DPI Project Manuscript 6 DQ1

Compare your DPI project manuscript thus far to the “Revised Standards for Quality Improvement Reporting Excellence: SQUIRE 2.0” guidelines. Discuss what you can improve in your DPI project manuscript. 1 page, APA

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Revised Standards for Quality Improvement Reporting Excellence

SQUIRE 2.0

Notes to Authors
The SQUIRE guidelines provide a framework for reporting new knowledge about how to improve healthcare. The SQUIRE guidelines are intended for reports that describe system level work to improve the quality, safety, and value of healthcare, and used methods to establish that observed outcomes were due to the intervention(s). A range of approaches exists for improving healthcare. SQUIRE may be adapted for reporting any of these. Authors should consider every SQUIRE item, but it may be inappropriate or unnecessary to include every SQUIRE element in a particular manuscript. The SQUIRE Glossary contains definitions of many of the key words in SQUIRE. The Explanation and Elaboration document provides specific examples of well-written SQUIRE items, and an in-depth explanation of each item. Please cite SQUIRE when it is used to write a manuscript.
Title and Abstract
1. Title	Indicate that the manuscript concerns an initiative to improve healthcare (broadly defined to include the quality, safety, effectiveness, patient-centeredness, timeliness, cost, efficiency, and equity of healthcare)
2. Abstract	a. Provide adequate information to aid in searching and indexing b. Summarize all key information from various sections of the text using the abstract format of the intended publication or a structured summary such as: background, local problem, methods, interventions, results, conclusions. DPI Project Manuscript 6 DQ1
Introduction	Why did you start?
3. Problem Description	Nature and significance of the local problem
4. Available Knowledge	Summary of what is currently known about the problem, including relevant previous studies
5. Rationale	Informal or formal frameworks, models, concepts, and/or theories used to explain the problem, any reasons or assumptions that were used to develop the intervention(s), and reasons why the intervention(s) was expected to work
6. Specific Aims	Purpose of the project and of this report
Methods	What did you do?
7. Context	Contextual elements considered important at the outset of introducing the intervention(s)
8. Intervention(s)	a. Description of the intervention(s) in sufficient detail that others could reproduce it b. Specifics of the team involved in the work
9. Study of the Intervention(s)	a. Approach chosen for assessing the impact of the intervention(s) b. Approach used to establish whether the observed outcomes were due to the intervention(s)
10. Measures	a. Measures chosen for studying processes and outcomes of the intervention(s), including rationale for choosing them, their operational definitions, and their validity and reliability b. Description of the approach to the ongoing assessment of contextual elements that contributed to the success, failure, efficiency, and cost c. Methods employed for assessing completeness and accuracy of data
11. Analysis	a. Qualitative and quantitative methods used to draw inferences from the data b. Methods for understanding variation within the data, including the effects of time as a variable
12. Ethical Considerations	Ethical aspects of implementing and studying the intervention(s) and how they were addressed, including, but not limited to, formal ethics review and potential conflict(s) of interest
Results	What did you find?
13. Results	a. Initial steps of the intervention(s) and their evolution over time (e.g., time-line diagram, flow chart, or table), including modifications made to the intervention during the project b. Details of the process measures and outcome c. Contextual elements that interacted with the intervention(s) d. Observed associations between outcomes, interventions, and relevant contextual elements e. Unintended consequences such as unexpected benefits, problems, failures, or costs associated with the intervention(s). f. Details about missing data
Discussion	What does it mean?
14. Summary	a. Key findings, including relevance to the rationale and specific aims b. Particular strengths of the project
15. Interpretation	a. Nature of the association between the intervention(s) and the outcomes b. Comparison of results with findings from other publications c. Impact of the project on people and systems d. Reasons for any differences between observed and anticipated outcomes, including the influence of context e. Costs and strategic trade-offs, including opportunity costs
16. Limitations	a. Limits to the generalizability of the work b. Factors that might have limited internal validity such as confounding, bias, or imprecision in the design, methods, measurement, or analysis c. Efforts made to minimize and adjust for limitations
17. Conclusions	a. Usefulness of the work b. Sustainability c. Potential for spread to other contexts d. Implications for practice and for further study in the field e. Suggested next steps
Other Information
18. Funding	Sources of funding that supported this work. Role, if any, of the funding organization in the design, implementation, interpretation, and reporting

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DPI PROJECT MILESTONE 1

DPI PROJECT MILESTONE 5

Assessing how Advanced Practice Providers Minimize Delays in Emergency Departments

