Project 1: Quality Measurement and Assessment
Introduction
This QI project looks into improving healthcare outcomes by reducing crowding in my hospital’s emergency department (ED) setting. This QI issue considers adequate staffing and staff education as the necessary drivers towards enhanced patient flow, thus reduced ED crowding. The initiative serves as an encouragement for the facility to grow and develop its staffing and educational requirements for nurses. The idea here is that skilled and adequately staffed nurses can reduce ED crowding, thus advancing care quality and patient outcomes.
My hospital recognizes patients and the staffing unit as essential elements in healthcare service delivery. The facility treats its primary care practitioners and nurses as highly skilled professionals that can help transform care delivery. That said, the hospital’s mission is to promote efficiency in the provision of services through patient-centered care, education, leadership, and research. Finally, the hospital values the support and promotion of its mission and vision statements. The facility such support through the creation of an environment that can enhance high-quality care initiatives (Boyle, Beniuk, Higginson, & Atkinson, 2012).
This QI initiative aligns with the above-stated mission, vision, value and strategic elements given its adherence to healthcare promotion. Further, the move follows the quality improvement regulatory requirements advanced by reputable organizations such as the Joint Commission and AHRQ. Ideally, nurse education and adequate staffing needs exist as a top priority in meeting the hospitals, AHRQ’s, and the Joint Commission’s mission of attaining excellence in patient care. Both initiatives, therefore, support professional responsibility, teamwork, and dedication to streamlined patient flows (Tanabe, et al., 2008).
Overview
Overcrowding in ED is a QI issue that poses a massive threat to the quality of patient care. In essence, the problem increases the risk of patient mortality, pain, the length of stay, and medication errors. Thus, crowded EDs imply a full occupancy rate for licensed beds amidst frequent patient overflow and overwhelmed staff. Given such circumstance, ED nurses and primary care physicians may find it hard offering optimal care to their patients (Pines, Singer, Thode, & Viccellio, 2011). Further, there is an apparent failure in nursing support, patient privacy, diagnostics, and adequate care management. Finally, the placement of new patients on the waiting list reveals a further risk, due to reduced patient surveillance mechanisms (Sadeghi, Barzi, Mikhail, & Shabot, 2013).
In the U.S, EDs offer round-the-clock 24-hour emergency services. This specification implies a direct correlation between patient flow and quality utilization of ED services. The two most significant causes of ED crowding, according to Rabin, et al. (2012), include limited staff education and the nursing shortage. The situation is graver within the telemetry bed department as well as the ICU. Thus, the ability to care for patients in the unit further relies on bed availability, RN staff, RN-patient ratio, and availability of ancillary services, among other factors (George & Evridiki, 2015; & Sun, et al., 2013).
Measures and Indicators
The first step towards QI achievement will entail patient flow team selection. The vitality of establishing such a team lies in its composition and ultimate importance in reducing ED patient traffic. Jayaprakash, O’Sullivan, Bey, Ahmed, & Lotfipour (2009) show that there is a direct positive relationship between multidisciplinary team development and QI initiatives. In this case, the QI developer recommends that the QI team includes, at the minimum, the team leader, quality control officer, PCPs, ED RNs, clerks, and ICT representatives. The importance of setting up such a team is that the members’ diverse nature has the ability of positively affecting the QI strategy.
Further, performance measurement remains a vital tool for the identification and mitigation of QI variations in ED population processes. The information gathered here will be useful in exhibiting ED crowding as a clinical issue worth immediate clinical attention. Presently, my hospital is under the obligation to report its ED QI measures to responsible organizations such as the Joint Commission. There is, therefore, a recommendation for the collection of both qualitative and quantitative data on QI measures linked with ED crowding (Bernstein, et al., 2008).
Notably, the author intends to use a participatory approach to cover the views of all staff members involved in the initiative. The project reasons that the facility takes count of its staffing and patient flow needs through a centralized system. Further, it assumes that the facility allows the nursing staff to undergo various forms of education as a way of improving service delivery. That said, training sessions will conduct a review of the key issues identified with ED crowding and their possible solutions (McHugh, Van Dyke, McClelland, & Moss, 2014). Also, there will be a discussion on the effects of a reduced staffing ratio compared to increased remuneration on ED patient flows. During the education-associated data collection, RNs will develop guidelines at the end of each session on patient flow and patient safety. The idea here is the extent to which proper staffing and education close patient overflow (Tanabe, et al., 2008).
