Discussion Board I need at least 350 words and 3 references. Please see attached presentation so you can have an idea of what I'm talking about.
Michelle_Michy
20200521094010proposal_presentation_20201.pptxImproving Discharge Procedures to Reduce Unnecessary Emergency Department Return Visits
Name:
DNP Project Proposal
Purdue University Global
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Unnecessary return visits to the emergency department are a problem for most healthcare facilities face across Florida and other states.
Unnecessary return visits are indicators of poor care quality.
Numerous studies have demonstrated emergency departments discharge procedures are a significant contributor to unnecessary return visits (Taylor, 2000).
This issue creates gabs in continuity of care for patients resulting in an inadequate or incomplete emergency department discharge.
The healthcare providers must realize that inadequate discharge negatively impacts patient compliance with care, treatments and follow-ups.
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Introduction
Unnecessary return visits to the emergency department are a problem for most healthcare facilities face across Florida and other states. Unnecessary return visits are indicators of poor care quality. Numerous studies have demonstrated emergency departments discharge procedures are a significant contributor to unnecessary return visits (Taylor, 2000). This issue creates gabs in continuity of care for patients resulting in an inadequate or incomplete emergency department discharge. The healthcare providers must realize that inadequate discharge negatively impacts patient compliance with care, treatments and follow-ups. Providing verbal and pre-formatted written discharge instructions to the patient does not guarantee that the patient understands information provided. The patient must understand the medical information given and participates in their care. The best way to achieve patient understanding is communicating, and reinforcing while acknowledging culture, belief and language barriers.
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Project Purpose
The purpose of this project is to implement a discharge tool that will help healthcare providers to better communicate with patients and better achieve patient understanding.
The proposed intervention is to implement a discharge checklist tool that enables patients to document their understanding of discharge instructions by marking and answering questions about the discharge instructions packet.
The patient and the provider will document the exchange by both signing the discharge tool. The tool will remain in the patient’s medical records.
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Introduction
The purpose of this project is to implement a discharge tool that will help healthcare providers to better communicate with patients and better achieve patient understanding. The proposed intervention is to implement a discharge checklist tool that enables patients to document their understanding of discharge instructions by marking and answering questions about the discharge instructions packet. The patient and the provider will document the exchange by both signing the discharge tool. The tool will remain in the patient’s medical records.
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Problem Background and Significance to Healthcare
Florida Hospitals have been working to reduce costs and increase health care quality.
Despite hospital efforts, reducing emergency department unnecessary return visits has not been completely addressed.
In Florida, 28% of acute care visits and 50% of hospital admissions originate from the Emergency Department (ED).
Variables contributing to excess ED patient readmission rates include older age, non-ambulatory status, and absence of family support.
The unnecessary return visits are important care quality indicators.
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Introduction
The hospitals in the state of Florida have been striving to cut the cost, the problem of return visits to the emergency department has not been completely addressed. These visits are not only inconvenient to the healthcare personnel, but also an important indicator of the quality of care. The hospitals ED constantly face the issue of restricted assets, high rates of patient admissions, aging populace, and deficiency of human services suppliers. Majority of the ED have gotten amazingly overcrowded leading to long delays in care which contributes negatively to the patients' outcomes since they cannot get treated on time.
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Project Relationship to Advanced Nursing Practice and DNP Essentials
Offers nurses the opportunity to more effectively perform their patient care and discharge duties
Doctors and APRN can analyze itemized patient and disease data
Project will increase ED patient care trainings, including discharge skills that reduce return visits
Project’s intensive training will target nurses’ and doctors’ roles that maximize patient engagement.
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Introduction
This project has a close connection with Advanced Nursing Practice and DNP essentials, it provides nurses with an opportunity to perform their duties regarding patient discharge and patient care. Nurses assume a key role in transforming care. They can offer clarifications concerning discharge to the patients which will involve the factors that emerge while the patient is at home, and how to move toward circumstances that may force them to return to the ED
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Practice Setting and Target Population/ Community
The project will be done in the Florida Celebration community.
The project practice site is a private emergency department in Polk County.
The project target population includes adults with an average age of 35 years.
Diverse population:
African Americans, Hispanics, Asians, Native Americans, and multi-racial persons.
Gender distribution (49.1% male; 50.9% female).
