Class 4 Unit 8 Topic 2 Comment 1

Thing to Remember:

Answer this discussion with opinions/ideas creatively and clearly. Supports post using several outside, peer-reviewed sources.

1 References, find resources that are 5 years or less

No errors with APA format 6 Edition

To Comment:

My facility, we recently had a push on Emergency Room (ER) Throughput.  The waiting times were longer than corporate wanted.  The times from exam to disposition were too long and so were the times from admission to arriving in the room.  Looking back on the process, I can see many of the eight steps of Kotter and Cohen’s Model of Change mentioned in our text (Melnyk & Fineout-Overholt, 2015).

Step 1 - The sense of urgency was created by corporate by setting a time table to decrease the times.  This feeling was transferred from our administration to the ER Director and then the staff.

Step 2 – A panel of nurses from the ER and each floor were created to provide ideas and input on decreasing admission to room times.  Another team in the ER contained ER staff, mid-level providers and physicians to help provide solutions to decrease the other times.

Step 3 – Vision and strategy was solely based on decreasing the throughput times for the ER. 

Step 4 – Communicating the vision was performed by team members and the ER Director.  They provided positive influence for the staff members to assist and not impede the process.

Step 5 – Empowering and removing barriers.  This may be a bit vague.  I feel the biggest barrier was the staff’s feelings of being rushed.  ER staff may have a critical patient in one room and an admission patient in another room.  The floor nurse may have several high acuity patients when the ER nurse is ready to bring up the patient.  There is a certain timing involved in the whole process.  Forcing the idea of rapid admission by developing a ten minute time limit for admission to room was the administrative resolution.  It is mostly obtainable, but sometimes difficult still.

Step 6 – Short term wins were provided by continuous evaluation of times during the implementation [process and providing results to the staff.  Positive reinforcement was regularly provided in huddles and staff meetings.

Step 7 – Ongoing persistence was provided by the push from corporate to meet benchmark standards they provided.  This was in turn reflected down the chain at our facility. 

Step 8 – Nourishment is provided and reinforced on a regular basis to remind the staff that ER Throughput was not a one-time deal.  It is now the standard and we need to continue the trend of timely admissions or discharges from the ER.

Reference

Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-Based Practice in Nursing & Healthcare (3rd ed.). Philadelphia: Wolters Kluwer.