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Draft Proposal Development 1 Part 2 of Chapter 1

Significance of the Project

Globally, emergency departments(ED) have embraced and ensured the implementation of triage a term derived from the French verb trier, which means to sort. In extensive healthcare facilities, triage in the ED helps to sort and prioritize patients’ care according to their acuity levels. Suffice it to say that long wait times within the ED lead to triage backup can lead to ambulance diversion, which in turn strains the community health care system. The Direct Practice Improvement Project endeavors to introduce a social change in practice through a clinical interprofessional team in triage (CITiT). The project is bound to improve the trust communities have in the ED when disasters as well as public health emergencies. The DPI contributes to the current literature by addressing the research gap on issues that lead to delays in patients’ throughput processes in the ED (Jarvis, 2016). It also can help develop strategies that could lead to reduced patient wait times in the ED, which would, in turn, reduce the rate of patients who left without being seen.

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Rationale for Methodology

Research benefits both small and large healthcare organizations by assisting the management as well as the administration to make informed decisions. As a result, clinical research on how to improve direct practice should form a part of the organizational culture, whether using a quantitative, qualitative, or mixed-method approach, amongst other research methodologies. This DPI will use quantitative research methodology, which examines measurable and numerical relationships to answer the pertinent issue under investigation as the researcher utilizes techniques in statistics, mathematics, or computations. Compared to qualitative research (which primarily looks at characteristics, concepts, and opinions), the quantitative methodology has several advantages, among them the fact that the use of experimental design can be tested and verified by other researchers. Prestige is also another benefit it involves complex statistics and analysis of data. The association of value and prestige with quantitative research can mirror the healthcare organizations well. Thirdly, the collected quantitative data indicates the most suitable appropriate statistical results to apply. The disadvantages of the qualitative methodology include more time consumption, conscious or unconscious researcher bias, and absence of rigorous scientific controls. These and other advantages not listed herein informed the nurse researcher’s decision to use a quantitative method over qualitative

Nature of the Design

The research also adopts a quasi-experimental design since it is not always possible to control all the critical factors as opposed to the actual experiment, which targets to completely control all the factors that would influence the phenomenon being studied. The first reason why this researcher adopted quasi-experiment design is that the control and treatment group differences in terms of the experimental treatment that they receive giving the benefit of studying things that are not prone to a random assignment like ethnicity and gender. Other benefits of using the quasi-experimental design are the use of different variable approaches and having a greater external validity.

Definition of Key Terms

Door to physician time: The time is taken since the patient first checked in the ED to the time a medical screening exam is conducted (El-Sayed et al., 2015)

ED overcrowding: Describes a situation whereby the number of patients seeking treatment in the ED is more than the beds and resources available (Salway et al., 2017). 

Left without being seen (LWBS): Patients, who complete the triage process, are assigned an acuity level but decide to leave the ED without being attended to by the physician (Saia & Fonzo, 2017).

Clinical significance: A term meaning the researchers found a statistically significant difference, which makes the experts believe that there is a need to consider the research findings to be used in the direct care of patients (Schober et al., 2018).

Statistical significance:  This means the research findings point to an association or distinction that cannot be attributed to normal variations or the element of chance only.

Assumptions, Limitations, Delimitations (s)

In order to explore how the implementation of a CITiT project, the researcher made the following assumptions. First, that implementation of guidelines, algorithms as well as having a clinical interprofessional team in triage would lead to decreased times spent indoor to the physician as well as door to discharge. The second assumption as that opening an observation unit managed by the ED would reduce the door to discharge and door to admission times. At the same time, having a physician and a nurse practitioner in triage would reduce the number of patients with non-urgent medical conditions requiring to be attended to in the ED treatment area. This decrease would, in turn, reduce these cases to triage level- 5 discharge times.

As you continue, has the top and most qualified writers to help with any of your assignments. All you need to do is place an order with us. (Draft Proposal Development 1 Part 2 of Chapter 1)

Draft Proposal Development 1 Part 2 of Chapter 1
Draft Proposal Development 1 Part 2 of Chapter 1

A limitation to this DPI was the formulation of the staff’s self- reflection survey because, upon reexamination of the survey, some questions were not fully developed with suitable response options. At the same time, the questions were not fully replicated during the analysis of pre- and post-survey results. This section identifies the assumptions and specifies the limitations, as well as the delimitations of the project. The scope of the current DPI is to establish how implementing a CITiT program would result in decreased rates of patients who leave the ED without being seen increase patient satisfaction with the services offered and improved patient outcomes (Pielstickjer et al., 2015). The study was delimited to a healthcare system that is integrated into an urban setting healthcare facility and to the patients who sought medical care within this facility. Most importantly, it was of paramount importance that all the healthcare professionals within the facility supported and sustained the introduced change process.


The ED of the healthcare organization in context was exceeding the two-hour door to triage and the four-hour door to admission times which happen to be arbitrary times

This section summarizes the key points of Chapter One and provides supporting citations for those critical points adhered to throughout the US. The effects of ED overcrowding led to an increase in the number of patients who left without being seen, left without being treated or left against medical advice besides being above the facility’s 3% threshold. In the context of this DPI, an increase in the patient wait time from door to triage has been determined to cause delayed diagnosis and timely interventions in critical conditions resulting in poor patient outcomes. This DPI study purposes of addressing issues that lead to ED overcrowding and increased door to triage patient wait times. The DPI formulated strategies through the CITiT that could result in decreased rates of LWBS. In Chapter Two, the study will review existing evidence on the research topic. It will review collected data that the organization can implement on having a clinical interprofessional team in triage, particularly those that directly address measures that can reduce the door to triage and door to physician-patient wait times.

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El Sayed, M. J., El-Eid, G. R., Saliba, M., Jabbour, R., & Hitti, E. A. (2015). Improving emergency department door to doctor time and process reliability: successful implementation of lean methodology. Medicine94(42).

Jarvis, P. R. E. (2016). Improving emergency department patient flow. Clinical and experimental emergency medicine3(2), 63.

Pielsticker, S., Whelan, L., Arthur, A. O., & Thomas, S. (2015). Identifying patient door-to-room goals to minimize left-without-being-seen rates. Western Journal of Emergency Medicine16(5), 611.

Saia, M., & Fonzo, M. (2017). Emergency department patients who leave without being seen (LWBS): A population-based study in Veneto region, Italy. J Community Med1, 1001.

Salway, R. J., Valenzuela, R., Shoenberger, J. M., Mallon, W. K., & Viccellio, A. (2017). Emergency department (ED) overcrowding: evidence-based answers to frequently asked questions. Revista Médica Clínica Las Condes28(2), 213-219.

Schober, P., Bossers, S. M., & Schwarte, L. A. (2018). Statistical significance versus clinical importance of observed effect sizes: what do P values and confidence intervals represent?. Anesthesia and analgesia126(3), 1068.

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