Average family size of 3.14 persons.
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Introduction
The Celebration community in Florida is populous, which makes it an ideal area to create and execute the intervention. The population for this DNP Project is located in an acute care hospital in rural Central Florida. They have differing social foundations, which are primarily dictated by race. Among the social or cultural perspectives that prevail in the American culture can be ordered into whites, African Americans, Hispanic, Asians, Native Americans, and individuals with a mix of two races. The estimated demographic descriptors of the population are 49.1% male and 50.9% female and a median age of 35 for both genders. The population has an average family size of 3.14. The health literacy of the target population varies significantly according to race.
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Project Alignment with Practice site Mission and Goals
Project objectives align with practice site mission and goals
Project site goal is to eliminate poor-quality patient care indicators and enhance high-quality patient care provision
Project increases patient care quality and reduces unnecessary ED return visits
Increases care transition safety, which is essential to improving patient experiences, reducing costs, and enhancing patient outcomes.
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Introduction
The practice site for this project is a standalone emergency department in Polk County in the state of Florida. The facility is currently open twenty-four hour daily and staffed with healthcare professionals such as physicians, mid-levels providers, registered nurses and paramedics. Its mission and goals are closely aligned with the project objectives which include providing high quality care to patients, ensuring patient compliance with discharge instructions and patient satisfaction. Other goal aligned with project is safe transitions of care, that is essential in promoting better patient experiences, reducing costs, and enhancing the quality of outcomes. Unscheduled return visits to the emergency department reflects inadequate follow-up procedures or discharge practices. The goal of the project site is to eliminate indicators of poor-quality patient care and ensure that the facility enhances its provision of high-quality care by providing sufficient resources to the patients for them to be compliant with their care.
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Key Stakeholders
ED Patients, Families, and Caregivers
ED Providers – Nurses and Physicians
Managers
Insurance companies
Pre-hospital care personnel
Home care providers
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Introduction
The key stakeholders in this project are patients and families, and the physicians, nurses, home care providers, managers, and prehospital care personnel, as well as the insurance companies who pay for the patients’ medical care. The emergency department stakeholders primarily focus on the several indicators that that focus mainly on their capacity to provide quality care.
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Project Benefit to Practice Setting
Project will have multiple practice setting impacts, including:
Increase the quality of patient care, discharge processes and follow-up care.
Reduce the overall cost of patient care
Reduce ED over-crowding
Improve clinical practice of nurses, physicians and other healthcare practitioners.
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Introduction
The major benefits of this project to clinical practice is to ensures improvement of the quality of care, patient satisfaction, discharge process and follow-up care, as well as significantly reducing the overall cost of patient care. According to Lee et al (2015) a study done by Dr. Sabbatini and colleagues, it was determined that patients who unnecessary return to ED for further treatment have longer lengths of stay and increased costs during the repeat hospital admissions compared to those who do not return to the emergency department. A greater understanding of the essentials of this project will be beneficial to physicians, nurses and other healthcare practitioners and improve their clinical practice; hence enhancing the overall patient care and outcomes, preventing unnecessary return visits to the emergency department.
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Range of 72- 98 daily ED patient admissions.
Excess non-emergent ED visits - 35% of patients return due to unclear follow up instructions, inadequate diagnosis explanation, or missing test results.
Potentially avoidable hospital admissions - 12% of return ED patients are admitted.
Return visit reasons - failure to complete treatment, relevant to insufficient discharge instructions.
More than a third of the revisits happen due to information gaps
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Needs Assessment
The volume of patients’ received in the ED ranges anywhere from 72 to 98 patients per day., with 35% of these patients returning back to the ED because they did not have instructions for follow up, diagnoses explained, or test results given so they can provide to their primary care provider which has cause the PCP to referred the patient back to ED for further treatments. From that 35%, 12% end up being admitted due to their failure to complete treatment and to the lack of instructions in care after they had been discharged.
