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NUR 550 DQ: Quality Improvement Initiative in Population Health

NUR 550 Discussion: Barriers to Translating Research into Practice

Quality improvements are frameworks used to systematically enhance how care is delivered to patients (Dixon-Woods & Martin, 2016). To use the frameworks, health professionals establish problems and areas of waste, develop and implement a plan for improvement, track the initiative over time and adjust it when necessary to achieve the set objectives. In doing so, health professionals become patient advocates since they make decisions that enhance the delivery of care. The purpose of this paper is to analyze a quality improvement initiative in a health care setting, evaluate the success of the initiative using recognized benchmarks and outcome measures, incorporate interprofessional perspectives on the QI functionality and outcomes and recommend additional indicators and protocols to improve and expand the quality outcomes of the QI.

Eliminating Discharge Delays

Managing the bed capacity in a hospital is a critical issue because increased inefficient discharges slow care, increase cost and impact patient flow (Khalifa, 2017). In the assessed hospital, the initial projects aimed at discharging a specific percentage of patients at a given time of day to free up beds. Nevertheless, system inefficiencies were still there and they contributed to delayed admissions and transfers. Patient flow was hampered by unpredictable discharges and length delays which increased the cost for everyone involved. The hospital had fragmented discharge planning, sub-optimal assessment of readiness for discharge, a breakdown in information transfer and communication between physicians and inadequate post-discharge care and follow-up (Khalifa, 2017). After an analysis of the available evidence, a project team came up with standard discharge criteria for eleven common inpatient diagnoses.

The information was then embedded in the electronic medical record and the new discharge process focused on patient needs first by ensuring that patients were discharged when medically ready.  The nurses could monitor and signal when patients met discharge goals and physicians could prioritize early rounding (Emes, Smith, Ward & Smith, 2019). The process also created a streamlined pharmacy prescription process which improved discharge efficiency. Additionally, there was consistent communication of patient needs between all care providers regardless of the time of day. Due to the process, 80% of eligible patients are released within two hours of meeting the discharge criteria. The project decreased waste linked to inefficient discharges and it saved money for families, hospitals and health plans. Equally, the process focused on patient needs and thus higher acuity patients benefited from the more existing bed. It also reduced the length of stay in line with the global aim of reducing the cost of care (Emes, Smith, Ward & Smith, 2019).

Benchmarks and Outcome Measures

The absence of a standardized process in the discharge planning system results in inconsistencies as well as poor patient outcomes like avoidable hospital re-admissions. The best way to analyze the project on eliminating discharge delays is through internal benchmarking since it identifies best practices within an organization, compares practice within the organization and compares practice over time (Davidson et al., 2017). The analysis looks at a hospital in terms of effectiveness, efficiency and customer satisfaction. To help in the analysis of the quality initiative, the Centers for Medicare and Medicaid Services (CMS) outcome measures were used. The first assessment looked at the mortality rates in the hospitals. The mortality rates reduced after the implementation of the project since it automated the discharge process. The automation increased workflow efficiency and staff productivity and it freed hospital resources which made it possible for the physicians to cater to more complicated cases. Automation also reduced clerical functions by 75% which offered staff more time to interact with patients and initiate interventions when needed (Davidson et al., 2017).

The second outcome measure assessed was readmissions. The number of readmissions decreased due to the effectiveness of discharge planning. It ensured that medications are prescribed and given correctly and the family members are prepared to take over the care of their loved ones. The discharge process covers patient education, medication reconciliation and follows up which has not only enhanced patient satisfaction but reduced rehospitalization (Davidson et al., 2017).  In terms of patient experience, decreasing the discharge delays has led to increased patient satisfaction especially because patients are only discharged when medically ready. The last outcome measured is the timeliness of care. In terms of access to care, reducing the discharge delays has increased the number of available bed which in turn has led to reduced overcrowding in the emergency department (Davidson et al., 2017). The number of patients who leave without being seen has reduced in the hospital. In overall, the project has enhanced patient flow and decreased cost since a 38% increase in patient discharged within two hours has been seen and the hospital has saved $5.9 million.

