Quality Improvement Assignment
For this assignment select a practice improvement issue within your organizational system and within the realm of your practice area. Using the grading rubric as a guide, develop a quality improvement plan to address the identified issue.
The purpose of this paper is to demonstrate knowledge of the essential elements of quality improvement, with change theory as an underpinning for the process.
Do not use a quality intervention plan that has already been implemented for this assignment; this should be a new plan for the organization with a clear measurable problem statement and a planned evidence-based intervention.
Students are not expected to implement the plan; however, the process for implementation and evaluation is addressed as part of the planning process.
The paper should be carefully written in a formal style, based on primary sources, provide an integration of ideas, and be 6 to 7 pages in length, excluding title page, appendices & reference list. Organized flow, logical progression of ideas, and clarity in thought are essential.
Please use headings consistent with the topic areas of the rubric to separate content. References must be timely; published within the previous five (5) years. Liberal number of primary and peer reviewed references (minimum of 10). This paper will be automatically submitted to Turnitin when you submit your assignment. You will be allowed to view the Turnitin report and resubmit the paper until the due date. Any papers submitted OR resubmitted after the due date will have a late penalty applied consistent with the syllabus unless prior arrangements were approved by the primary faculty.
Reduction of Patient Wait Time in the ED
Longer wait times in the emergency department will be associated with increased morbidity and mortality among patients and a decreased level of patient satisfaction (Shen & Lee, 2018). Efficiency and timeliness are, therefore, some of the main domains of healthcare quality that are highlighted by the Institute of Medicine (McIntyre & Chow, 2020). In contemporary times, an aging population, increased attendance into the emergency department, greater disease complexity coupled with physical infrastructure laws, and manpower limitations have therefore made it quite challenging to reduce wait times in the emergency department (Shen & Lee, 2018). The objective of this paper is to present a series of quality improvement interventions that could be adopted to decrease the wait time of patients in the emergency department.
Background and Context
In a large healthcare facility with more than 1000 inpatient beds, the emergency department is, therefore, able to attend to more than 135,000 patients annually. In a healthcare facility, most patients will therefore arrive at the emergency room and will undergo triage and be classified into various patient acuity categories as provided by the Agency for Healthcare Research and Quality (AHRQ). This includes assigning a score on a scale of 1 to 4 to patients. One represents stable patients while two represents moderate-risk patients, 3 represents complex patients, and 4 represents high-risk patients (Nyce et al., 2021). Patients with a rating of 4 will therefore require immediate management or resuscitation. On the other hand, patients in level 3 might have severe symptoms or acute medical conditions that may require very early medical attention. On the other hand, patients in categories one and two will have a minor emergency or non-emergency conditions. Depending on the condition of the patient and they are signed priority score, the patient might therefore be assigned to different treatment areas in a healthcare facility with various departments dealing with consultation. In a healthcare facility, the emergency department, therefore, normally attends to level three patients who might have severe symptoms or acute medical conditions that may require early medical attention (Paling et al., 2020). The patient wait time of patients in the emergency room is therefore taken as one of the key performance indicators in a healthcare facility. To evaluate the patient waiting time in the emergency room, the timing, therefore, begins when the patient registers upon arrival in the emergency room and ends when the consultation begins (Woodworth & Holmes, 2019). In a large healthcare facility, the target for patient wait times in the emergency room is normally 70 minutes, with a threshold waiting time of 120 minutes. The targets related to patient wait times in a healthcare facility are therefore determined by obtaining a moving average of the patient wait times in a given healthcare facility over a predetermined period. In the US, achieving or low patient wait times in the emergency department have therefore become more difficult in contemporary times due to the aging population that has greater disease complexity, increased attendance to the emergency room, and physical infrastructural and manpower limitations, among others (Vainieri et al., 2020).
Because prolonged wait times in the emergency room will be associated with poor outcomes among patients, such as high mortality and morbidity, the quality improvement project would aim to reduce the wait time for ER patients to less than 70 minutes in six months.
Theoretical Underpinnings of Change
One of the most applicable theoretical underpinnings of change that can be utilized in the quality improvement initiative that involves reducing wait times in the emergency room is Kurt Lewin’s change management model. According to Lewin, Following three defined stages of unfreezing, changing, and refreezing can help organizations effectively deal with any form of change. According to Lewin, the process of change will entail creating a perception that given change will be required in an organization and then moving forward towards new desired behaviors and finally solidifying the introduced behavior as the norm (Burnes & Bargal, 2017). Unfreezing is, therefore, the first step of change management. Before change can be implemented, it must therefore go through the initial step of unfreezing. This is because people, including healthcare practitioners, will naturally resist change. The unfreezing stage, therefore, includes providing awareness to organizational members related to impending changes. In the unfreezing stage, the various processes, ways of thinking, and organizational structures must therefore be carefully examined so as to clearly highlight the necessity of change in a given health care facility. Communication is therefore central to the unfreezing stage of change management. Adequate communication can therefore help organizational members, including healthcare practitioners, to be more enthusiastic to implement certain changes and to understand that adopting such change will be urgent in an organization (Burnes & Bargal, 2017).
In the quality improvement project involving reducing wait times in the emergency room, the unfreezing stage would therefore involve educating health caregivers in the ER on the negative effect of long patient wait times, including increased morbidity and mortality (Burnes & Bargal, 2017). Educating the health caregivers in the emergency room on the negative effect of longer wait times would therefore help to create engagement and to ensure that the health caregivers are committed to adopting the quality improvement project of reducing wait times in the ER.