Answer

How to decrease wait times in the Emergency Room at Parrish Medical Center

Practicum Learning Agreement: Learning Strategies and Evidence of Accomplishments

Measuring Attainment of Objectives

The attainment of the objectives would be evaluated to establish the degree to which they have been achieved. Conducting assessments would be critical in measuring the attainment of the learning objectives. However, the type of assessments will be selected based on the objective whose attainment is to be measured. The section below matches the objectives and the types of assessments that will be used to measure learning objective attainment.

Objective 1: Identify and evaluate the standard patient wait time in the Emergency Room at the Parrish Medical Center

Report: A short report will be written to establish the findings on the patient wait time in the Emergency Room at Parrish Medical Center.

Objective 2: Establish the factors causing delays in the Emergency Room at the Parrish Medical Center.

Write a short report on the factors causing delays in the Emergency Room at the Parrish Medical Center.

Objective 3: Explain the consequences of longer wait times in the Emergency Room.

Short form test: Multiple choice questions on the effects of longer wait times will be effective in determining the understanding of the key concepts. A feedback from the mentor will be also important in determining the progress of the project on reducing emergency room wait time.

Objective 4: Develop a quality improvement plan constituting of activities such as a faster patient history taking for decreasing wait times

Performance test: Testing the speed of history taking. There should be an improvement on the results of these tests to indicate that some learning has taken place.

A comprehensive lesson plan will be also effective in determining whether the objectives have been achieved by analyzing the degree of performance of the activities in the lesson plan. For this particular objective, the following lesson plan will be effective;

Parrish Medical Center

Nursing Education Lesson Plan: 2/15/2016

Objective: Communicate the strategies that Parrish Medical Center can take to reduce wait time in the Emergency Room by concept mapping the variables affecting wait time such as use of technology and communication skills of the healthcare professionals.

Time: 45 minutes

Materials: Internet access, Projector, Laptop, and textbooks for validating facts on patient wait times

Procedure:

• Ask the learners what they think are the most suitable strategies for reducing wait time in the Emergency Rooms. After a 5-minutes brainstorming, the students will be given the main strategies as enhancing communication between patient and providers, effective system for taking patient personal details, redesigning Emergency Rooms to improve workflow, and relocating the Emergency Room away from the main hospital to avoid unnecessary admissions.
• Now request the learners to give brief descriptions of how the factors aforementioned can reduce wait time in the emergency room.
• Divide the class into several groups and give each group a task of giving more details. Each group must have at least one peer-reviewed article and two textbooks to confirm their conclusions.
• Get two group leaders from the teams to present their findings.
• Summarize the findings on the strategies for reducing wait time.

Assignment: Read through the article Patrick, J., & Puterman, M. L. (2008). Reducing wait times through operations research: optimizing the use of surge capacity. Healthcare Policy, 3(3).

Write a review of the article.

 However, there are some challenges that might arise during the measurement of attainment of the learning objectives. This section describes the difficulties that might be encountered in each objective.

Objective 1: Identify and evaluate the standard patient wait time in the Emergency Room at the Parrish Medical Center

Effective reporting write skills are critical for the learner to be evaluated using assessment reports. There could be a difficulty in a case where the trainees are unable to write an error free and coherent report. Therefore, additional learning on report writing skills will be necessary.

Objective 2: Establish the factors causing delays in the Emergency Room at the Parrish Medical Center.

It is difficult to evaluate the practical understanding of factors leading to long wait times from the learner’s perspective by using written reports only.

Objective 3: Explain the consequences of longer wait times in the Emergency Room         

The trainees might lack adequate time to answer the short questions due to working time constraints. Therefore, it will be important to involve the management to ensure adequate time is given to the employees to participate in the program.

Objective 4: Develop a quality improvement plan constituting of activities such as a faster patient history taking for decreasing wait times

Some nurses might be unwilling to perform the tests and the assignment. Therefore, follow-up plan should be made to ensure the trainees complete the tasks.

 These measures will be very accurate due to the combination of the various assessment methods. Errors made in one assessment will be realized in evaluations of the subsequent objectives.

Learning Strategies

Objective 1: Identify and evaluate the standard patient wait time in the Emergency Room at the Parrish Medical Center

1-A Conduct a literature review of 4 peer-reviewed articles on the average national emergency room waiting time

1-B Consult with the emergency room experts and nurses to identify the factors leading to delays in emergency rooms. After the consultation, visit the emergency room to try if the proposed barriers exist and the potential solutions. Experiential learning is important in gaining professional experience while learning (Moon, 2013).

1-C Develop and administer a needs assessment to nurses on how patient wait time affects quality of care. The mentor will be helpful in designing the staff opinion survey. The needs are the gaps between what should be met and what are available (McCawley, 2009). Additionally, the mentor can also give feedback on the survey after investigating the methodology and the results of the survey. A survey of the staff will also be essential for assessing the learning needs of the staff members on policies and procedures of emergency rooms.

Evidence of Accomplishments:

1-A Annoted Bibliography

Horwitz, L. I., Green, J., & Bradley, E. H. (2010). US emergency department performance on wait time and length of visit. Annals of emergency medicine, 55(2), 133-141.

This article provides an overview of the current wait times in emergency rooms in the United States. The aim of the study was to describe the hospital-level performance on Emergency Department wait time and visit length. According to the article, consistency of admitting patients within the recommended timeframe is important in ensuring there are no delays in the emergency department. Only a quarter of hospitals admit 90% of their patients to the Emergency Rooms within 4 hours and 48% of the Emergency Departments admit 90% of their patients within 6 hours. Therefore, the average time for admission is approximately 6 hours and this calls for the need to improve the workflow in the emergency rooms.