Interprofessional Perspectives

To get a better understanding of the quality improvement initiative, the interprofessional perspectives were taken. The nurses indicated that before the project, everyone was stressed due to delayed discharges. Among the reasons attributed to the stress were lengthened waiting list which created pressure for some patient to be discharged home (Pinelli, Stuckey & Gonzalo, 2017). The effect was frustration and guilt among health professionals who felt like patients were pressured to leave the hospital. The concern shifted from providing care to those in need to discharging patients to meet government targets. The overall effect was a negative experience among patients due to the delay and also a negative reaction from the staff. However, after the project was implemented, interprofessional communication and pre-discharge planning became effective eventually helping the health professionals meet the government targets while enhancing the patient experience. Patients were less depressed and bored. Patients are no longer rushed to free beds and can ask any questions making them engaged in discharge planning (Pinelli, Stuckey & Gonzalo, 2017).

The nurses noted that the new discharge system has reduced the number of stressed, bored and anxious inpatients. Additionally, it has reduced the lengths of time and thus other service users can access therapeutic interventions and care packages can be arranged effectively. The hospital previously felt overstretched and with insufficient staff but the streamlined system has enhanced care coordination (Pinelli, Stuckey & Gonzalo, 2017). The risk for serious incidents, self-harm, substance misuse, aggression and violence on the wards has reduced and the potential delays when admitting appropriate at-risk service users, as well as premature discharges, have reduced. The nurses also pointed out that the hospital had an inappropriate transfer of service users between services and wards which have changed. The patients also faced an increased risk of service user dependence on inpatient care and lost coping skills post-discharge while the staff morale, retention, and recruitment were affected (Pinelli, Stuckey & Gonzalo, 2017). The new system has tackled these issues since staff input was obtained when implementing the system.

Reducing Discharge Delays Further

To enhance the initiative further, the hospital should adopt a centralized billing system between various departments to facilitate easy real-time billing. A billing system will help in informing the patient about interim pending amount any time they enquire which will prevent discount requests at the wrong times (Stelfox et al., 2015). The hospital should also improve its information system in a way that various departments in the hospital have a central platform. The platform will ease communication among the department and clearance from the various department will be reduced. With a centralized platform, once a consultant triggers a discharge, the concerned departments are notified right away and they clear the patient automatically (Stelfox et al., 2015). The effect is reduced delays since final bill preparation can be done within the shortest time possible.

The hospital should also create a centralized bed management system. The system will indicate whether beds are available and make room and bed assignments to new patients more efficient. The system will also trigger bed cleaning notice during discharge reducing the number of hours needed to assign beds to new patients (Stelfox et al., 2015). Lastly, an automated inventory management system should be in place to ensure that discharge medication from the pharmacy reaches the ward as early as possible. The system will ensure that excess medication return to the pharmacy and discharge medication to the wards is completed ahead of time enhancing the discharge process.

Conclusion

Quality improvements initiatives enhance the care offered to patients. The analyzed healthcare facility had implemented an initiative that eliminated discharge delays. The hospital had started with a project that aimed at discharging a specific percentage of patients at a given time to free up beds but it resulted in system inefficiencies.  A team was set and analyzed the weakness and it came up with standard discharge criteria that were embedded in the electronic medical record. The initiative has enhanced care and analyzing healthcare outcomes reveals that mortality rates have reduced, readmissions have reduced, patient experience enhanced as well as timeliness of care.  Even the health professionals in the hospital outline a positive impact of the initiative which has enhanced morale and satisfaction. The system, however, can benefit from a centralized billing system, a central information system, centralized bed management system and an inventory management system.

References

Dixon-Woods, M., & Martin, G. P. (2016). Does quality improvement improve quality?. Future Hospital Journal, 3(3), 191-194.

Pinelli, V., Stuckey, H. L., & Gonzalo, J. D. (2017). Exploring challenges in the patient’s discharge process from the internal medicine service: A qualitative study of patients’ and providers’ perceptions. Journal of interprofessional care, 31(5), 566-574.