Databases
Cochrane library
MEDLINE
CINAHL
Key words
Return visits
Emergency department
Overcrowding
Discharge process
Quality of care
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Literature Review
The research conducted online for the purpose of this investigation were reliable sources such as Cochrane library, MEDLINE, and CINAHL. The key words utilized for the search of this project were the following: return visits in the emergency department, discharge process in the emergency department, emergency department overcrowding, quality of care in the emergency department, correct way to discharge a patient from the emergency department, return visits to the emergency department costs, emergency department discharge policies, high quality discharge, best discharge process in the emergency department, improve emergency department discharge process
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| Title | Author(s) | Year | Article Type | Grade | Summary |
| Return visits to the emergency department: The patient perspective | Rising, L. k, Padrez, A, B’Brien, M, Hollander. E. J Carr, G. B & Shea, A. J. | 2014 | Original Research | 2 | The paper summarizes the perspectives of patients on the reasons for return visits to emergency departments |
| Minimizing ED waiting times and improving patient flow and experience of care | Sayah, A, Rogers, L, Devarajan, K, Rocker, K. L & Lobon, F, L. yah et al. | 2014 | Original Research | 1 | The paper examines the ways of minimizing waiting time in emergency departments and to improve experience of care |
| Revisiting the behavioral model and access to medical care: Does it matter? | Andersen, R. | 1995 | Original Research | 2 | The paper looks at the behavioral models applied in healthcare and the extent to which it influences the quality of care |
| National health surveys and the behavioral model of health services use. Med Care | Andersen RM | 2008 | Original Research | 2 | The paper also looks at various health behavioral models and the extent to which they impact access to health services |
| Societal and individual determinants of medical care utilization in the United States | Andersen, R., & Newman, J. F. | 2005 | Original Research | 2 | The paper discusses the societal and individual factors that determine the utilization of care services in the country |
Literature Review
The purpose of this section is to provide a review of the literature regarding the concept of return visits of patients to Emergency Departments (ED) and the extent to which they affect the quality of care in medical facilities.
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| Title | Author(s) | Year | Article Type | Grade | Summary |
| Emergency department visits | Centers for Disease Control and Prevention | 2017 | Short report | 1 | Discusses a wide range of emergency issues in many health facilities |
| Trends in emergency department use by rural and urban populations in the United State | Ericksen, G, M & Kocher, K. | 2019 | Original Research | 1 | The paper takes a look at the trends in America’s emergency departments with a keen interest in quality indicators |
| Environmental health | Healthy People 2020 | 2019 | Short Report | 1 | The paper looks at the environmental factors that influence the health of individuals |
| Examining health literacy disparities in the United State: A third look at the National Assessment of Adult Literacy (NAAL) | Rikard et al. Rikard, V. R, Thompson, S. M, McKinney, J & Beauchamp, A. | 2016 | Original Research | 1 | The paper summarizes health literacy in the United States. It is concerned with the manner in which health literacy impacts health choices |
Literature Review
The authors mentioned that before patients are discharged from medical facilities, there is a need to make sure that they have enough information that they will rely on during their recovery. However, in many instances, the medical care providers fail, out of human error, to give adequate instructions to the patients. In these instances, mistakes occur, and these mistakes may have adverse effects on the recovery of the patients.
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Project Theoretical Framework
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The Andersen health utilization framework will guide study execution
Andersen framework used to analyze and explain the factors that influence people’s ability to access healthcare services
Alignment with Project
The framework may be used to improve the quality of care in emergency departments
Through this model, it will become possible to have an understanding of the nature of the challenges facing the department. Such knowledge will be helpful in the determination of quality improvement strategies. The Andersen framework of health utilization makes it possible to understand the implications of discharging patients before giving them adequate care services. Additionally, explores quality of care through outcomes and patient satisfaction. The framework will make it possible to create a connection between quality of healthcare services in the emergency departments and the rates of unnecessary returns visits.
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Project summary and expected outcomes
The project aims to implement of a clinical tool to reduce unnecessary return ED visits.
Anticipated outcomes include:
Reduced unnecessary ED returns.
Reduced avoidable hospital admissions.
Increased ED patient care quality.
Increased patient treatment compliance.
Increased patient satisfaction.
Improved ED provider competence.
Reduced patient care costs, and unreimbursed care form medical insurances.
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Project Description
By educating doctors, mid-levels providers and nurses on how to utilize the discharge tool they should be able to provide a high-quality discharge instruction to the patients. Most importantly, once individuals have been educated on the appropriate way to discharge a patient from the ED, it can be assumed these patients will continue to seek care accordingly.
