Order ID | 53563633773 |
Type | Essay |
Writer Level | Masters |
Style | APA |
Sources/References | 4 |
Perfect Number of Pages to Order | 5-10 Pages |
Improving Discharge Procedures to Reduce Unnecessary Emergency Visits
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.
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.
Expected Outcomes
After educating doctors, mid-levels providers and nurses on how to utilize the
discharge tool they should be able to provide patients higher quality discharge
instructions.
Most importantly, once individuals have been educated on the appropriate way to
discharge an ED patient, it can be assumed these patients will continue to seek care
accordingly. The implementation of this tool is expected to achieve the following
outcomes.
· Reduce or possibly eliminate unnecessary ED returns visits.
· Improve the ED quality of care.
· Improve patient satisfaction.
· Improve providers competence.
Negative Outcome
Negative outcomes can occur with the implementation of the discharge tool. The
providers will need to take time to explain and make sure the patient understands
discharge material. This can cause a delay in discharges that will lead to an increase
in discharge time. The issue can be resolved by delegating certain discharge topics
between doctors and nurses.
For example, the doctors will discuss diagnosis, test results and treatments with the
patient, while nurses will discuss treatment side effects, follow-up care and reinforce
all material given.
Background
Although hospitals have been striving to cut the cost, this goal has not been
satisfactorily addressed because of the problem of unnecessary return visits to the
ED. Most hospitals in the state of Florida have been concentrating on reducing 30-
day readmission with a few activities and intercessions (Centers for Disease Control
and Prevention, 2017).
In Florida, it is estimated that 28% of the acute care visits and half of the hospital
admissions emerge from the ED (Center for Disease Control and Prevention, 2017).
The authorization of Patient Protection and Affordable Care Act 2010 has shown the
requirement for coordinating patient care voice in structuring the conveyance of
social insurance (Rising et al., 2014).
The clarifications for patients to come back to the ED, the possibility of future return,
and the recurrent unnecessary return visits can be obtained from administrative data.
Some common factors have been associated with high rates of readmission of
patients to ED.
They include low follow up care and any language barrier that limits patients from
understanding the discharge instructions. Other variables include old age, non-
ambulatory status, and absence of family support.
These visits are not only cumbersome to the healthcare personnel, but also an
important indicator of the quality of care. The EDs constantly face the issue of limited
resources, high rates of patient admissions, aging population, 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 be treated
on time. Patients returning to the emergency department have medical issues that
have either failed to go away or improve or have gotten worse.
Being an important metric to measure the quality of healthcare, the problem of
unnecessary return visits to the ED is very important to healthcare providers since it
provides with essential information regarding their performance.
A reduction in the rate of unnecessary return visits to the ED is a marker of high-
quality care, while an increase in the rate signifies poor healthcare performance and
poor patient outcomes.
Advanced Practice Relationship
The nurse practitioners possess a deep level of knowledge in health care that allows
managing a broad spectrum of clinical problems that ends with positive outcomes.
Nurses assume a key role in transforming care.
They can offer cross cultural competencies and proficiency in care that leads to clear
clarifications concerning patient discharge which involve the factors that emerge
while patient is at home, and how to move toward circumstances that may force
them to return to the ED (Rafnsson & Gunnarsdottir, 2010).
This will help keep the patients from heading off to the ED once more. Moreover,
nurse practitioner’s relationship with patients is built on working together to achieve a
positive outcome which helps with care compliances.
Nurse practitioners are proven to decrease patients ED visits, hospital admissions,
and healthcare cost (Rushforth, 2015). The nurse practitioner can provide training
that points towards upgrading the nurses and doctor roles that incorporates patient
engagement.
DNP Essentials
This DNP Project is supported by the eight DNP Essentials. The essential I am the
scientific underpinnings of this education which reflect the complexity of practice at
the doctoral level and the rich heritage that is the conceptual foundation of nursing
(AACN, 2006).
The educational part of this project will assist healthcare providers to understand the
patterning of human behavior in interaction with the environment in normal life
events and critical life situations after being discharge from the ED.
This will help improve science discipline by understanding the nature and
significance of health and health care delivery phenomena. This essential also
maintains that the extensive understanding of the nursing theory ensures that
advanced nursing practice is built upon a solid foundation.
Graduates can therefore integrate nursing practice with organizational or analytical
sciences (AACN, 2006). These science-based concepts can therefore be used to
improve the quality of healthcare.
Essential II is the organizational and systems leadership to improve quality and
systems thinking meaning that doctoral level knowledge and skills in these areas are
consistent with nursing and health care goals to eliminate health disparities and to
promote patient safety and excellence in practice (AACN, 2006).
This essential helps in transforming research into practice. The project is based on
quality improvement by making changes to current discharge policies by providing
the best practice to discharge a patient. This will improve patient outcomes after
being out of the ED and prevent them from returning because they didn’t understand
discharge/after care instructions.
Essential III states scholarship and research are the hallmarks of doctoral education
(AACN, 2006). This essential mainly focuses on the complex issues that face
modern health.
It further focuses on the medical dilemmas that physicians face in patient care, as
well as shaping the evidence-based initiatives in the agenda of healthcare. The
project uses analytic methods to critically appraise existing policies and other
evidence to determine and implement the best practice to discharge a patient from
the ED.
Essential IV allows the DNP prepared nurse to design by selecting, utilizing, and
evaluating the programs that monitors outcomes of care, care system, and quality
improvement including consumer use of health care information system (AACN,
2006).
