Proposal for Quality Improvement Initiative in the Emergency Department
You are the unit director of the emergency department and part of an ad hoc interdisciplinary committee newly formed to address a 30% rise in arrival-to- provider time over the past six months. Six months ago, the ED consistently recorded an arrival-to-provider time less than the national benchmark of twenty minutes. The arrival-to-provider time is presently over one hour. A root cause analysis study finds that arrivals to the ER have increased by 50% and the lobby is usually filled to capacity. Often patients must stand due to lack of adequate seating. FTEs have not been added and staffing is consistently short due to call-offs. Patients are not being discharged from inpatient beds in a timely manner. The task for the committee is to propose a solution for the problem. Looking at this through the lens of an evidence-based quality improvement process, what would you propose as the PICOT for this initiative? Who are the stakeholders represented in your group? (Remember, this is an internal organizational issue, and while patients are impacted by the issue and are the beneficiaries of the work done, they would not be included in this type of task force)
(for your review, see the example for developing a PICOT below or refer to the Nurse Executive Track CGE
Academy webinar located in resources and announcements)
Proposal for Quality Improvement Initiative in the Emergency Department
PICOT Framework
In addressing the increased arrival-to-provider time in the emergency department (ED), we can utilize the PICOT format to structure our quality improvement initiative. PICOT stands for Population, Intervention, Comparison, Outcome, and Time, and it provides a systematic way to frame our approach.
P: Population
Emergency department patients presenting during peak hours (e.g., evenings and weekends) who are experiencing increased wait times due to overcrowding and insufficient staffing.
I: Intervention
Implementing a comprehensive staffing enhancement plan that includes the addition of Full-Time Equivalents (FTEs) for nursing and support staff, alongside revising the triage process to prioritize patients based on clinical need more effectively.
C: Comparison
Comparing arrival-to-provider times before and after the implementation of the staffing enhancement plan against historical data from the ED's performance six months ago when arrival-to-provider times were consistently below the national benchmark of 20 minutes.
O: Outcome
Reduction of arrival-to-provider times to below the national benchmark of 20 minutes, with improved patient flow and satisfaction.
T: Time
The proposed timeline for evaluation will be three months post-implementation of staffing changes and triage process revisions.
Complete PICOT Statement
In emergency department patients presenting during peak hours (P), will the implementation of a comprehensive staffing enhancement plan (I), compared to current staffing levels (C), result in reduced arrival-to-provider times to below the national benchmark of 20 minutes (O) within three months of implementation (T)?
Stakeholders Represented in the Committee
The interdisciplinary committee formed to address the rise in arrival-to-provider times consists of various stakeholders who play critical roles in the emergency department's functioning. These stakeholders include:
1. Emergency Department Physicians: Directly involved in patient assessment and treatment; their insights on patient volume and care protocols are vital.
2. Nursing Staff Representatives: Frontline providers who experience the challenges of staffing shortages and patient care firsthand; their perspective will inform staffing needs and workflow improvements.
3. Healthcare Administrators: Individuals responsible for operational oversight, budgeting, and resource allocation; they can facilitate changes needed for staffing enhancements.
4. Quality Improvement Specialists: Experts in evidence-based practices who can guide the committee in developing strategies that align with best practices and ensure measurable outcomes.
5. Patient Flow Coordinators: Focus on the logistics of patient movement through the ED and inpatient units; their input is crucial in identifying bottlenecks and improving discharge processes.
6. Information Technology/Health Informatics Staff: Responsible for data collection and analysis; they can provide insights into the current data trends and assist in monitoring improvements post-implementation.
7. Supply Chain/Operations Managers: Ensure that necessary supplies and resources are available for both patient care and staff operations, contributing to an efficient workflow.
By involving these stakeholders, the committee can take a holistic approach to address the factors contributing to increased arrival-to-provider times while ensuring that all relevant perspectives are considered in developing effective solutions.
Conclusion
Utilizing the PICOT framework provides a structured methodology for addressing the significant rise in arrival-to-provider times in the emergency department. By focusing on comprehensive staffing enhancements and effective triage processes, this initiative aims to restore timely patient care while engaging key stakeholders in the solution process. The successful implementation of this initiative could lead to improved patient outcomes, satisfaction, and operational efficiency within the emergency department.