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    Application: Creating a Flowchart

    Workflow analysis aims to determine workflow patterns that maximize the effective use of resources and minimize activities that do not add value. There are a variety of tools that can be used to analyze the workflow of processes and clarify potential avenues for eliminating waste. Flowcharts are a basic and commonly used workflow analysis method that can help highlight areas in need of streamlining.

    In this Assignment, you select a common event that occurs regularly in your organization and create a flowchart representing the workflow. You analyze the process you have diagrammed and propose changes for improvement.

    To prepare:

    • Identify a common, simple event that frequently occurs in your organization that you would like to evaluate.
    • Consider how you would design a flowchart to represent the current workflow.
    • Consider what metrics you would use to determine the effectiveness of the current workflow and identify areas of waste.

    To complete:

    Write a 3- to 5-page paper which includes the following:

    • Create a simple flowchart of the activity you selected. (Review the Sample Workflow of Answering a Telephone in an Office document found in this week’s Learning Resources for an example.)
    • Next, in your paper:
      • Explain the process you have diagrammed.
      • For each step or decision point in the process, identify the following:
        • Who does this step? (It can be several people.)
        • What technology is used?
        • What policies and rules are involved in determining how, when, why, or where the step is executed?
        • What information is needed for the execution of this step?
      • Describe the metric that is currently used to measure the soundness of the workflow. Is it effective?
      • Describe any areas where improvements could occur and propose changes that could bring about these improvements in the workflow.
      • Summarize why it is important to be aware of the flow of an activity.
    • Remember to include a cover page, introduction, and summary for your paper.





    Required Resources

    Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.


    • McGonigle, D., & Mastrian, K. G. (2012). Nursing informatics and the foundation of knowledge(Laureate Education, Inc., custom ed.). Burlington, MA: Jones and Bartlett Learning.
      • Chapter 16, “Nursing Informatics: Improving Workflow and Meaningful Use”

        This chapter reviews the reasons for conducting workflow analysis and design. The author explains specific workflow analysis and redesign techniques.

    • Huser, V., Rasmussen, L. V., Oberg, R., & Starren, J. B. (2011). Implementation of workflow engine technology to deliver basic clinical decision support functionality. BMC Medical Research Methodology,11(1), 43–61. 
      Retrieved from the Walden Library databases.

      In this article, the authors describe an implementation of workflow engine technology to support clinical decision making. The article describes some of the pitfalls of implementation, along with successful and future elements.

    • Koppel, R., & Kreda, D. A. (2010). Healthcare IT usability and suitability for clinical needs: Challenges of design, workflow, and contractual relations. Studies in Health Technology and Informatics157, 7–14. 
      Retrieved from the Walden Library databases.

      This article points to many health information technology designs and workflow decisions that limit their value and usage. The authors also examine the structure of the conceptual relationships between HIT vendors and the clinical facilities that purchase HIT.

    • S. Department of Health & Human Services. (n.d.b). Workflow assessment for health IT toolkit. Retrieved, June 18, 2012, fromhttp://healthit.ahrq.gov/portal/server.pt/community/health_it_tools_and_resources/919/workflow_assessment_for_health_it_toolkit/27865

      This article supplies a toolkit on the planning, design, implementation, and use of health information technology. The sections of the website provide a definition of workflow, examples of workflow tools, related anecdotes, and research.

    • Document: Sample Workflow of Answering a Telephone in an Office (Word document)
      Note:You will use this document to complete this week’s Assignment.


    • Laureate Education, Inc. (Executive Producer). (2012f). System design and workflow.Baltimore, MD: Author. 



Subject Business Pages 9 Style APA


Workflow Distribution in an Emergency Department





















Emergency department   are used for life threatening cases like stroke or accidents. However, other less critical conditions may be seen. Emergency departments are normally filled to capacity. To enable correct clinical evaluation and treatment, the emergency department is divided into four critical areas; pre-triage, triage, waiting and treatment areas. The pre-triage is the initial step from where the nurse will either refer you to the triage nurse, waiting room or treatment area. A tried nurse will do further assessment and refer the patient for treatment or to the waiting room. The final step is bed allocation where a district nurse will monitor the patient as he/she is undergoing treatment. Aronsky et al. (2008) defines triage as “a fast-paced process that prioritizes the allocation of limited health care resources to patients in greatest need”. This paper aims to create a workflow diagram showing the processes from arrival, treatment to registration in and emergency department. The workflow will be used to identify weaknesses in the processes involved and to recommend changes.

Admission Process

The first step on arrival is to be received by a nurse who performs preliminary assessment where the patient provides the reason for the visit. The nurse also indicates the patient’s name, age and the major complaint. Depending on the assessment, the patient may be taken for treatment or to the waiting room. All patients must pass through the pre-triage nurse unless the patient is arriving by ambulance then he goes straight for treatment. The files are arranged with the most urgent at the top of the list. The triage nurse then takes the chart at the top and finds the patient in the waiting room. A clinical evaluation is then done on the patient. The patient’s vitals are recorded on a printed chart. The patient is assigned an emergency category and any tests that are indicated are ordered. The nurse then enters the data in a computer system whose function is tracking patients.

