Building this robotics program allows our Marin County patients to receive patient centric, innovative, and cutting-edge robotics procedures close to home instead of having to travel outside of the service area. More than 55 cases have been successfully completed by mid-December 2024. The collaborative efforts of the surgical team and detailed planning have contributed substantially to success, setting a strong foundation for continued growth and innovation.   

The ribbon cutting ceremony for Robotics program pictured above includes Daniel Domer, BSN, RN, robotics coordinator; Dr. Jose Gomez, general surgeon, APIC surgical services; and Jeannette, Surgical Technician. 

The daily work of bedside nursing care is stressful, and stressors have increased dramatically since the pandemic. Well documented literature points to compassion fatigue, burnout and secondary trauma causing many nurses to leave the profession. Nurses are not recognizing their value and are losing their ability to make authentic connections with patients and peers.

The (Re) Brilliancy study is to assess whether the 8-hour (Re) Brilliancy workshop centered on Dr. Jean Watson’s Caring Science theory provides an authentic connection by increasing compassion, satisfaction and self-compassion in bedside nurses and nurse leaders. This study investigates whether there will be a decrease in burnout and secondary traumatic stress in this population group. 

In a pivotal study, San Rafael Emergency Department (ED) leaders Tina J. Vitale McDowell, MSN, RN, CPEN, PECC, and Dana Sax, MD, have brought to light critical insights into the accuracy of triaging pediatric patients in the ED. Their research, published in JAMA Pediatrics, reveals a troubling trend: nearly 60% of pediatric ED visits are over triaged, and 7% are under triaged, leading to significant consequences for patient safety, throughput, and the quality of care. Through their collaborative efforts, Vitale-McDowell and Sax are championing improvements in pediatric care that are essential for protecting our young patients. 

 “This work is vital to support pediatric readiness and care in our EDs,” said Vitale-McDowell. “It underscores our ethical responsibility to improve pediatric triage and ensure the safety of our most vulnerable population.”

A collaborative effort is now underway involving Regional Quality, Maternal Child Health, Pediatric Emergency Medicine, and the Division of Research to further examine the impacts of mis triage. To understand the challenges faced during triage, front-line staff from all 21 NCAL ED facilities are providing their insights.

“Emergency department triage is inherently a very challenging job. Triage nurses are asked to make triage assignments with limited time to take a history or review a chart, while simultaneously managing a busy waiting room and acting as the liaison between the waiting room and the back of the ED,” explained Sax. “We are learning more about how triage is currently done, how it impacts patient outcomes and ED operations, and we can better support our front-line triage nurses in this difficult but critically important task of sorting patients on ED arrival.”

The focus ahead will be on refining triage processes to better safeguard patient safety and reduce health care disparities. The insights gained from these initiatives are instrumental in supporting our triage nurses, enhancing the care we provide to pediatric patients.

“This collaborative work is paving the way for more accurate and equitable care in our emergency departments, ensuring that every child receives the attention they need when they need it most,” said Vitale-McDowell.