Promoting Health Care Quality – Evaluation Plan

Promoting Health Care Quality – Evaluation Plan Promoting Health Care Quality – Evaluation Plan This week you have been examining evaluation tools and how they can be used as part of a plan to promote quality and safety. As you develop an evaluation plan for your Course Project, consider the insights you have gained through your analysis of your selected organization, as well as the highly regulated and competitive health care environment. To prepare: Review the information on evaluation, including data representation and quality monitoring, presented in the Learning Resources. Review your work on the Course Project thus far, particularly Sections 3 and 4. Think about how your quality improvement initiative could be evaluated. Consider the following: Which stakeholders need information related to this initiative? What do they need this information for? How would you assess the outcomes in the short-term and long-term? How would you analyze related processes, including but not limited to the one you redesigned in Section 4? How should an analysis of organizational structures be integrated into your evaluation? How would you identify and evaluate any unintended consequences that may arise? What metrics should the organization use to gauge progress and the effectiveness of the quality improvement initiative? How would these metrics incorporate the measures and indicators that you identified in Section 3? Are there additional measures and indicators that you now think should be included? How should the organization track and display data for an interdisciplinary audience? How could the use of a dashboard or balanced scorecard be of value? How could the organization create an integrated view of performance that links finance and quality? Promoting Health Care Quality – Evaluation Plan To complete: Develop a 2- to 3-page evaluation plan that includes the following: An outline of the methods that you would propose for evaluating the quality improvement initiative and the financial implications A description of specific metrics that integrate your previously identified measures and indicators and any others that you have deemed important A recommendation of how the organization could represent data related to this quality improvement issue for ongoing monitoring and to determine the value or success of the initiative An explanation of how the organization could create an integrated view of performance that links finance and quality wk8proj1ellenberghr.docx wk8proj2ellenberghr.docx ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS Quality Measurement and Assessment Walden University NURS 6231-4: Healthcare Systems and Quality Outcomes Helen Renee Ellenberg July 22, 2018 Introduction Quality improvement (QI) comprises of regular and continuous activities that lead to measurable improvement in health care services and the health status of focused patient groups. Effective measurement of care quality in the healthcare organization involves careful observation and documentation of procedures and processes (Sadeghi et al., 2013). The quality of care and improvement of patient care has become an essential standard goal for healthcare organizations. For a healthcare organization to successfully promote a quality improvement project, it must be accurately detailed and must be a measurable goal. The quality improvement projects selected by healthcare organizations are intended to improve patient care in various units. One important quality measure that is being measured at Colquitt Regional Medical Center is the time it takes for a patient to be transferred from the emergency room to the unit of admission. The healthcare organization should be able to present objective data to validate goal achievements. The goal of quality healthcare service should be to practice with more benefits than harm (Sadeghi et al.,2013). The purpose of this portfolio assignment is to examine the measurable goals of this quality improvement issue and to reduce the transfer time for patients being admitted in efforts to reduce patient mortality and length of stay. Quality Improvement Issue Overview The Agency for Healthcare Research and Quality (AHRQ) reports multiple adverse effects which emerge from the emergency department being overcrowded (2011). Research has proven that extended wait times result in an increased mortality rate. When effective and timely treatment is not provided the patient is at greater risk of a negative outcome (Erkuran et al., 2014). Colquitt Regional Medical Center has established strategic goals for the staff regarding patient flow which largely effects the emergency room as well as the patient care units since overcrowding compromises patient care quality. Changing policies and procedures for hospital bed management are worth exploring to improve emergency room patient flow. Overcrowding in the emergency