Depending on the workload of district nurses available in the treatment areas, the triage nurse will decide where the patient will go. Communication among the triage nurses is essential at this point to avoid sending two patients to the same area. The assigned nurse and area are indicated in the chart. Afterward, the patient is either taken to the emergency department treatment area or the waiting area. After the triage nurse hands over the patient to the district nurse and provides all the necessary information about the patient, the chart is finally given to the registration who enters the data into the electronic patient record. The pre-triage and triage nurses use printed papers to fill the patient’s details. The triage nurse later transfers all the information on the chart into a computerized patient tracking system.

The pre-triage nurse is tasked with determining the level of urgency and taking patient information.  At this stage the privacy of the patient is critical and governed by the HIPAA. Most hospital policies provide the emergency department its own floor. A pre-triage nurse does her/his work in an area near the entrance of the emergency department and near the waiting room to allow for easy identification of new patients and movement to the waiting area.  To enable tracking and billing process, the information required includes age, address, and medical history including any current medication. This is important in order to effectively deliver health care.

The triage nurse will also assign level of urgency to a patient after performing an assessment. She/he will fill the results of the examination in the chart that the triage nurse had started with. He/she may suggest that further diagnostic tests to be performed. In order to facilitate adequate patient care, necessary patient information should be made available to all the concerned parties. In accordance with this policy, the triage nurse enters the information gathered so far into an electronic tracking system. According to McGonigle& Mastrian (2012), health information is critical in providing sound clinical decisions.

Policies governing the emergency department provide for priority of treatment to be based on urgency or severity of a condition (McGonigle& Mastrian 2012). That is why a triage nurse can send one patient to the emergency waiting room while the other is directed to the treatment area. At this point, patients who only came for consultation are recommended for discharge. Additionally, some minor conditions can be addressed eliminating the need to assign a bed. Patients arriving in ambulances do not pass through the waiting or triage stage.  Life threatening cases are given the first priority. Patients are advice to inform the triage nurse if their condition changes. This is important since most of the time emergency department is packed to capacity where bed allocation is determined by emergency and it is common for patients to wait for long periods of time in the waiting room.

The district nurse is responsible for providing ongoing care to patients referred by the triage nurse. The patients wait for results from their tests as they are being monitored. In contrast, the clerk is responsible for completing the registration process where the patient’s information as presented by the triage nurse in addition to insurance information and consent forms are fed into the system.


The waiting room can be incorporated with physicians, triage nurses and other practitioners needed to treat minor cases to prevent overcrowding and increase efficiency of health care delivery. In addition, the use of papers during triaging is not only inefficient as more time is taken to duplicate the same information on the record system but also introduces avenues for errors during duplication. Additionally, although the system for tracking district nurse availability is computerized, regularly updates are sometimes not done resulting to triage nurses committing to memory who has been assigned where increasing the inefficiency.  An integrated electronic system can be used to integrate tracking and electronic medical record (EMR) systems to enable faster triaging. EMR enable more time to be allocated to patient care as opposed to documentation (Gruber et al., 2010). Since the pre-triaging nurse is located near the waiting area, there is a risk of confidential information being overheard. Providing a separate area where privacy can be observed will serve to preserve patient privacy.

A workflow chart is important in providing insight to how tasks are performed and the processes involved. It enables spotting duplication in activities and irrelevant tasks. This is helpful in looking for ways to optimize operations as flaws in the processes can be identified.


Emergency departments use both paper and electronic means to enter patient information. However, paper systems lead to inefficiencies and poor delivery of care. Using technology to speed up and increase efficiency is therefore a viable option. According to Fickenscher& Bakerman (2011), such a change is bound to present challenges and staff needs to be eased into the change. Such change is only possible with innovative leaders in health care (Hyrkäs& Harvey 2010).




Aronsky, D., Jones, I., Raines, B., Hemphill, R., Mayberry, S. R., Luther, M. A., &

Slusser, T. (2008). An Integrated Computerized Triage System in the Emergency Department. AMIA Annual Symposium Proceedings, 2008, 16–20.

Fickenscher, K., & Bakerman, M. (2011). Change management in health care IT.

 Physician Executive, 37(2), 64–67.

Gruber, N.G., et. al. (2010). Embracing change to improve performance: Implementation

 of an electronic health record system. Long-Term Living: For the Continuing Care Professional, 59(1), 29-31.

Hyrkäs, K., & Harvey, K. (2010). Leading innovation and change. Journal of

Nursing Management, 18(1), 1–3.

McGonigle, D., & Mastrian, K. G. (2012). Nursing informatics and the foundation of

 knowledge. Burlington, MA: Jones & Bartlett Learning.


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