Benchmark for Proposed EBP Project on Implementation Comprehensive Nursing Essay Example
Overcrowding and delays in the Emergency Department (ED) are well-documented systematic challenges that affect clinical environments across hospitals in the US. ED boarding, increasing rates of left without being seen, ambulance diversion, and inadequate access to timely care is linked to ED throughput’s complexity in many hospital settings. According to Morley et al. (2018), these factors adversely affect patient outcomes, patient and staff satisfaction, public health outcomes, and ultimately the healthcare organization’s revenue. Healthcare providers need to devise measures to improve moving patients through the ED within a specified amount of time. One focal point would be the extended wait times within the ED emanating from delayed processing of inpatient admissions that leads to a patient backlog. The ED exercises limited control over patient input compared to other units within the same healthcare facility. Owing to its limited number of beds available in the ED, it implies that throughput issues exacerbate wait time problems, amongst other issues. Healthcare experts also know that ED throughput challenges are not a singular event in this department. Instead, it is symptomatic across the system-wide inefficiencies that occur within the healthcare organization. The current intervention focuses on the medical-surgical unit, while the proposed EBP project targets to reduce delays during admission through the successful implementation of the one bed ahead concept.(Benchmark for Proposed EBP Project on Implementation Comprehensive Nursing Essay Example)
Description of the Population’s Demographics and Health Concerns
The community hospital selected as the proposed PICOT–based EBP project site serves the residents of Los Angeles City. This vast and diverse region boasts more than four million residents. The county is home to some of the richest and poorest communities in the US, in some cases situated side by side where the observable differences are evident in wealth, opportunities, and surroundings that mirror themselves as health inequalities (Los Angeles City, 2018). The city’s population by race/ ethnicity has 50% as Latinos, followed by White at 28.9%, then Asians at 11.9, and blacks at 9.1%. Less than 0.5% of the population trace their ethnic origin as either American Indians, Alaska Native. NativeHawaain or Pacific Islander. Like other counties in the state of California, the leading health concerns in Los Angeles City are heart disease that claims the highest number of lives, closely followed by cancer, stroke, Alzheimer’s disease, chronic lower respiratory diseases, and accidents. Diabetes, Influenza/pneumonia, hypertension, and chronic liver disease complete the list of the top ten leading causes and, therefore, arguably the leading health concerns of this county (CDC, 2017). The study population identified to participate in the study are patients aged eighteen years or more who attended the proposed site of implementing the project (an acute care medical facility) and were admitted to the facility’s medical-surgical unit.(Benchmark for Proposed EBP Project on Implementation Comprehensive Nursing Essay Example)
Description of the Proposed Evidence-Based Intervention
The proposed intervention is EBP- guided change process that seeks to alter the method of assigning beds from the current approach to a bed-ahead concept to streamline the flow of inpatients within the medical-surgical unit. The intervention will utilize the Lean principles, where the primary investigator anticipates that using the bed-ahead concept in bed assignment eliminates some steps of the current process. The bed–ahead concept entails having the charge nurse in the medical-surgical unit review the beds available and staff workload within the unit at the start of every shift. This review ensures there is a minimum of two beds and a nurse combination. Raine et al. (2016) (Benchmark for Proposed EBP Project on Implementation Comprehensive Nursing Essay Example)contend that appropriate healthcare equity evaluation must measure horizontal and vertical equity components to determine whether patients get health care cutting across all levels of need. Therefore, the proposed intervention has examined the interaction between social factors of concern and need and stratified each level of need so that both horizontal and vertical equity. Most people consider ED throughput problems as stemming from this unit alone, while in fact, it is a culmination of hospital-wide inefficiencies. Subsequently, the intervention has focused on the implementation of a bed ahead concept in the medical-surgical unit.(Benchmark for Proposed EBP Project on Implementation Comprehensive Nursing Essay Example)
Comparison of Bed Ahead Concept Implementation to Previous Practice or Research and Is and Time for Implementing
Hospital capacity planning ranks among the top issues in both developed and developing nations because of resource constraints, increasing demand for patient care, and the attendant rising costs of inpatient care. Ravaghi et al. (2020) posit that bed capacity and related indices like bed occupancy and the ratio of bed to population are vital metrics in determining the availability of inpatient care. Policymakers at the hospital level acknowledge that the number of beds needed to provide quality healthcare depends on many factors ranging from models of care, patient needs, policies at the national level, and contextual circumstances. Given these factors, the proposed intervention appreciates these factors’ role in successfully implementing the bed ahead concept in the medical-surgical unit. Nevertheless, some studies have found that optimizing intensive care unit use reinforces physicians’ essential quality improvement efforts in the critical care units (Mathews & Long, 2015).(Benchmark for Proposed EBP Project on Implementation Comprehensive Nursing Essay Example)
Similarly, optimizing bed use within the medical-surgical unit would avail an evidence-based structure for data-based modeling of patient flow in the selected unit. The proposed intervention would also echo the findings of previous researchers who proposed a new simulation framework that bridges the gap between the actual patient discharge process and its mathematical modeling. A distinction is that instead of being in the critical care setting, it would be in the medical-surgical unit (Azcarate et al., 2020).(Benchmark for Proposed EBP Project on Implementation Comprehensive Nursing Essay Example)
Expected Outcome for Intervention
An anticipated of the proposed intervention is that its implementation would result in fewer time delays for admission and decreased length of stay in the unit. Specifically, the expected outcome is that each of the two components would decrease by a minimum of 15%. Evaluation of the outcome measures in the proposed project happens after four months of the project implementation. An EHR software known as EDIS for EDs is a product of physicians and nurses in clinical settings to measure the actual outcomes. The Emergency Department Information System (EDIS) will be used to measure these outcome measures because it helps in supporting workflow efficiency and patient safety. EDIS eliminates drop-down menus, unnecessary screens, confusing dialogue boxes, and unnecessary keystrokes.(Benchmark for Proposed EBP Project on Implementation Comprehensive Nursing Essay Example)
The same outcome measures will be compared to those of four months before the project implementation.
