Framework or Model for Change

2

PICOT Final

Name_________________Daysha Polk____________________

Complete your PICOT using your approved proposed nursing practice problem. If they were approved, you may use the population and intervention developed in your Topic 1 assignment. Include any necessary revisions in this submission. Refer to the “Example PICOT” below as needed for guidance on how to complete the PICOT.

References

Asheim , A., Nilsen, S. M., Carlsen, F., Næss-Pleym, L. E., Uleberg, O., Dale, J., Bache-Wiig Bjørnsen, L. P., & Bjørngaard, J. H. (2019, December 26). The effect of emergency department delays on 30-day mortality in Central Norway. European journal of emergency medicine : official journal of the European Society for Emergency Medicine. https://pubmed.ncbi.nlm.nih.gov/31135613/. 

Fudge, N., Sadler, E., Fisher, H. R., Maher, J., Wolfe, C. D. A., & McKevitt, C. (n.d.). Optimising Translational Research Opportunities: A Systematic Review and Narrative Synthesis of Basic and Clinician Scientists’ Perspectives of Factors Which Enable or Hinder Translational Research. PLOS ONE. https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0160475.

Morrison, L. E., & Joy, J. P. (2016, June 20). Secondary traumatic stress in the emergency department. Wiley Online Library. https://onlinelibrary.wiley.com/doi/abs/10.1111/jan.13030.

Wand, T., Crawford, C., Bell, N., Murphy, M., White, K., & Wood, E. (2019, April 30). Documenting the pre-implementation phase for a multi-site translational research project to test a new model Emergency Department-based mental health nursing care. International Emergency Nursing. https://www.sciencedirect.com/science/article/abs/pii/S1755599X19300400?via%3Dihub.

Wang, H., Kline, J. A., Jackson, B. E., Robinson, R. D., Sullivan, M., Holmes, M., Watson, K. A., Cowden, C. D., Phillips, J. L., Schrader, C. D., Leuck, J. A., & Zenarosa, N. R. (2017, October 5). role of patient perception of crowding in the determination of real-time patient satisfaction at Emergency Department. OUP Academic. https://academic.oup.com/intqhc/article/29/5/722/4158405?login=true.

© 2021. Grand Canyon University. All Rights Reserved.

© 2021. Grand Canyon University. All Rights Reserved.

BENCHMARK 1

Evidence-Based Practice Project: PICOT Paper

Daysha Y. Polk

NUR 550

Grand Canyon University

June 1st, 2021

Evidence-Based Practice Project: PICOT Paper

Generally, a high level of patient satisfaction for the clients in the emergency department (ED) is vital, especially at this time when the healthcare system is shifting towards patient-centered care. Prakash (2010) notes that patient satisfaction levels significantly impact on medical malpractice claims, patient retention, and clinical outcomes. That is, it affects quality healthcare’s timely, efficient, and patient-centered delivery, making it both a proxy but a very effective key indicator for measuring the hospitals and doctors’ success. Consequently, supporting the improvements of patient satisfaction levels can positively affect several healthcare organizations’ components, such as preventive possible malpractice lawsuits, securing a positive local reputation, and enhancing patient retention rates. Thus, there is an increased need to develop strategies to improve ED patient’s satisfaction with the provided care services. Increasingly, the use of real-time location systems (RTLS) by hospitals to track patients, instead of relying on the traditional, manually-entered status updates, is increasingly being viewed as a better strategy to decrease the number or rate of Left Without Being Treated (LWBT) patients, and thus, improve ED patient’s satisfaction levels and hospital’s revenue collection (Boulos & Berry, 2012). Thus, the paper will explore whether the utilization of RTLS in the hospital’s ED, compared to manually-entered status updates to tract patients, help decrease the rate of LWBT and to raise revenue collection within 6 months, for ED patients with decreasing satisfaction levels with the provided healthcare services.

A wide array of factors is responsible for the decreased rate of satisfaction levels amongst ED patients. The current delays, long waits, leaving without being treated, decreased revenue collection from the ED unit, and reduced patient satisfaction scores have negatively portrayed the hospital’s reputation to the public. As a result, the daily patient visits have continued to decrease as people attribute the facility to poor emergency care services delivery. All these complications result from the use of combined data resources and manual entry status updates when tracking patient records. This manual tracking cannot meet the demand for many patients and leads to overcrowding due to and reduced patient flow in the ED. Therefore, there is a need to install an automatic patient tracking system to increase the flow.