Jones, P., & Schimanski, K. (2010). The four hour target to reduce emergency department ‘waiting time’: a systematic review of clinical outcomes. Emergency Medicine Australasia, 22(5), 391-398.

This article describes the impact of the “four hour rule” on the level of performance in the emergency department. The results were arrived at after a meta-analysis. The rule has not changed the consistent care quality despite the massive financial investments associated to its implementation. Some hospitals have also recorded low return rates with the emergency room admission rates increasing. Therefore, strategies for reducing wait time in emergency rooms should be implemented with caution.

Travers, J. P., & Lee, F. C. (2006). Avoiding prolonged waiting time during busy periods in the emergency department: is there a role for the senior emergency physician in triage?. European journal of emergency medicine, 13(6), 342-348.

This article describes the effectiveness of changing workflow to reducing wait times in emergency rooms. The research method involved placing a senior physician with the triage nurse in the Emergency Department for 2 months and measurements of wait times recorded. It was observed that the average wait time for walk-in patients was 19 minutes while the normal average time used to be 35.5 minutes. Therefore, the study posits that use of senior physicians can help in reducing wait times in the emergency rooms.

Objective 2: Establish the factors causing delays in the Emergency Room at the Parrish Medical Center.

2-A Conduct self-study on the factors causing long wait times

2-B Consult the emergency unit expert on the possible challenges to good workflow in the department.

2- C Design and administer questionnaires to nurses on the factors leading to delay of care delivery in the department.

2-B Summary of the mentor feedback

The need to visit the unit expert, conduct self-study, and administer questionnaires to nurses was sent to the mentor who advised accordingly. She proposed that the questionnaires be open-ended to enable the nurses provide more details on the factors hindering their work in the emergency unit. We then identified common factors such as poor health literacy among patients and the affordability of the services to most of the population.

Objective 3: Explain the consequences of longer wait times in the Emergency Room

3-A Conduct self-study on the consequences of longer wait times. According to the adult learning theory, self-directed learning is recommendable for the adults to learn from their daily routines and at their conveniences (Merriam, 2015).

3-B Participate in seminar discussions on patient wait times to identify the abstract ideas on emergency room management. According to Learning Progression Theory affective, cognitive, and psychomotor skills are learnt in stages from conscious tasks to more abstract ideas (Lehrer & Schauble, 2015).

3-B Summary of the mentor feedback

The learning needs assessment was sent to the mentor including the plan to participate in the seminar discussions. The mentor advised for the inclusion of a PowerPoint during the discussion. We then reviewed the current policies and procedures in the emergency room and identified the weaknesses in the current policies such as failure to partner physicians with triage nurses and absence of translators in the care team to enhance communication.

Objective 4: Develop a quality improvement plan constituting of activities such as a faster patient history taking for decreasing wait times

4-A Identify nurses to assist in monitoring Emergency Room wait times

4-B Analyze the effectiveness of the current emergency room policies and procedures by consulting with the emergency department manager

4-C Review the national guidelines on ways of preventing delays in the emergency rooms

4-D Create and administer questionnaires to the nursing staff on the barriers to workflow in the emergency room and the possible solutions to these problems. According to DeSilets (2006), staff survey is important in determining the learning needs from the employees’ viewpoint.

4-B Summary of the policies and procedures

The applicable policies and ER procedures were discussed with Rosaline Emmy, RN, emergency department specialist. Transcripts of these discussions were then provided as Evidence of Accomplishments. Parrish Medical Center provides 24-hour emergency care all the days of the week. The peak hours range from 11 am to 10 pm particularly during the weekends. However, due to the unpredictability of accidents, planning for the emergency room has been a challenge. However, the hospital has inter-disciplinary team comprising of physicians, physician-assistants, radiologists, nurses, nurse practitioners, and support staff. 

Mentor

Mentoring will be a very important concept in effectively learning the strategies for reducing wait times. Inclusion of experts in the emergency room will ensure that I get sufficient information based on their professional experiences. The functions of the mentor will include nurturing and role modeling to sustain my professional development. Additionally, a mentor will be important in assisting as a sponsor, teacher, encourager, friend, and counselor (Riley & Fearing, 2009). However, there are specific guidelines on mentor selection and how to work with the mentor. The mentoring relationship will be initiated naturally by connecting with an expert in the emergency department, possibly an advance nurse practitioner. The first quality to consider would be the experience of the nurse practitioner. The expert should have at least 10 years of experience in offering care in the emergency department. Secondly, the mentor must have the interest of the learner to develop a mutual trust between the two. I will choose a mentor who I trust and admire. Time is a very useful resource and the proposed mentor must be able to fix time in the schedule. According to de Tormes Eby, Brown, & George (2014), the mentor must also have strong professional network and the ability to listen and understand others’ perspectives. Lastly, the mentor must be honest and open to give sincere feedbacks to facilitate effective learning.

On the other hand, I will need to be cooperative and have a personal commitment to be involved in working with another professional for a long duration. Working with the mentor will also require determination in completing the tasks given to gain the knowledge, skills, and the experience. It is the determination of the learner that helps in the achievement of the learning needs (Ross & Jaafar, 2006). Most importantly, the learner should be open to learning and motivated so that it is a pleasure for the mentor to provide the required nurturing. Lastly, the mentoring program should be supplemented with other sources of information for effective learning. As such, the experience gathered during the normal patient-care will still be treated as critical.ns