Project 1: Evaluation Plan
Evaluation Method
For a favorable assessment of this QI initiative, the quality control department proposes the utilization of the formative evaluation (FE) approach. There are four main types of FE analyses that can result in an exhaustive evaluation of this program, namely developmental, implementation, progress, and interpretive assessments. For instance, implementation-focused analysis evaluates differences between plan execution and implementation. Here, the sources of data include stakeholder interviews, focus group discussions, observations, and patient charts (McGowan, Cusack, & Poon, 2008).
Contrarily, progress analysis concentrates on progress towards improvement and implementation at first intervention. The analysis considers clinical performance data on process and patient outcomes. This information is vital given moves on reinforcement and encouragement among ED staff. The primary data sources here will include structured surveys and patient charts. Ideally, this evaluation method should allow for a pre-and post-implementation comparison to identify and sustain any positive changes in patient flow within the ED.
This QI initiative focuses health care outcome improvement in ED through a significant reduction in patient overcrowding. The project recommends two key processes aimed at enhancing patient flow. These procedures include nurse education and subsequent increment in the number of PCPs and RNs on the floor. On the one hand, such increases place emphasis on reduced workloads during high traffic times. Contrarily, nurse education advances the RN’s ability to tackle the pressure that arises from heavy workloads and teamwork environments (Geonnotti, Peikes, Wang, & Smith, 2013).
Metrics
The following four metrics would be vital in the evaluation phase of this project. The first metrics fall under demographics collected on practices and stakeholders. Some of the training information includes average length of stay at the department before and after the intervention and staff-to-patient mix. Contrarily, participant information will include patient age, language, gender, and time of condition among others. The second batch of metrics concerns process measurement. Here, the providers may wish to collect information on the level of participation of nurses and PCPs in the program. Also, it would be vital to consider the number of successful patient admissions before and after the QI process (Geonnotti et al., 2013).
The third set of metrics involves outcome measurements. For instance, one could prioritize the frequency of readmission and time taken for the RN to assess and refer patients to PCPs. Also, considers collecting information on perceived and recorded differences in health outcomes before and after the implementation. Lastly, impact measures serve as the primary indicators of significant transformations within the department upon process improvement. Here, the primary areas of concern include percentage increments in ED patients served by RNs and PCPs, additional revenue from the ED, and rate reduction waiting time and LWBS cases (Geonnotti, et al., 2013).
Recommendation for data Representation
The planner recommends that the organization uses control charts to monitor ongoing changes in patient flow within the ED. Control charts are a type of graphical representations that display changes in processes over time. The chart includes three reference lines, that is, the central, upper, and lower lines. These lines represent the average, upper control limit, and lower control limit, in that order. A comparison of current information to these reference lines would allow the organization to assess the extent to which the QC and ED departments are in control of patient flow. Other vital forms of representation will include pie charts, run charts, and histograms (HRSA, 2013).
Finance and Quality
The organization could consider a return to investment approach as a way of linking finance to quality. As explained by McGowan, et al. (2008), ROIs use costing information on additional staff time and educational session as compared to changes within the ED. This approach helps administrators collect information on some of the benefits gained by the organization with the advent of the QI initiative. Eventually, they can make conclusions on the effect of measures taken towards improved patient flow on patient outcomes.
References
Geonnotti, K., Peikes, D., Wang, W., & Smith, J. (2013). Formative Evaluation: Fostering Real-Time Adaptations and Refinements to Improve the Effectiveness of Patient Centered Medical Home Models. Rockville, MD: Agency for Health Care Research and Quality.
HRSA. (2013). Managing Data for Performance Improvement. Retrieved from Health Resource and Services Administration: https://www.hrsa.gov/quality/toolbox/methodology/performanceimprovement/part2.ht ml
McGowan, J., Cusack, C., & Poon, E. (2008). Formative Evaluation: A Critical Component in EHR Implementation. Journal of the American Medical Informatics Association, 15 (3), 297-301.
Project 2: Quality Improvement Action Plan
Purpose
The QC department commits itself to helping the hospital improve patient flow within the ED through reduced overcrowding. This QI initiative has identified staff education and staffing increments as two practices necessary to the achievement of the program’s goals. Ideally, the department reasons that the facility could see up to 80 percent crowding reductions within the first three months upon implementation. The project’s long-term objective is to achieve a complete reduction in ED crowding within six months upon initiation date.
Activities and Timeframes
The timeframes consider the days or dates upon which the planners strategize the occurrence of critical activities. This plan considers short-term improvements as those that within occur within the first three months. That said, the midrange and long-term activities will happen within six months upon program initiation. The following is a discussion of these activities and timeframes.
Team Selection (0-14th day upon approval)
This activity supports problem identification and proposal approval. The department intends to pitch and have the administration approve the proposal within 30 days. Upon approval, the planners will select a team to act as champions to the project. The team comprises of a series of professionals within the ED and other related departments. These include PCPs, RNs, administrative assistants, lab technicians, a representative from the ICT departments, and pharmaceutical assistants (Boyle, Beniuk, Higginson, & Atkinson, 2012).
Time Documentation (15th- 21st day upon approval)
In this activity, administrative assistants will collaborative with the ICT representative and RNS to details times and days deemed to present high patient traffic. The importance of this activity is to determine days that require additional RNs and PCPs on the ED floor. The event takes seven days for an all-around review of patient flows within the emergency department. This move rides on the assumption that an increase in the number of RNs and PCPs during high traffic times enhances the standards of care (Vermeulen, et al., 2014).
Education on Teamwork and Burnout (22nd- 36th day upon approval)
This activity looks into training members of staff tied to the ED on the importance of teamwork as well as dealing with burnout. The educators will be part of the QC department and will focus on the role of education in fostering performance improvements. The department will identify ED floor nurses and PCPs that fit the preceptor role. These individuals will then incorporate educational activities into the organization’s official training calendar for continuous service delivery (Boyle, et al., 2012).
Project Implementation (37th- 45th day upon approval)
This activity aims at familiarizing all members of staff working in the ED on the essentials of proper patient flows. The selection considers the fact RNs and PCPs remain the most active stakeholders in performance improvement measures that target the ED. The purpose of this timeframe, therefore, is to bring them at par with crowding resolution practices (Geonnotti, Peikes, Wang, & Smith, 2013).
Data Collection and Evaluation for Continuous Improvement
The data collection process will take place on a monthly basis, starting on the 60th day. This process will prioritize clinical, operational, and financial data collected for the purpose of service improvement. The planners aim at setting a baseline before project implementation to act as a corresponding element. The evaluation process follows a similar pattern except that it will begin on the 70th day. The evaluation process will involve a series of activities taken within the FE framework for continuous improvement exercises. Finally, continuous improvement initiatives will remain under review after six months of active project activities (Geonnotti et al., 2013).
References
Boyle, A., Beniuk, K., Higginson, I., & Atkinson, P. (2012). Emergency Department Crowding: Time for Interventions and Policy Evaluations. Emergency Medicine International, 2012 , 1-8.
Geonnotti, K., Peikes, D., Wang, W., & Smith, J. (2013). Formative Evaluation: Fostering Real-Time Adaptations and Refinements to Improve the Effectiveness of Patient Centered Medical Home Models . Rockville, MD: Agency for Health Care Research and Quality.
Vermeulen, M., Stukel, T., Guttmann, A., Rowe, B., Zwarenstein, M, & Bell, R. (2014). Evaluation of an Emergency Department Lean Process Improvement Program to Reduce Length of Stay . Annals of Emergency Medicine, 64 (4), 427–438.