Emes, M., Smith, S., Ward, S., & Smith, A. (2019). Improving the patient discharge process: implementing actions derived from a soft systems methodology study. Health Systems, 8(2), 117-133.

Davidson, G. H., Austin, E., Thornblade, L., Simpson, L., Ong, T. D., Pan, H., & Flum, D. R. (2017). Improving transitions of care across the spectrum of healthcare delivery: A multidisciplinary approach to understanding variability in outcomes across hospitals and skilled nursing facilities. The American Journal of Surgery, 213(5), 910-914.

Ulin, K., Olsson, L. E., Wolf, A., & Ekman, I. (2016). Person-centered care–An approach that improves the discharge process. European Journal of Cardiovascular Nursing, 15(3), e19-e26.

Stelfox, H. T., Lane, D., Boyd, J. M., Taylor, S., Perrier, L., Straus, S., & Zuege, D. J. (2015). A scoping review of patient discharge from intensive care: opportunities and tools to improve care. Chest, 147(2), 317-327.

Khalifa, M. (2017, August). Reducing Length of Stay by Enhancing Patients’ Discharge: A Practical Approach to Improve Hospital Efficiency. In ICIMTH (pp. 157-160).

Topic 5 DQ 2

Description:

 Identify a quality initiative from your workplace. What were some barriers to implementation? What are common barriers to translating research into practice?

Description:

The purpose of this assignment is to provide research evidence in support of the PICOT you developed for your selected topic.

Conduct a search for 10 peer-reviewed, translational research articles published within the last 5 years that demonstrate support for your PICOT. You may include previous research articles from assignments completed in this course. Use the “Literature Evaluation Table” provided to evaluate the articles and explain how the research supports your PICOT.

Identify a quality initiative from your workplace. What were some barriers to implementation? What are common barriers for translating research into practice?

Re: Topic 5 DQ 2

Sepsis remains a significant cause of mortality in the United States because identifying sepsis in its early stages is challenging. Sepsis Alliance (2021) defines sepsis as a life-threatening response to infection that can lead to organ failure, damage, and even death. Therefore, patients with sepsis require close monitoring and assessment. At my workplace, although we had previously adopted a program with the slogan “Recognize, Resuscitate, refer” to reduce the intensive care unit rates and deaths associated with sepsis. The program was proven effective and working at the health facility. However, the implementation of the program was faced with some barriers that hindered complete transition. Among the obstacles that I identified include the technology gap, lack of clarity, and instability leadership. In modern health care practice, technology has influenced the dissemination of information and application of skills. Now that this program was more aligned with technology, some of the older health care providers were not conversant and lacked the know-how to use identified technology to recognize, resuscitate, and refer sepsis patients. Also, lack of clarity contributed to the partial failure of the 3R program. Some people did not clarify specific issues, such as recognizing patients suffering from sepsis and referring such patients. In addition, in less than two months after the 3R program was enrolled, the managing director who was coordinating the program resigned from work. This disrupted the implementation process.

Available evidence shows that translating research into clinical practice is becoming a challenge despite its importance (Curtis et al., 2017). Nevertheless, translating research to clinical practice has led to efficient and effective healthcare responses meeting patient’s expectations. Some of the common barriers include but are not limited to inadequate resources, personal experience, unsupportive leadership, negative organizational culture, and lack of continuing nursing education (Curtis et al., 2017). For instance, disseminating research knowledge requires adequate resources such as training health care providers on best approaches to translate research to clinical practice.