	10 Strategic Points	Comments/Feedback
Broad Topic Area	The use of advanced practice providers in triage to improve waiting times in emergency departments.
Literature Review	a) Background of the problem/gap; I. The waiting times in the emergency departments are mostly fueled by the large number of the patients seeking the requisite medical services. The large number of such patients causes overcrowding in the emergency department. The overcrowding is a major problem in the emergency department even in the global arena (Di Somma, Paladino, Vaughan, Lalle, Magrini, & Magnanti, 2015). II. The mismatch between the demand for the emergency services and the available resources has greatly contributed to the overcrowding within the emergency departments (Murphy, Lietz, &Jordan, 2012) III. When advanced practice practitioners are placed in the emergency department, the quality of care as well as reduced overcrowding become the order of the day (Bahena & Andreoni, 2013; Imperato et al., 2012). DPI Project Manuscript 6 DQ1 b) Theoretical foundations; I. Demand and capacity variation model by Eriksson (Bergbrant, and Berrum-Svennung, 2011) II. The co-management model in healthcare (Norful, Jacq, Carlino & Poghosyan, 2018) c) Review of literature topics with the key themes; I. Critical Care Medicine Advanced Practice Provider Model at a Comprehensive Cancer Center: The increasing demand for meeting the critical medical services are prompting for the increment of the number of the advanced practice providers (APPs). The role of APPs, especially in the ICUs, cannot be underestimated (Paton, Stein, Agostino, Pastores, & Halpern, 2013). II. Frequent Overcrowding in the U.S. Emergency Departments: Overcrowding in the emergency departments is a serious problem which affects not only the US but also the other countries across the world. This overcrowding cannot be limited to the county or public hospitals since it has been evident even in both the private and academic hospitals within the urban and rural areas (Derlet, Richards, & Kravitz, 2001). d) Summary; I. Gap/problem: There is a need to reduce the waiting time or delays in the emergency departments. II. Prior studies: The prior studies have proved that the involvement of advanced practice providers not only reduces the delays in the emergency departments but it also leads to provision of a quality care. III. Quantitative application: Instruments and sources of data exist to collect numerical data on the value of advanced practice providers in emergency departments.
Problem Statement	While the literature indicates that the involvement of advanced practice providers helps reduce the delays in the emergency departments, it is yet to be known how they help to reduce these delays.
Clinical/PICO Questions	How effective is the use of Advanced Practice Providers in triage in improving waiting times in Emergency departments?
Sample	Location: District of Columbia. Population: Three county hospitals. Sample: 30 adult patients receiving the care at the emergency department.
Define Variables	Dependent variable: The waiting times. Independent variable: The Advanced Practice Providers.
Methodology and Design	This project will use the quantitative methodology with a descriptive research design
Purpose Statement	The purpose of this quantitative descriptive research study is to assess how the advanced practice providers help reduce the waiting times in the emergency departments. The advanced practice providers will be defined as the assistant physicians as well as the nurse practitioners. The waiting time will be measured by the number of hours or even days that a patient queues in the emergency department prior to getting the requisite medical services.
Data Collection Approach	This study will use questionnaires which will be provided to the participants to fill, but for those without literary skills, oral questions will be posed.
Data Analysis Approach	Descriptive statistics will be used to summarize the sample descriptive data. The data will then be presented in tables and pie charts.

References

Bahena, D., & Andreoni, C. (2013). Provider in triage: Is this a place for nurse practitioners? Advanced Emergency Nursing Journal, 35(4), 332-343. doi 10.1097/TME.0b013e3182aa05ba.

Derlet, R., Richards, J., & Kravitz, R. (2001). Frequent overcrowding in the US emergency departments. Academic Emergency Medicine, 8(2), 151-155. doi: 10.1111/j.1553- 2712.2001.tb01280.x

Di Somma, S., Paladino, L., Vaughan, L., Lalle, I., Magrini, L., & Magnanti, M. (2015). Overcrowding in emergency department: an international issue. Internal and Emergency Medicine, 10(2), 171-175. doi:10.1007/s11739-014-1154-8

Eriksson, H., Bergbrant, I., Berrum-Svennung, I. (2011). Reducing queues: Demand and capacity variations. International Journal of Health Care quality Assurance/MCB University Press, 24(8), 592-600.

Imperato, J., Morris, D. S., Binder, D., Fischer, C., Patrick, J., Sanchez, L. D., & Setnik, G. (2012). Physician in triage improves emergency department patient throughput. Internal and Emergency Medicine, 7(5), 457-462. doi 10.1007/s11739-012-0839-0

Love, R. A., Murphy, J. A., Lietz, T. E., & Jordan, K. S. (2012). The effectiveness of a provider in triage in the emergency department: A quality improvement initiative to improve patient flow. Advanced Emergency Nursing Journal, 34(1), 65-74. doi:10.1097/TME.0b013e3182435543

Norful, A., Jacq, K., Carlino, R., & Poghosyan, L. (2018). Nurse practitioner–physician comanagement: a theoretical model to alleviate primary care strain. The Annals of Family Medicine, 16(3), 250-256. doi:10.1370/afm.2230

Paton, A., Stein, D., D’Agostino, R., Pastores, S., & Halpern, N. (2013). Critical care medicine advanced practice provider model at a comprehensive cancer center: Successes and challenges. American Journal of Critical Care, 22(5), 439-443. doi:10.4037/ajcc2013821

Professor’s comments:

Please note the followings: The introduction and the literature review are complete and thorough. The problem statement is written clearly PICOT is clear and very good Sample: How will you determine the sample size? What are the inclusion/exclusion criteria of the subjects? Methodology: Why is the selected methodology is appropriate? Please justify! Data collection approach is not clear. How will you collect your data? What is needed here is to describe the process of collecting data form signing the informed consent until completing the measuring. Data analysis-What test will you use to answer your research question? Thank you for a work well done. DPI Project Manuscript 6 DQ1