department can be costly for the patient and the healthcare organization. According to the Centers for Medicare and Medicaid (CMS), (2018), hospitals may soon be required to report emergency department crowding measures. The healthcare organizations mission and values are the foundation of quality. Colquitt Regional Medical Center defines quality within its mission and vision statements and are “committed to providing exceptional healthcare that exceeds expectations and will be recognized as a superior provider of quality healthcare” (Colquitt Regional Medical Center, n.d.). Our mission and vision statements were composed with our patients, staff and community in mind. The organization each year creates clear strategic goals and objectives which are unit based with incentive bonuses paid out to employees for achieving the goals. Promoting Health Care Quality – Evaluation Plan The goals created must be realistic with criteria being pushed to optimal levels rather than minimally acceptable levels (Marquis & Huston, 2015). Managers must be skilled in determining and detailing the organizational goals and objectives established for their unit and employees while maintaining a constructive and effective environment. Managers and leaders are responsible for creating a positive working environment that allows the staff to prosper which results in improvements in patient experience (Wadsworth, Felton & Linus, 2016). Quality Improvement Measures and Indicators Benchmarking is the method of measuring products, practices, and services against the best performing healthcare organizations (Marquis & Huston, 2015). There are several items that are being measured when a patient presents to the emergency department. These include: door to decision to admit, decision to admit to admission order, admission order to transfer, door to floor, door to discharge. This data is obtained through our charting system and documented into a spread sheet which is shared weekly with administration, unit directors, emergency room staff, quality / risk management. This measurement of care is also displayed on our sign out by the main road detailing the length of time to see a provider in our emergency room. This is something commonly seen these days with emergency rooms in attempts to gain customers. Measurement is the crucial part of the testing and shows the team if the implemented changes are leading to improvement (Institute for Healthcare Improvement (n.d.). The average time for the patient receiving treatment in the emergency department to the arrival of the admission unit is defined as the process measure and hospitalized patient mortality and extended length of service are defined as outcome measures (Sadeghi et al., 2013). The emergency room director discovered in the beginning of this project that >50% of the patient delays to the admission unit seemed to occur even when the unit had clean beds available. After further review it was found that the patient care units were deliberately giving a room assignment in which the room was dirty and was waiting to be cleaned. It was noted in some areas that the charge nurses were doing this to intentionally hold up the patient transfer process. Process maps were developed in order to assess the current practice, determine problem areas, and create solutions (Sadeghi et al., 2013). Current Data and Methods This quality improvement project has been ongoing for approximately 6-8 months now and the staff has been educated on the importance of patient flow and the new processes being developed. All unit directors are involved in this project and are all working together to make patient flow better at Colquitt Regional. There are two target goals that the organization must meet with the emergency room throughput and patient flow. One is the “door to decision to admit” and the target goal is 105 minutes. The second target goal is the “door to floor” and that target goal is 210 minutes. It is important to keep the goal and targets in sight since that is the only way for it to be achieved (Sadeghi et al., 2013). As stated before, the data is obtained through our charting system and documented into a spread sheet that is then shared with all unit directors and administration. A process improvement method has been developed in order to reduce admit wait times and alleviate overcrowding in the emergency department. Computerized tracking systems are in place which allow more specific information related to the patients. Promoting Health Care Quality – Evaluation Plan This same computerized tracking system is being used by the clinical directors to observe inpatient status and emergency department bed status. Measurable processes and goals were again established and shared with the directors. Conclusion Recent studies have shown an increase in mortality rate with lengthy emergency room wait times. Colquitt Regional Medical Center began a quality