Patient satisfaction level, especially for hospital’s emergency department (ED) is increasingly becoming a key health quality indicator. Patient satisfaction regards the degree to which patients are happy with their healthcare (Heath, 2016). Patient satisfaction levels is a care quality measure and gives healthcare providers information on the various aspects of health and medicine, such as their care’s effectiveness and their empathy levels. According to Xesfingi & Vozikis (2016), patient satisfaction is a healthcare quality’s measure given that it provides insight into the provider’s success at realizing the patient’s care expectations, and is also a key patients’ perspective behavioral intention’s determinant. While satisfaction has always been an important factor when delivering any form of a service, it has recently gained prominence or primacy within the healthcare space, especially at this time when the healthcare industry is fast shifting towards patient-centered models. According to Vocera’s 2016 ‘Rise of the Chief Experience Officer’ report, about 64% of the interviewed healthcare professionals stated that their healthcare organizations prioritize patient satisfaction in a similar extent to which they value clinical workflow and patient safety improvements. Increasingly, patients are demanding a larger claim in their healthcare, with the expectation that their healthcare providers will attain a certain service level.

Healthcare quality is increasingly becoming a universal issue, making the healthcare industry to undergo rapid transformations. According to Asamrew, Endris and Tadesse (2020), the rapid transformations are primarily driven by the need to realize its patient population’s ever-increasing needs and demands, instead of the traditional professional practice standards-based needs. In their study of a patient’s satisfaction score with a specialize hospital in Ethiopia, the researchers determined that patient-healthcare provider interaction and general facility amenity-related factors explained about 96.4% of the variability in the net overall satisfaction score. The hospital’s inpatient pharmacy services, the availability of laboratory, radiology and pain management services, and good quality services provided by the hospital physicians positively influenced patient satisfaction scores. Additionally, availability of accommodation rooms, toilet cleanliness, and dietary services had significant association with the patient satisfaction levels. In yet another study, Son and Yom (2017) classifies the factors impacting on ED patient’s satisfaction levels into three interrelated forces, including predisposing characteristics, enabling resources and need. First, the predisposing characteristics include demographic factors (age, sex, marital status and past illness), social structure (education and employment), and belief (subjective health, perceived social class and attitude towards health service – quality and status). Secondly, then enabling resources include family (income and type of health insurance) and community (type of hospital, mode of arrival, time taken, delayed or missed treatment and frequency of visiting the ED). Finally, the need factors include reason for visit and service received. Joe Greskoviak, president and chief operating officer at Press Ganey, categorizes the factors into communication, provider empathy, and care coordination (Heath, 2016). All these points are interrelated and affect each other.

Delayed or missed treatments have become a notorious phenomenon in most hospitals. In a recent research by Asheim et al., (2019), it was discovered that the prolonged ED stay was associated with a higher probability of being discharged from the ED without admission to the hospital and that there was no significant difference in hospitalization length for the admitted patients. Thus, the researchers concluded that prolonged ED stay was not associated with increased risk of death. However, many studies have determined that delayed or missed treatments are strongly associated with decreased patient satisfaction levels and reduced revenue for hospitals. Furthermore, ED overcrowding also reduced emergency care quality by prolonged patient total length of stay, increased rate of patients left without being seen, ambulance diversion, decreased patient satisfaction, decreased revenue collection, and etcetera (Wang et al., 2017). According to Wand (2019), the lengthy documentation and assessment processes, timeliness of consultations and delays in decisions about patient disposition in ED can lead to reduced ED patient satisfaction levels and frustrations by ED staff and hospital executives. As noted above, the complications are primarily caused by the hospital’s reliance on combined data resources and manual entry status updates when tracking patients and their records – all of which cannot meet the healthcare service demand for the many patients, leading to reduced patient flow in the ED, overcrowding, and delayed and missed treatments.