Time Estimated for Implementing Intervention and Evaluating Outcome
The project is scheduled to take a total of weeks. Many activities are to take place across the twelve, beginning with a meeting with the preceptor. Other activities to take place but not in chronological order are securing project approval with preceptor and advisor, identifying key stakeholders and having meetings with them, getting managers’ buy-ins, and completing the project’s SWOT analysis. The primary investigator will also create a data collection tool, conduct a risk assessment, prepare the budget, educate staff on the new process and monitor admission delay times. There will also be PowerPoint presentations to the facility, prepare findings for dissemination and submit findings for publication dissemination.(Benchmark for Proposed EBP Project on Implementation Comprehensive Nursing Essay Example)
How Nursing Science, Social Determinants of Health, And Epidemiologic, Gnomic, and Genetic Data Are Applied
Contemporary healthcare emphasizes the role of nursing science through the progress in genetics and genomics shed light on novel approaches to health, illness, disease risk, and treatment (Casey et al., 2016). Collected data on social determinants of health and epidemiologic statistics are utilized in treating adult patients admitted to the medical-surgical unit. Applying these data is guided by the fact that most disease risk, health conditions, and therapies initiated to treat and manage these conditions have a genetic or genomic component. Furthermore, lifestyle, environmental, and other factors impacting the entire nursing profession impact genetic and genomic elements.(Benchmark for Proposed EBP Project on Implementation Comprehensive Nursing Essay Example)
Conclusion
In conclusion, the purpose of the proposed EBP project is to streamline assigning of beds within the medical-surgical unit. The investigator anticipates that the successful implementation of this project would increase not only decrease the time it takes to admit a patient in this unit but also increase efficiencies, reduce nurse workload, and significantly improve both patient and healthcare staff satisfaction. Successful implementation will be evidenced by improved patient outcomes in the medical-surgical unit due to reduced delays in the process of admission.(Benchmark for Proposed EBP Project on Implementation Comprehensive Nursing Essay Example)
References
Azcarate, C., Esparza, L., & Mallor, F. (2020). The problem of the last bed: Contextualization and a new simulation framework for analyzing physician decisions. Omega, 96, 102120.(Benchmark for Proposed EBP Project on Implementation Comprehensive Nursing Essay Example)
Casey, J. A., Schwartz, B. S., Stewart, W. F., & Adler, N. E. (2016). Using electronic health records for population health research: a review of methods and applications. Annual review of public health, 37, 61-81.(Benchmark for Proposed EBP Project on Implementation Comprehensive Nursing Essay Example)
Centers for Disease Control and Prevention(2017) Stats of the State of California URL: https://www.cdc.gov/nchs/pressroom/states/california/california.htm Accessed Nov 7, 2021.
Los Angeles City (2018) City and Community Health Profiles (Benchmark for Proposed EBP Project on Implementation Comprehensive Nursing Essay Example)URL: http://publichealth.lacounty.gov/ohae/docs/cchp/pdf/2018/CityofLosAngeles.pdf Accessed Nov 8, 2021.
Mathews, K. S., & Long, E. F. (2015). A conceptual framework for improving critical care patient flow and bed use. Annals of the American Thoracic Society, 12(6), 886-894.(Benchmark for Proposed EBP Project on Implementation Comprehensive Nursing Essay Example)
Morley, C., Unwin, M., Peterson, G. M., Stankovich, J., & Kinsman, L. (2018). Emergency department crowding: a systematic review of causes, consequences, and solutions. PloS one, 13(8), e0203316.(Benchmark for Proposed EBP Project on Implementation Comprehensive Nursing Essay Example)
Raine, R., Or, Z., Prady, S., & Bevan, G. (2016). Evaluating healthcare equity. In Challenges, solutions and future directions in evaluating service innovations in health care and public health. NIHR Journals Library.(Benchmark for Proposed EBP Project on Implementation Comprehensive Nursing Essay Example)
Ravaghi, H., Alidoost, S., Mannion, R., & Bélorgeot, V. D. (2020). Models and methods for determining the optimal number of beds in hospitals and regions: a systematic scoping review. BMC health services research, 20(1), 1-13.(Benchmark for Proposed EBP Project on Implementation Comprehensive Nursing Essay Example)
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