improvement project to analyze their wait times and the patient flow through the emergency department. This is an ongoing project and several new processes have been developed and continue to be developed. The process improvement plan has been established by this organization in order to reduce admission wait times for our patients. The staff is continually educated on the emergency room patient flow process and the importance for quality care for our patients. For this process to be effective the staff has to be involved and eager to assist in the improvement. Policies are being changed regarding bed management and new ideas are being explored in efforts to improve emergency room patient flow. Consistent, effective, and safe patient care is the intention of every healthcare organization, the desire of every nurse, and the right of each patient (Markey & Tingle, 2012). References: Colquitt Regional Medical Center n.d. Retrieved from https://colquittregional.com/ Erkuran, M. K., Duran, A., Ocak, T., Citisli, V., & Kaya, H. (2014). The impact of the duration of admission to the emergency room on the mortality of intensive care patients. Nigerian Journal Of Clinical Practice, 17(3), 320-323. doi:10.4103/1119-3077.130233 Institute for Healthcare Improvement (n.d.). Retrieved from http://www.ihi.org/resources/Pages/Measures/default.aspx Markey, L., & Tingle, C. (2012). Screening RNs: A change in hiring practice. Nursing Management, 43(2), 13-15. Marquis, B., & Huston, C. (2015). Leadership roles and management functions in nursing: theory and application. Philadelphia, PA: Lippincott, Williams & Wilkins. McHugh, M., Van Dyke, K., McClelland M., Moss D.(2011). Improving Patient Flow and Reducing Emergency Department Crowding: A Guide for Hospitals. (Prepared by the Health Research & Educational Trust, an affiliate of the American Hospital Association, under contract 290-200-600022, Task Order No. 6). AHRQ Publication No. 11(12)-0094. Rockville, MD: Agency for Healthcare Research and Quality; October 2011. Quality Measures. (2018, June 04). Retrieved July 14, 2018, from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-AssessmentInstruments/QualityMeasures/index.html Sadeghi, S., Barzi, A., Mikhail, O., & Shabot, M. (2013). Integrating quality and strategy in health care organizations. Burlington, MA: Jones & Bartlett Learning. Wadsworth, B., Felton, F., & Linus, R. (2016). SOARing Into Strategic Planning: Engaging Nurses to Achieve Significant Outcomes. Nursing Administration Quarterly, 40(4), 299306. doi:10.1097/NAQ.0000000000000182 Quality Improvement Strategies Walden University NURS 6231-4: Healthcare Systems and Quality Outcomes Helen Renee Ellenberg July 22, 2018 Introduction Many healthcare organizations work consistently to develop strategies for quality improvement projects which will provide patient safety along with positive patient outcomes. Some of the major goals or targets with quality improvement projects are the improvements in the patient’s health, improvements in population health and reduction in healthcare associated costs (Weston & Roberts, 2013). Promoting Health Care Quality – Evaluation Plan The improvement of quality involves making healthcare more centered around the patient with safe and effective practice. Quality improvement projects generally include interventions from the clinical setting as well as the educational side of the healthcare organization. The purpose of this assignment is to identify and describe quality improvement strategies related to emergency room patient flow. Quality Improvement Strategies One important quality measure that is being measured at Colquitt Regional Medical Center is the time it takes for a patient to be transferred from the emergency room to the unit of admission. The Agency for Healthcare Research and Quality (AHRQ) reports multiple adverse effects which emerge from the emergency department being overcrowded (2011). Research has proven that extended wait times result in an increased mortality rate. When effective and timely treatment is not provided the patient is at greater risk of a negative outcome (Erkuran et al., 2014). Operational strategies are one initiative outlined to improve patient flow through the hospital beginning with the emergency department to admission and to discharge (Moskop et al., 2009). Healthcare organizations are creating multidisciplinary teams which address the emergency department and inpatient crowding issue. These teams assist with the data collection process and work together to implement strategies to evaluate and alleviate the problem (Moskop et al., 2009). The multidisciplinary teams can provide education to the staff to ensure better understanding of the problem. Another operational strategy that my healthcare facility is considering is a bed management coordinator. This employee would facilitate patient flow by directing inpatient admissions to the