Project Description
Project Timeline
Project Budget and Justification
| ITEM | COST ($) |
| Employee training and materials, e.g., printing costs | $127.89 |
| Discharge checklist tool copies | $152.59 |
| Discharge policy changes, printed papers of evidence-based data collection and editing services | $175.00 |
| TOTAL | $455.48 |
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March – April 2020: Existing Employee Training
April-May 2020: Review existing policies
June 2020: Impact analysis and change introduction
Implementation will follow discharge checklist tool development.
Patients will mark checklist boxes to document understanding of discharge instruction packet.
Patients will sign if satisfied with the discharge instructions received from the physicians and nurses.
Provider will also sign tool, documenting delivery of complete discharge instructions.
Upon project proposal approval, an application will be submitted for IRB approval.
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Project Implementation Plan
The nurses are at an ideal position of providing the discharge instructions appropriately because they are in direct contact with patients. Nurses can take this opportunity to explain in detail all the questions that the patients have and even asking them questions to ensure that they understand the provided information in detail.
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Discharge Checklist Tool
| EMERGENCY DEPARTMENT PATIENT DISCHARGE CHECKLIST Hospital Logo Patient Label | ||
| DISCHARGE CHECKLIST | ANSWERS | COMMENTS |
| Language of preference | Spanish | |
| Certified interpreter present | Yes | C.P #1234 |
| Education given: Verbal, Written, Video | Verbal and Written | |
| Diagnosis | Hypertension | |
| Prescriptions given | Yes | Beta Blockers |
| Prescriptions instructions explained | Yes | Side effects |
| Test results given: verbal, copies | copies | Explained |
| Follow up care with specialists or PCP given | Yes | Dr. John Doe Cardiologist |
| Care notes given and discussed | Yes | Monitor B/P, HTN diets |
| Hospital property returned | Yes | Gown, blankets |
| Presense of next of kin | No | No companion |
| Discharge instructions understood | Yes | |
| Addional instructions material provided | No | |
| PATIENT SIGNATURE | Joe Doe | |
| DISCHAGE NURSE SIGNATURE | CPales MSN ARNP | |
| DISCHARGE DOCTOR SIGNATURE | John Doe MD |
The implementation strategy will be a classroom presentation and training of the appropriate ways for discharging patients and how to utilize the new discharge checklist tool.
A pre-test and post-test will be provided in order to validate employees learning and understanding of the material given.
Employees at the facility need to be trained on then-emerging medical practices.
Intensive training can concentrate on improving the role of doctors, nurses and incorporating patient engagement.
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Project Implementation Plan
The implementation strategy will be a classroom presentation and training of the appropriate ways for discharging patients and how to utilize the new discharge checklist tool. A pre-test and post-test will be provided in order to validate employees learning and understanding of the material given. Most importantly, employees at the facility need to be trained on then-emerging medical practices. From the interaction with the employees, it is notable that a significant number of the employees, especially the medical staff, are not conversant with the prevailing medical practices. Intensive training can concentrate on improving the role of doctors, nurses and incorporating patient engagement. The efforts can guarantee that patients don't go to the emergency department again because discharge instructions were not provided the correct way, or no one took the time to make sure that patient understood entirely after care.
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The data analysis is taken from the answers provided by ED employees questionnaire which was evident of avoidable mistakes that some of the staff members commit during discharge process.
One of the possible reasons is the failure of the organization to train employees and enhance their skills continually in discharging patients from ED.
The efforts can guarantee that patients don't go to the emergency department again because discharge instructions were not provided the correct way, or no one took the time to make sure that patient understood entirely after care.
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Data Analysis Plan
The data analysis is taken from the answers provided by ED employees questionnaire which was evident of avoidable mistakes that some of the staff members commit during discharge process. One of the possible reasons is the failure of the organization to train employees and enhance their skills continually in discharging patients from ED. The implementation strategy will be a classroom presentation and training of the appropriate ways for discharging patients and how to utilize the new discharge checklist tool. A pre-test and post-test will be provided in order to validate employees learning and understanding of the material given. Most importantly, employees at the facility need to be trained on then-emerging medical practices. From the interaction with the employees, it is notable that a significant number of the employees, especially the medical staff, are not conversant with the prevailing medical practices. Intensive training can concentrate on improving the role of doctors, nurses and incorporating patient engagement. The efforts can guarantee that patients don't go to the emergency department again because discharge instructions were not provided the correct way, or no one took the time to make sure that patient understood entirely after care.