Technology can significantly help hospitals solve the mentioned complications. Primarily, by installing a RTLS, an automatic patient tracking system in the ED, hospitals can significantly increase the patient flow in their EDs (Drazen & Rhoads, 2011). According to Garie Fallo, the Western Reserve Hospital’s CNO, a technology suite can help improve care efficiency in EDs and boost patient satisfaction scores by 90% through streamlining the clinical workflow (Heath, 2016). With an automatic patient tracking system, patients would not need to stop at any stage for manual tracking, stipulating that there would be neither delays, prolonged wait times on stretchers, nor family waiting. Rather, the process would appear more satisfied, with a very seamless move to the ED room. Thus, right from their arrival, the patients would have a higher satisfaction with the provided services. The side-effect of the high satisfaction scores, according to a review of various peer-reviewed publications on the importance of patient satisfaction carried out by Prakash (2010), includes improved patient loyalty and retention, reduced vulnerability to price wars or bargains, consistent improvement in revenue and profitability, increased staff morale with reduced staff turnover, reduced risk or malpractice suits and accreditation issues, and increase personal and professional satisfaction. Consequently, by installing the proposed RTLS, hospitals can improve the ED patient’s satisfaction levels. Specifically, RTLS, compared to the manually-entered status updates to tract patients, help decrease the rate of LWBT and to raise revenue collection within 6 months, for ED patients with decreasing satisfaction levels with the provided healthcare services.

References

Asamrew, N., Endris, A. A., & Tadesse, M. (2020). Level of Patient Satisfaction with Inpatient Services and Its Determinants: A Study of a Specialized Hospital in Ethiopia. (J. Haughton, Ed.) Journal of Environmental and Public Health, 2020(Article ID 2473469), 1-12. Asheim, A., Nilsen, S. M., Carlsen, F., Næss-Pleym, L. E., Uleberg, O., Dale, J., et al. (2019, December). The Effect Of Emergency Department Delays On 30-Day Mortality in Central Norway. European Journal of Emergency Medicine, 26(6), 446-452. Boehm, L., & Petty, K. (2016). The Rise of the Healthcare Chief Experience Officer. Vocera’s Experience Innovation Network. Boulos, M. N., & Berry, G. (2012, June 28). Real-Time Locating Systems (RTLS) In Healthcare: A Condensed Primer. International Journal of Health Geographics, 11(25). Drazen, E., & Rhoads, J. (2011, April). Using Tracking Tools to Improve Patient Flow in Hospitals. Retrieved May 30, 2021, from California Health Care Foundation (Online): https://www.chcf.org/wp-content/uploads/2017/12/PDF-UsingPatientTrackingToolsInHospitals.pdf Heath, S. (2016, May 24). Patient Satisfaction and HCAHPS: What It Means for Providers. (Xtelligent Healthcare Media, LLC) Retrieved May 30, 2021, from Patient Engagement HIT (Online): https://patientengagementhit.com/features/patient-satisfaction-and-hcahps-what-it-means-for-providers Prakash, B. (2010). Patient Satisfaction. Journal of Cutaneous and Aesthetic Surgery, 3(3), 151–155. Son, H., & Yom, Y.-H. (2017). Factors Influencing Satisfaction With Emergency Department Medical Service: Patients’And Their Companions’Perspectives. Japan Journal of Nursing Science, 14, 27–37. Wand, T., Crawford, C., Bell, N., Murphy, M., White, K., & Wood, E. (2019, July). Documenting The Pre-Implementation Phase For A Multi-Site Translational Research Project To Test A New Model Emergency Department-Based Mental Health Nursing Care. International Emergency Nursing, 45, 10-16. Wang, H., Kline, J. A., Jackson, B. A., Robinson, R. D., Sullivan, M., Holmes, M., et al. (2017, October). The Role Of Patient Perception Of Crowding In The Determination Of Real-Time Patient Satisfaction At Emergency Department. International Journal for Quality in Health Care, 29(5), 722–727. Xesfingi, S., & Vozikis, A. (2016, March 15). Patient Satisfaction With The Healthcare System: Assessing The Impact Of Socio-Economic And Healthcare Provision Factors. BMC Health Services Research, 16(94).

Rubic_Print_Format

Applying a model or framework for change ensures that a process is in place to guide the efforts for change. In 500-750 words, discuss the model or framework you will use to implement your evidence-based practice proposal project. You will use the model or framework you select in the Topic 8 assignment, during which you will synthesize the various aspects of your project into a final paper detailing your evidence-based practice project proposal.

Include the following:

1. Identify the selected model or framework for change and discuss its relevance to your project.

2. Discuss each of the stages in the change model/framework.

3. Describe how you would apply each stage of the model or theoretical framework in your proposed implementation.

4. Create a concept map for the conceptual model or framework you selected to illustrate how it will be applied to your project. Attach this as an appendix at the end of your paper.

Refer to the “Evidence-Based Practice Project Proposal – Assignment Overview” document for an overview of the evidence-based practice project proposal assignments.

You are required to cite minimum of four peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

Prepare this assignment according to the guidelines found in the APA Style Guide.

Please follow rubric.