Data Presentation
The researcher will conduct qualitative data presentation given the QI activity for both staffing and educational initiatives. The aim of this perspective is to improve learning and ensure that the process adheres to set guidelines. Qualitative analyses include unstructured responses done through scripted information. Such studies will use content richness in revealing interesting findings and perspectives on ED crowding. Here, the researcher will quote the most appropriate results as a way of deducting themes from the text (Anderson, 2010).
On the other hand, quantitative analysis will use summative assessment at the end of the learning process. The purpose here is to aid in making decisions and final judgments. The idea here is to compare current and past data on the rate of ED crowding. The researcher aims at presenting quantitative data in table and chart form. In these presentations, data would include images targeting clarifying QI issues being passed around. Pie charts, for instance, will quantify information through divisions that show differences in the composition of staffing.
Evidence-Based Targets
This project targets reduced ED crowding at the hospital as a QI indicator. Upon completion, the author recommends that nurses exhibit increased awareness of efforts, timelines, resources, and budgets related to the QI issue. Mainly, the project developer will aim at reducing the current crowding rate by 80 percent within the first three months. The project’s long-term objective, however, is to reduce ED crowding by 100 percent after six months from the date of initiation. However, the project’s plan will have to overcome three primary barriers to the achievement of these objectives. These barriers include the need for additional staff, staff buy-in, and administrative approval (McHugh, Van Dyke, McClelland, & Moss, 2014).
Project 2
Purpose and Objectives
This project determines that the crowding rate at the hospital’s ED was higher than nationally acceptable rates. In response to this QI issue, the author will implement a plan aimed at reducing the crowding rate by 80 percent within the first three months. Ideally, the project planners focus on improving the care of ED patients by adjusting the nurse-patient ratio and enhancing nurse education on their role in streamlining ED patient flows. They hope to achieve this objective within six months upon initial change implementation.
Strategies
The QI project, therefore, follows two processes as a way of improving patient flow, thus reducing crowding. The first strategy is to increase the number of RNs and PCPs during high traffic days. Chan et al. (2014) as well as Ng, Vail, Thomas, & Schmidt (2010) note that an increase in the number of healthcare providers per patient would have a positive effect on the standards of care within the ED. In essence, emergency medicine is characteristic of increased demand for care, inadequate RN supply, increased overtime, and minimum length of stay. For instance, the demand for RNs in the ED continues to grow with an increase in demand for emergency medicine in the United States. Second, however, the supply of nurses remains low to meet this demand due to high turnout rates. The resulting shortage, therefore, increases the workload for current ED nurses, increasing chances of crowding (Vermeulen, et al., 2014).
The second strategy is to educate nurses on their roles in enhancing patient flow within the ED environment. This approach will advance the RN’s ability to deal with heavy workloads in teamwork settings. Insight from Ajiebge et al. (2014) finds that educating ED nurses on collaboration increases their perception of work control and job satisfaction (Ajiegbe, McNeese-Smith, Phillips, & Leache, 2014). Also, Liang et al. (2009) recommend that hospitals educate their ED nurses on the benefits of job rotation as a way of informing fairness in service delivery (Liang, Shih, Chang, & Ho, 2009). Given both instances, RNs learn appropriate methods of receiving patients as well as care coordination with other members of the department.
Implementation
An overview of the process map shows that the ED staff will be responsible for receiving, guiding, and releasing the patients. The planners will identify a team of primary care physicians and RNs attached to the ED as the primary project implementers and the leading champions. This team’s primary role is to train other members to enhance their methods of dealing with ED patients (Holden, 2011). Further, ED nurse practitioners have a vital role in supervising LPNs for the creation of a coordinated system with the PCP. Finally, the planners have developed an evaluation plan for ED staff to identify the kinds of patients that best suit the ED environment (Cain & Haque, 2008).
Expected Results
Lastly, from the above discussion, one can note that the challenges resulting in ED crowding within the facility include lack of enough staffing, staff miseducation, and lack of appropriate organizational culture. The project planner suggests appropriate RN education on the benefits of proper patient flow and an increment in the number of nurses on the floor during high patient traffic. Given these strategies, an improvement in ED operational efficiency will allow the facility to accommodate increased patient volumes during the identified high traffic periods. Eventually, the department will have the ability to utilize its current resources to improve care quality as well as patient satisfaction through reduced crowding (Khademian, et al., 2013).
Process Map
References
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