The plan is to evaluate if employees are adapted to new changes with discharge process and evaluation of unnecessary return visit outcomes.
This will help to determinate if the project was successful and sustainable.
The next step is to make changes in the current discharge policy by adding discharge checklist tool in the policy.
This step will assure that project will sustain, and all employees will be required to discharge patients appropriately.
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Project sustainability
There is a need to evaluate the suitability of data collection instruments.
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Project Evaluation Plan
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Select formative evaluation approaches:
Generation of possible intervention ideas.
Testing of ideas and concepts.
Seeking early responses to assess intervention acceptability.
Establishing communication channels to acquire staff perspectives of intervention implementation process.
Summative evaluation processes:
Determine if project is completed within planned timelines.
Evaluate target audience responses to assess goal achievement.
Quantify meaningful change in patient outcomes
Formative evaluation is an important process that helps individuals, groups and teams to determine whether they are on course with their project. Some of the approaches with which formative evaluation will be conducted in this project
Summative evaluation is an incredibly important exercise whose primary objective is to measure the success or lack of it in a project implementation. By conducting a summative evaluation, it becomes possible to know if the project has achieved its goals.
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Data Collection Plan
Data collection will play an important role in the accurate determination of the most relevant approaches to use in addressing the needs of the facility. Then the accuracy of data will make it possible to develop the most suitable approaches to solve the challenges facing society. One of the approaches that is used in data collection is a questionnaire. The questionnaire will be provided to patients who are leaving the hospital, the medical and non-medical staff of at the facility. Specifically, the open-ended questionnaire will be used to enable then individuals to provide all the necessary information that may be useful in making decisions concerning the hospital. An open-ended questionnaire is advantageous in the sense that it is possible for a respondent to provide additional information that was not sought in the questionnaires (Saris & Gallhofer, 2014).
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Information Dissemination Plan
Written dissemination
Final project paper
Oral presentation to key stakeholders
Telling the story
Future scholarship
Submit article for publication
Submit abstract for national conference presentation
The project will be disseminated throughout doctors and nurses working in the emergency department via educational activity and training. The information will contain the reason for training, problem, the importance of quality of care and the implementation of a new discharge tool to ensure a reduction of unnecessary return visits to the emergency department. This project will extensively address the issues that make these return visits to be rampant in the health facilities. The educational material and training will provide possible interventions that will improve the situation. In the long run, it is expected that this project will be essential in improving the outcome of emergency unnecessary returns in hospitals.
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Executive Summary
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The project purpose is to implement a clinical intervention to reduce excess unnecessary return ED visits.
The project will address issues that result in excess unnecessary return visits.
The project will identify factors that contribute to unnecessary ED return visits
The project will provide evidence to support policy changes to improve discharge processes, and subsequently reduce unnecessary ED return visits and avoidable hospital admissions.
The purpose of this project is the implementation of a clinical intervention to ensure a reduction of unnecessary return visits to the emergency department. The problem is the healthcare providers are not providing high quality of discharge instructions to patients and it reflects as a poor quality of care. The findings in this project indicates that patients are returning to the ED unnecessarily due to the lack of resources provided by health care providers upon discharge. These providers are not explaining diagnosis entirely, treatment options, side effects and follow-up care resources to patients. On the other hand, many patients do not understand medical terminology and further education such as reinforcing is needed, others is language barrier issue because translation takes a lot of time. Many healthcare providers in the ED are in a fast pace and time is not enough for explanations which have led to poor quality of care. The issue is causing patients to return to ED due to poor outcomes in patient care. At the moment, it is evident several challenges are making it possible for many healthcare facilities to realize increased cases of unnecessary return visits. The purpose of this project is to addressed these issues by training healthcare providers on appropriate ways to discharge patients and also the implementation of a discharge checklist tool that will ensure that patients receive discharge instructions in their preferred language with all resources needed well explained in simple vocabulary to help patient to understand after care plan or treatments. This project will improve the quality of care and will reduce unnecessary return visits to the emergency department.
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Questions?
Improving Discharge Procedures to Reduce Emergency Department Return Visits
Christine M Pales
Purdue University Global
February 27, 2020
