The fundamental objective of this policy change proposal is to improve the delivery of care and service in the emergency department. The improvement process focuses on vital operational, service, and clinical improvement strategies that will improve the following provisions:
To reduce the average time a patient takes before admission
To reduce the hospital’s transfer time in the organization by 30 minutes
To reduce the time during which a patient with broken bones is attended to by approximately 10 minutes
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The three-metrics identified are below the benchmark standards set by both the government. Improving the metrics will fundamentally assist in the improvement of patient flow (Baker & Esbenshade, 2015), which is fundamental to the reduction of crowding in the emergency department.
In spite of the need to ensure efficiency based on the identified metrics, much effort has been devoted over the years to investigate the sources of crowding in the emergency department, which is an indication that mitigation efforts needed to identify the sources have been considered. Based on the considered efforts, the management in Oklahoma Hospital has agreed to the idea that improving patient flow is one of the provisions that would address the issue of crowding. In this regard, the implementation of the proposed policy follows the call by hospital and healthcare leaders to adopt improvements in patient flow, which is essential for taking care of the different benchmark metrics identified.
Strategy considered for implementation
The formation of a patient flow team
The strategy considers the inclusion of a multidisciplinary team that will be responsible for planning and implementing quality improvement interventions. This team will also take care of the staffing needs of the healthcare institution (Hess, 2005). A beneficial aspect of including a multidisciplinary team emanates from the provision that they will introduce a variety of perspectives and knowledge regarding the issues, the causes of the issues, and the potential solutions needed for improving the delivery of services in the emergency services department.
According to McHugh et al. (2011), the members of the multidisciplinary team will be in a suitable position to encourage buy-in for some of the solutions that their peers might be having. In this light, the identification of the most appropriate members to be included in the team needed for the implementation of suitable strategies to overcome the ER deficiencies will be central to ensuring the success of the effort to improve the delivery of services in the ER.
It would be proper to propose that the multidisciplinary team should be based on experience. In this regard, it would be essential to recommend that, at a minimum, the team should be inclusive of a team leader who is responsible for the day-to-day activities, a chief quality officer, personnel that can offer technical expertise needed for the implementation of the change strategy, and the physicians and nurses that have experience in the emergency department. Other members will include the emergency department support staff, data analysts, as well as the representatives that are responsible for overseeing the inpatient units.
The collection of data for implementation
Measurement of the considered strategy calls for the need for data collection. As included in the proposal, there are three fundamental stages needed to collect the data to be used for the provision of feedback to the stakeholders. The first stage involves the element of data generation, which is inclusive of the element of introducing the processes and opportunities needed in the management information systems. The rationale for this step is to provide essential information for tracking the progress of the improvements, which informs the second step that involves the harvesting of the collected data from the system (McHugh et al., 2011). The harvested data will inform the creation of workflows needed to be choreographed between different busy departments. Finally, key decisions will be made depending on the data reporting, in this regard, the strategic planning decisions will be dependent on the need to align some of the departmental, administrative, and the objectives of the different units in the facility.
Proposed changes, repercussions, and the recommended ethical, evidence-based strategies for resolving the attached performance issues
To take care of the challenges identified, the healthcare institution can consider setting up different operational units that would improve the considered benchmark metrics. This strategy will be essential for redesigning work systems around the needs of the patients. Conversely, it would be possible to assign different specialists in the benchmark metrics identified, which is essential for achieving timely access to the different opinions of specialists. For this reason, it would be possible to alleviate crowding, leading to the reduction of the time patients take to be admitted (IOM, BHCS, CFECUSHS, 2007). In this case, the units would assist in taking care for patients that the physicians would otherwise admit for inpatient stays two times as long (McHugh et al., 2011). The provision would assist in freeing up other patients that would otherwise be boarded in the emergency department, consequently leading to the reduction of the diversion time.
The Oklahoma Hospital should also implement a people centered system that will be responsive to the needs of individuals. For this reason, it would be essential to develop a consumer participation plan as part of the healthcare institution’s plan. This provision calls for the implementation of a report that monitors the progress of healthcare delivery, geared towards meeting the targets and the outcomes outlined in the participation plan. In this regard, the participation plan will work towards fulfilling the ethical provisions revolving around the idea of patient consent. However, it would be vital to consider the environmental challenges posed by the ongoing construction. The construction creates a lot of traffic, which means that the efficiency of ambulatory services will be affected. However, by improving the efficiency of service delivery within the hospital, it will be possible to take care of the incoming patients at a faster rate.
Colleagues, individual stakeholders, and stakeholder groups
Considering the need to sensitize the community about home-based care, it would be vital to involve several stakeholders that are inclusive of the Government, the health workforce and the management of the hospital. To take care of the increasing shortage of medical practitioners, the government should execute its responsibility involving the increase in the placements for undergraduate medical students. This provision will provide an additional pool of nurses and physicians that will improve the capability of the healthcare workforce (Hess, 2005). The increased workforce will enable the hospital management to align its processes with the needs of the different patients being admitted in the emergency department. This recommendation is realistic given that the Oklahoma Hospital is short of specialists that would take care of the needs of the patients as they come in.
References
Baker, S., & Esbenshade, A. (2015). Partnering Effectively with Inpatient Leaders for Improved Emergency Department Throughput. Advanced Emergency Nursing Journal , 37 (1), 65-71.
Hess, P. (2005). A Pragmatic Approach to Improving Patient Efficiency Throughput . Ihi.org . Retrieved 15 July 2017, from http://www.ihi.org/resources/Pages/ImprovementStories/APragmaticApproachtoImprovingPatientEfficiencyThroughput.aspx
Hyman, D. A., United States., & United States. (2005). Improving healthcare: A dose of competition: a report by the Federal Trade Commission and the Department of Justice (July, 2004), with various supplementary materials . Dordrecht: Springer.
Institute of Medicine, Board on Health Care Services, & Committee on the Future of Emergency Care in the United States Health System. (2007). Hospital-based emergency care . Washington, D.C.: National Academies Press.
McHugh, M., Van Dyke, K., McClelland, M., & Moss, D. (2011). Improving Patient Flow and Reducing Emergency Department Crowding: A Guide for Hospitals . Rockville, MD: Agency for Healthcare Research and Quality.