Resources

Curtis, K., Fry, M., Shaban, R. Z., & Considine, J. (2017). Translating research findings to

clinical nursing practice. Journal of clinical nursing26(5-6), 862–872. https://doi.org/10.1111/jocn.13586

Sepsis Alliance. (2021). What is Sepsis? https://www.sepsis.org/sepsis-basics/what-is-sepsis/

 

RESPOND HERE (150 WORDS, 3 REFERENCES)

Hello Listra,

I do agree with you that sepsis is a life-threatening condition in US which requires immediate medical intervention measure. The condition affects approximately 1.7 million adults annually in the US, with an annual death toll of about 250, 000 people (Rhee et al., 2019). Healthcare organizations need to advance the clinical procedures to have the sepsis recognized early and treated before progressing to a more fatal condition. This calls on quality improvement and effectiveness in the nursing process. Implementation of the measures faces challenges ranging from financial, human resource and leadership that does not recognize the need for promoting quality care. Transformational leadership is crucial in driving change processes in healthcare organization hence improved quality of care, patient satisfaction and general well-being of the public (Asif et al., 2019). Another barrier to implementing the change process on the sepsis treatment and control measure is limited resources which hinder the acquisition of appropriate technological tools and expertise required to speed up the diagnosis and treatment of the condition.

References

Rhee, C., Jones, T. M., Hamad, Y., Pande, A., Varon, J., O’Brien, C., Anderson, D. J., Warren, D. K., Dantes, R. B., Epstein, L., & Klompas, M. (2019). Prevalence, Underlying Causes, and Preventability of Sepsis-Associated Mortality in US Acute Care Hospitals. JAMA Network Open, 2(2), e187571. https://doi.org/10.1001/jamanetworkopen.2018.7571

Asif, M., Jameel, A., Hussain, A., Hwang, J., & Sahito, N. (2019). Linking Transformational Leadership with Nurse-Assessed Adverse Patient Outcomes and the Quality of Care: Assessing the Role of Job Satisfaction and Structural Empowerment. International Journal of Environmental Research and Public Health, 16(13), 2381. https://doi.org/10.3390/ijerph16132381

Once your instructor returns this assignment, review the feedback and make any revisions necessary. If you are directed by your instructor to select different articles in order to meet the assignment criteria or to better support your PICOT, make these changes accordingly. You will use the literature evaluated in this assignment for all subsequent assignments you develop as part of your evidence-based practice project proposal in this course and in NUR-590, during which you will synthesize all of the sections into a final written paper detailing your evidence-based practice project proposal.

Refer to the “Evidence-Based Practice Project Proposal – Assignment Overview” document for an overview of the evidence-based practice project proposal assignments.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are not required to submit this assignment to LopesWrite.

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Description

Objectives:

1. Explain how translational research can be used for safety and quality improvement initiatives related to improving population health.
2. Discuss common barriers to translating research into practice.

Evidence-Based Practice in Nursing and Healthcare

Description:

Read Chapters 4 and 9 in Evidence-Based Practice in Nursing and Healthcare.

Translating Evidence into Practice: How Advanced Practice RNs Can Guide Nurses in Challenging Established Practice to Arrive at Best Practice
Description:

Read “Translating Evidence into Practice: How Advanced Practice RNs Can Guide Nurses in Challenging Established Practice to Arrive at Best Practice,” by Fenci and Matthews, from AORN Journal(2017).

Eliminating Cardiovascular Health Disparities: There has Been Progress, but There is More to
Do!

Description:

Read “Eliminating Cardiovascular Health Disparities: There has Been Progress, but There is More to Do!” by Coke, from The Journal of Cardiovascular Nursing (2018).

Quality Improvement in Athletic Health Care

Description:

Read “Quality Improvement in Athletic Health Care,” by Sauers, Sauers, and Valier, from Journal of Athletic Training
(2017).

Lost in Translation: The Promise and Problems of the Globalization of Research

Description:

Read “Lost in Translation: The Promise and Problems of the Globalization of Research,” by Baumann, from Nursing Science Quarterly (2019).

Decreasing Barriers to Research Utilization Among Labor and Delivery Nurses

Description:

Read “Decreasing Barriers to Research Utilization Among Labor and Delivery Nurses,” by Heelan-Fancher, Edmonds, and Jones, from Nursing Research (2019).

Differentiating Between Research and Quality Improvement

Description:

Read “Differentiating Between Research and Quality Improvement,” by Gregory, from Journal of Perinatal and Neonatal Nursing (2015).

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