26-year-old woman developed gradual onset of shortness of breath over the past three days. She had no cough, fever, wheezing, or other symptoms. Because the sensation of shortness of breath increased in intensity, she went to her local hospital’s emergency department (ED). At the ED, she waited in the busy reception area until her name was called to registration. After providing her general and insurance information, she was told to wait. Twenty minutes later, a triage nurse obtained a brief history and took vital signs. She returned to the waiting room, where she waited for two and a half hours. During this time, she witnessed a steady flow of patients with various degrees of injury and distress pass through the emergency area; most appeared much sicker than she was. She was eventually led to a stretcher, where another nurse took a detailed history. A physician entered the room, took a more detailed history, performed a physical examination, and ordered blood tests, a chest X-ray, lung scan, and electrocardiogram. Over the next three hours the tests were evaluated, after which time the physician told her that he thought that she might have asthma, but no serious disease. She was instructed to follow up with her primary physician and was given a prescription for an inhaled bronchodilator.
The afternoon previous to the patient’s visit, a hospital administrator, the physician director of the emergency department, and the director of hospital performance improvement met to review several disturbing trends. Patient satisfaction with the emergency department was falling, the proportion of “elopements” (patients leaving the emergency department without being fully evaluated) was increasing, and there had been at least one instance of a patient falling in the crowded waiting room. The administrator wanted the physician director to organize the department more efficiently to address the fundamental problem of excess wait time; the physician director believed that the wait time was to be expected given the severity of illness of the patient population, and the existing resources. The performance improvement director suggested that the wait times first be measured and benchmarked before embarking on a performance improvement plan that focused on wait time.
Using the techniques described, with enthusiastic and substantive support from hospital administration and the medical staff, the emergency department embarked on a nine-month effort to measure, analyze, and improve the quality of care. They chose to focus on wait times; patient satisfaction with services delivered; timeliness of initiation of care for patients with time-sensitive diagnoses for cases such as stroke and chest pain; and return visits to the departments for the same complaint within 72 hours. Using tools from performance improvement organizations and ideas from staff within the hospital, they developed new policies and procedures, re-organized the functions of staff, hired additional staff, and instituted performance-based incentives. Some of the changes they initiated included:
_ Hiring a “greeter” to establish contact with every patient from the time they entered the ED
_ Moving triage out into the waiting area to better and more quickly identify seriously ill patients
_ Completing registration in the examination areas, with the aid of wireless computers, to begin diagnosis and treatment more quickly
_ Posting an electronic sign that reads, “Patients registering now may have an average wait time of . . . . ”
In addition, the greeter, registration, nursing, and other staff were trained in the recognition of and appropriate action for time-sensitive conditions. Each person was then empowered to initiate an appropriate care process (e.g., the greeter knew to escort any patient complaining of chest pain to a wheelchair and then immediately to the triage nurse, bypassing registration). Other improvements were made to decrease wait times and improve the quality of care.
Nash, David B. The Quality Solution: The Stakeholder's Guide to Improving Health Care. Jones & Bartlett Learning, 06/1905. VitalBook file.
Prepare an analysis of all the hospital's initiatives and apply at least three quality and/or risk management concepts, measures, and tools in your paper.
Your paper must be three to five double-spaced pages (excluding the title and reference pages). In addition to the text, utilize a minimum of two scholarly and/or peer-reviewed sources that were published within the last five years. Your paper and all sources must be formatted according to APA style
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