Literature Search, Rapid Critical Appraisal, and Summary

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Developing PICOT for Wait Times in The ER.

Vanessa Fandino

West Coast University

NURS 350 Research in Nursing

Dr. Sara Turpel

September 5th, 2021

Description of the Topic and the background information

The recent years have experienced an increase in the flow of patients in the emergency department, especially in the Western nations. This has led to the increase in the overcrowding in the emergency department thus extending the waiting times. Many factors have been linked to this phenomenon and one of them is the continuity of the primary care services. Other factors are the availability of specific clinical pathways for chronic patients; and the endowment of the personnel within the emergency departments (Vainieri et al., 2020).

The overcrowding leads to severe limitations of the hospital functions. It leads to delays in the patients' care and poor healthcare outcomes. The overcrowding is associated with the increased waiting times, and this leads to dissatisfaction from both physicians and nurses who are working under pressure. The patient is also dissatisfied with the services since it makes them wait for long to be treated. Specifically, waiting times are amongst the most important causes of emergency department patients' dissatisfaction. The adverse effect of the long waiting times in the emergency department is the change in the perception of the patients about the quality of services they are receiving (Vainieri et al., 2020). The complaints of the dissatisfied patient are reported, and this causes more pressure on the policymakers and the hospital managers to develop effective interventions.

The significance of the topic to nursing practice

The study is important to the nursing practice since it reveals the necessary changes that are required to ensure that there is improvement in emergency responses. It enables nurses or hospital management to learn about some of the factors that affect the high emergency waiting times. Some of the factors or concerns that the supervisors in the healthcare facilities can focus on are the emergency department endowment, the productivity of the staff, and the availability of the equipment that can be used to ensure that the problems are solved.

The study is also important since it helps in ensuring that the management can determine how the organization within the hospital facility for example the presence of the fast-tracking paths or the ability of the wards to help with rapid identification of the patients who require urgent admission. The study is also important in the nursing practice since it enables the nurse supervisors or hospital managers to determine the cause of the high admission rates and the increase in the waiting times by the patients. The managers get the opportunity of investigating a mix of problems associated with the factors the result in the patient long waiting times socially during emergencies (Lungu et al, 2019). The study is also important to the nurse practice since it guides the managers and the policymakers in developing some of the protocols that are based on the organizational choices associated with the hospital resource allocation.

PICOT Questions

For the elderly patients (Population) visiting the hospital for emergency services, is triage approach (Intervention) effective than no intervention (Comparison) in the reduction of waiting times (Outcome) during emergency service (Time)?

For the patients seeking emergency services (Population), does change in the patient triage and the caregiver workflow (Intervention) with the present model (Comparison) help in the reduction of the patient overcrowding and reduction in the length of stay (Outcome) for the one week stay in the facility (Time)?

For the patients waiting in the emergency department (ED) (Population), will patient placement in result pending units (RPU) (Intervention) compared to no intervention (Comparison) assists in improving the emergency department patient flow by reducing the emergency waiting times and length of stay (LOS), and improve patient satisfaction (Outcomes) throughout patient stay at the hospital (Time)?

References

Vainieri, M., Panero, C. & Coletta, L. Waiting times in emergency departments: a resource

allocation or an efficiency issue? BMC Health Serv Res 20, 549 (2020). https://doi.org/10.1186/s12913-020-05417-w

Lungu, D.A., Grillo Ruggieri, T. & Nuti, S. (2019). Decision making tools for managing waiting times and treatment rates in elective surgery. BMC Health Serv Res 19, 369. https://doi.org/10.1186/s12913-019-4199-6