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NUR 550 DQ: Quality Improvement Initiative in Population Health

NUR 550 DQ: Quality Improvement Initiative in Population Health

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 1

Description:

Identify either a safety or q Explain how translational research can influence the development of the initiative. Include a specific example to support your response.

Identify either a safety or quality improvement initiative related to improving population health. Explain how translational research can influence the development of the initiative. Include a specific example to support your response.

Re: Topic 5 DQ 1

Healthcare organizations face pressing problems that require swift solutions. Examples of problems include medical errors, delayed patient discharge, hospital-acquired infections, and any others, which in one way or another affects population health. According to Sauers et al. (2017), quality improvement is a concept that ensures health care providers provide high-quality, safe, timely, and patient-centered care. Therefore, to improve population health, nurse leaders and managers should incorporate translational research in developing quality improvement initiatives to improve health care services. For example, in this discussion, physical fitness and healthy eating habits positively impact population health. For instance, Baumann (2019) opined that healthy eating and drinking quality water play a vital role in improving health status among the aging population. In a randomized control trial, Baumann (2019) found that older men and women who did not participate in physical exercise and engaged in bad eating habits experienced health conditions such as increased body weight, joint problems, and cardiovascular-related problems. Therefore, with translational research, health care researchers can assess and evaluate whether physical activities and good eating habits would improve aging and longevity.

Translational research can be used to influence the development of health initiatives aimed at improving the health population. This course has emphasized that translational research involves four stages, T1, T2, T3, and T4. In the given an example, stage two (T2) which test efficacy and effectiveness of health initiatives can be integrated into the current research to evaluate the correlation between physical exercise and good eating habit and aging and longevity. The findings obtained will determine whether the proposed initiative will improve the healthy population, particularly among the elderly.

References

Sauers, A. D. L., PhD., Sauers, Eric L, Ph.D., A.T.C., F.N.A.T.A., & Valier, Alison R Snyder,

Ph.D., A.T.C., F.N.A.T.A. (2017). Quality improvement in athletic health care. Journal of Athletic Training, 52(11), 1070-1078. doi:http://dx.doi.org.lopes.idm.oclc.org/10.4085/1062-6050-52.10.15

Baumann, S. & (2019). Lost in Translation. Nursing Science Quarterly, 32 (1), 68-72. DOI:

http://dx.doi.org.lopes.idm.oclc.org/10.1177/0894318418807927

 

RESPOND HERE (150 WORDS, 3 REFERENCES)

Hello Listra,

I do agree with your statement that healthcare organizations face many daily challenges that range from simple operational problems to complex clinical and medical errors that put the lives of the patients in danger. Healthcare organizations and professionals have a responsibility of ensuring that they do offer quality care that helps promote the safety of patients, proper recovery and reduced chances of readmission. In order to achieve these objectives, it is imperative for healthcare organizations to carry out proper EBP and enhance translational research that will put the EBP outcomes into proper clinical practice (Weiss et al., n.d.). One example of clinical challenge where translational research is crucial is the reduction in catheter -associated urinary tract infections (CAUTI) among patients in the renal department. The EBP research outcomes focuses on educational programs for the nurses and short-term indwelling as some of the efficient methods of reducing incidences of CAUTI (Atkins et al., 2020). Additionally, in order to achieve the desired objectives, it is imperative to enhance multidisciplinary teams’ approach and collaborative working.

References

Atkins, L., Sallis, A., Chadborn, T., Shaw, K., Schneider, A., Hopkins, S., Bunten, A., Michie, S., & Lorencatto, F. (2020). Reducing catheter-associated urinary tract infections: a systematic review of barriers and facilitators and strategic behavioural analysis of interventions. Implementation Science, 15(1). https://doi.org/10.1186/s13012-020-01001-2

Weiss, M., Bobay, K., Johantgen, M., & Shirey, M. (n.d.). Aligning Evidence-Based Practice With Translational Research: Aligning Evidence-Based Practice With Translational Research: Opportunities for Clinical Practice Research Opportunities for Clinical Practice Research. https://epublications.marquette.edu/cgi/viewcontent.cgi?article=1606&context=nursing_fac

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.

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.

Click here to ORDER an A++ paper from our MASTERS and DOCTORATE WRITERS: NUR 550 Assignment: EBP Project Evaluation of Literature Table

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 for 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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