appropriate unit and providing bed assignments. My facility has created a bed ahead policy to improve the quality of communication when receiving an admission from the emergency department. Bedside report is given to the staff nurse on the inpatient unit from the emergency department nurse. The emergency room nurse also provides a report sheet to the receiving nurse with details the patient’s visit through the emergency room including lab results, diagnostic imaging results, medications administered, IV sites, admitting physician, etc. This is a new policy that began a few weeks ago so the kinks are currently being worked out but so far it has proven decreased times for the patient in the emergency room. The American Nursing Association states that “identifying strategies and technologies to enhance communication among the healthcare clinicians and consumers in order to minimize risks, especially in the transition of care as a standard of practice for nursing informatics” (ANA, 2015, p.86).Promoting Health Care Quality – Evaluation Plan Colquitt Regional Medical Center has also recently written a capacity management policy for instances when the emergency department is holding inpatients due to the facility being at capacity. These types of strategies increase hospital-wide awareness of the overcrowded conditions and motivates the physicians to assist in making beds available (Moskop et al., 2009). Summary Colquitt Regional Medical Center has seen many improvements in the bed ahead policy and our main goal as a healthcare facility is “excellent care by excellent people”. (Colquitt Regional Medical Center, n.d.). Implementation of quality improvement strategies and new policies and procedures improves the quality of care, patient satisfaction and overall a more positive working environment. Consistent, effective, and safe patient care is the intention of every healthcare organization, the desire of every nurse, and the right of each patient (Markey & Tingle, 2012). Patient Arrives at Emergency Department Patient is quickly placed in room and triaged appropriately Left Without Being Seen Placed in appropriate area, either fast track or acute side Fast Track Acute Side Treatment Treatment Discharge Discharge Home Home Admit into Hospital hi Receive Orders and Bed Assignment and Prepare PT for Bed Ahead Policy Process Map Unit pre-shift huddle / RNCharge makes staff assignments / order of admission beds Nursing Supervisor looks at staffing for the shift / determines available beds Order of admission assignments given to staff nurses Charge-RN notifies nursing supervisor the order of admission beds Admission Supervisor notifies RNCharge on Unit of pending admission ER RN-Charge notifies nursing supervisor of admission / room assignment given ER nurse gives short phone report to receiving nurse Patient is transferred / Bedside report done Continual Flow References: American Nurses Association. (2015). Nursing informatics: Scope & standards of practice (2nd ed.). Silver Springs, MD: Author. McGonigle, D. & Mastrian, K. (2015). Systems development life cycle: NI and organizational decision making. In D. McGonigle & K. Mastrian (Eds.), Nursing informatics and the foundation of knowledge (2nd edition). Burlington, MA: Jones and Bartlett Learning. Colquitt Regional Medical Center n.d. Retrieved from https://colquittregional.com/ Erkuran, M. K., Duran, A., Ocak, T., Citisli, V., & Kaya, H. (2014). The impact of the duration of admission to the emergency room on the mortality of intensive care patients. Nigerian Journal Of Clinical Practice, 17(3), 320-323. doi:10.4103/1119-3077.130233 Markey, L., & Tingle, C. (2012). Screening RNs: A change in hiring practice. Nursing Management, 43(2), 13-15. McHugh, M., Van Dyke, K., McClelland M., Moss D.(2011). Improving Patient Flow and Reducing Emergency Department Crowding: A Guide for Hospitals. (Prepared by the Health Research & Educational Trust, an affiliate of the American Hospital Association, under contract 290-200-600022, Task Order No. 6). AHRQ Publication No. 11(12)-0094. Rockville, MD: Agency for Healthcare Research and Quality; October 2011. Moskop, J., Sklar, D., Geiderman, J., Schears, R., & Bookman, K. (2009). Emergency department crowding, part 2 — barriers to reform and strategies to overcome them. Annals Of Emergency Medicine, 53(5), 612-617. doi:10.1016/j.annemergmed.2008.09.024 Weston, M., & Roberts, D. W. (2013). The Influence of Quality Improvement Efforts on Patient Outcomes and Nursing Work: A Perspective from Chief Nursing Officers at Three Large Health Systems. Online Journal Of Issues In Nursing, 18(3), 2. … Purchase answer to see full attachment Student has agreed that all tutoring, explanations, and answers provided by the tutor will be used to help in the learning process and in accordance with Studypool’s honor code & terms of service . 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