NR631 Nurse Executive Concluding Graduate Experience - I

Week 8: CGE Project Portfolio - Part 1 Diego Bustillo Chamberlain Collage of Nursing December 2020 Week 8: CGE Project Portfolio - Part 1 Project PICOT question For patients presenting in the ED, does implementing purposeful rounding and bedside reporting improve the Left Without Being Seen rate? Abstract summary of project topic Within the Chamberlain Hospital ER scenario, problems can be noted in many areas. Among the main problems is the high rate of Left Without Being Seen (LWBS). Currently, the rate of LWBS is at 4.6 % considering that the national benchmark is 2%. There is a lack of effective communication along the care delivery process starting from triage to discharge. Nurses give reports at the nursing station and do not round on patients. They are on their mobiles phones, texting most of the time and are reluctant to discharge patients to avoid admissions at end of shift. To address these problems, the current project focuses on the implementation of bedside reporting and purposeful rounding among patients presenting to the ED as key strategies to reduce the rate of LWBS. The information collected from a review of the literatures clearly demonstrates the effectiveness of the proposed intervention in addressing the problems that Chamberlain Hospital is facing. For example, Sayah et a (2014) conducted a study to evaluate the effectiveness of process improvement/bedside reporting in reducing the Left Without Being Seen (LWBS) rate. Study findings showed that bedside reporting helped to reduce the mean rate of patients in the ED who left without being seen. Reflection on course outcomes, I am happy about the current progress in achieving course outcomes. For example, being able to identify literature on bedside reporting and purposeful rounding from different databases has facilitated the achievement of course outcome #2. The existence of an effective communication plan is one of the ways through which project managers ensure the existence of effective communication. For the current project, the communication plan includes key stakeholders, an assessment of the type of information required, and signoff from stakeholders. Following a successful implementation of the proposed change, I hope to achieve the key project deliverables that include a reduction in the rate of Left Without Being Seen for patients presenting in the ED, an improvement in patient satisfaction scores, and appropriate response to the issue of lengthy waits for patients presenting to the ED. I believe that utilizing a range of tools including the Work Breakdown Structure, Risk Register, and Gantt chart increases the chance that the project will be a success and will be completed within schedule. Literature review Sayah et al (2014) conducted a study to evaluate the effectiveness of process improvement/bedside reporting in reducing Left Without Being Seen (LWBS) rate at the Cambridge Hospital Emergency Department (ED). In their findings, the authors established that bedside reporting helped to reduce the mean rate of patients in the ED who left without being seen. The intervention allowed the hospital to increase the volume of patients in the ED while improving the quality of care and level of satisfaction. In a study by Daniels (2016) on purposeful and timely nursing rounds, the authors established that purposeful rounding is one of the best intervention practices that can be effectively implemented in the ED to ensure that they meet their patients’ needs and satisfaction hence reducing the rate of LWBS. Purposeful rounding should involve the nurses and all staff working within the ED. This ensures that there is effective communication of the patient’s needs and enhances staff interventions or responsiveness to meet their needs. In another conducted by Freibott (2017), the researchers sought to examine whether applying best practices such as bedside reporting could help improve patient flow and optimize ED. The initiative also focused on reducing time stamps for patients presenting in the ED. Their findings revealed a considerable reduction in the time frame for arriving patients and LWBS rates. In the study carried out by Cabilan and Eley (2015) seeking to examine how to examine efficiency at the ED, findings showed that using technology for instance implementing a computerized system with the ED boosts the number of early discharges and improve the patients’ admission rate. Through this, the ED will be able to serve more patients and reduce the number of Left without Being Seen (LWBS) patients. Tidwell (2011) conducted a study to examine the effectiveness of best practices/bedside reporting. Research data were analyzed using chi-square and paired t-test. Findings revealed that bedside reporting improves nurse and patient satisfaction and is a comprehensive approach to reducing LWBS. In another study by Johnson (2015), the purpose was to assess the impact of bedside report implementation to transition patients in different hospital units. In their findings, the authors established that the utilization of standard bedside reporting resulted in a significant improvement in care and a reduction in LWBS particularly for patients presenting to the ED. In the study by Stowell et al (2019), the authors sought to assess the impact of ED phlebotomists on LWBS rates. Their findings revealed that effective communication within an emergency department is critical when implementing a purposeful rounding process. It enhances the flow of information within the staff members and the nurses in the ED hence increasing the patient's care efficiency and reducing delays in the ED processes. Besides, purposeful rounding enhances improved communication that is essential to maintain the safety of the patients and the quality of service or care rendered to them hence reducing the rate of Left Without Being Seen. In a study conducted by Lucas, Batt, and Soremekun (2014), the objective was to study the rates of LWBS by triage class and wait times needed to attain specific LWBS rates. Theirs was a 3-year retrospective study of patients presenting to the ED. The authors concluded that attaining a target rate of LWBS requires a comprehensive analysis to comprehend abandonment behavior. Shekelle et al (2017) also conducted a study to ascertain the effectiveness of various interventions in improving efficiency in the ED. In their findings, the authors concluded that when implementing the purposeful rounding process, it is critical to creating awareness for all the stakeholders. This entails organizing educational forums to inform both the staff and nurses working in the emergency department of their expectations. For instance, the nurses should spend quality time with the assigned patients and fully understand the patients’ needs and serve them appropriately. All stakeholders should fully understand the ED processes and adhere to all the protocols implemented with the Emergency Department. In an