This project contains a significant analysis that involved patient’s quality of care and
the utilization of patient care technology. Findings represent an opportunity to
evaluate the return visits to ED for inappropriate discharge.
Essential V refers to engagement with the policy development by identifying the
problem and creating a healthcare system that meets the needs (AACN, 2006). This
project helps the DNP prepared nurse to educate others such as policy makers
regarding patient outcomes, policy change, and the correct way of discharging a
patient from the ED. Additionally, would address and facilitate health care needs in
acute care setting.
Essential VI states the importance of effective communication and collaborative skills
in the development and implementation of practice models (AANC, 2006). The
project demonstrates a collegiality within the community of knowledgeable people
from different professions in health care system with endeavors to serve the
population by utilizing healthcare resources.
Essential VII DNP prepared nurses is expected to evaluate care delivery models and
the utilization of using concepts related to community, environment and occupational
health, and cultural and socioeconomic dimensions of health (AACN, 2006).
The project embraces the community to the extent of knowledge by supporting
strategies directed to improve all dimensions of health. Additionally, supports the
theoretical framework that is utilized to guide the project in the community as a
whole.
Essential VIII the DNP prepared nurse is expected to design, implement, and
evaluate therapeutic interventions based on nursing science and other sciences
(AACN, 2006). This project focuses on the established strengths and knowledge of
the NP by applying them to the ability of the researcher of effectively evaluate, teach
and educate individuals on the correct alternative provision of health care. This
Essential shows DNP prepared nurse ability to demonstrate advanced levels of
clinical judgment such as systems thinking, accountability in designing, evaluating
evidence-based care to improve patient outcomes.
Population and Setting
Florida’s Celebration community 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 varying cultural backgrounds, which are mainly determined by race. Local
residents can be categorized into whites, African American, Hispanic, Asians, Native
Americans, and people with a combination of two races. The culture of the target
population impacts their health, beliefs about diseases and death, lifestyles as well
as health promotion.
The psychosocial dimensions include can be categorized into three. Medical
dimensions relate to the type of treatment, the perception of suffering, and the
clinical course.
Psychological factors cover the disruption of life goals and the potential of adjusting
life plans using coping strategies and emotional stability. The social factors comprise
the availability of support from close associates such as friends, family, and co-
workers.
Project Alignment with Practice Site Mission and Goals
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.
Target Population
The environmental factors for the target population are significant in influencing the
quality of their health and defining the necessary preventive measures. It is
estimated that 23% of all deaths in the world, as well as 26% of deaths in children
below the age of 5, are contributed by environmental factors that can be prevented
(Healthy People 2020, 2019).
Some of the factors that impact the target population include climate change,
exposure to toxins in food, water, air and soil, the contamination of their habitats, and
occupational dangers.
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. For example, 14% of the whites are proficiency in health literacy;
the rate literacy rate for Hispanics is 4%, with that of the African American being only
2% (Rikard et al., 2016).
The intermediate literacy rate for the three races is 58%, 31%, and 41 %,
respectively. The proficiency level implies that individuals can clear read, write,
understand, and solve problems. The intermediate level suggests that people can
experience a problem, such as solving problems. Health literacy has direct impacts
on health outcomes.
Literate people have better outcomes than illiterate ones. In 2016, the life
expectancy of the target population was 78.8 (Rikard et al., 2016). Diabetes and
stroke caused 21.3 and 37.6% of all deaths in this population. The adults that smoke
cigarette makes 15.1% of the entire population. It is further estimated that 21.8% of
the people visit the emergency room at least once a year.
Key Stakeholders
The key stakeholders in this project are 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 focus mainly on their capacity to provide quality care.
For emergency departments to effectively respond to patient care needs, the
stakeholders must step in to ensure the current environment of health care delivery,
enabling the ED to adjust changing models of care delivery; hence creating a
controlled process that enhances the achievement of goals and efficiencies of the
healthcare facility.
Benefit of Project
The major benefits of this project to clinical practice are 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.
Conclusion
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 are 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.
References
Andersen RM, (2008) National health surveys and the behavioral model of health
services use. Medicine Care. 46(7), 647–653. doi:
10.1097/MLR.0b013e31817a835d.
Andersen, R. (1995). Revisiting the behavioral model and access to medical care:
Does it matter? Journal of Health and Social Behavior. 36(3), 1-10, Retrieved from
http://www.jstor.org/discover/10.2307/2137284
Andersen, R., & Newman, J. F. (2005). Societal and individual determinants of
medical care utilization in the United States. The Milbank Quarterly, 83(1), 1–28
Boyle, A., Beniuk, K., Higginson, I., & Atkinson, P. (2012). Emergency department
crowding time for interventions and policy evaluations. Emergency Medicine
International, 13(1), 9-16.
Centers for Disease Control and Prevention [CDC]. (2017). Emergency department
visits. Retrieved from https://www.cdc.gov/nchs/fastats/emergency-department.htm
Chan, A. H. S., Ho, S. F., Fook-Chong, S. M. C., Lian, S. W. Q., Liu, N., & Ong, M.
E. H. (2016). Characteristics of patients who made a return visit within 72 hours to
the emergency department of a Singapore tertiary hospital. Singapore Medical
Journal. 57(6), 301-308.
Dugas, A. F., Hsieh, Y. H., Levin, S. R., Pines, J. M., Maraniss, D. P., Mohareb, A.,
… & Rothman, R. E. (2012). Google Flu Trends: correlation with emergency
department influenza rates and crowding metrics. Clinical Infectious Diseases. 54
(4), 463-469.
Ericksen, G, M & Kocher, K. (2019). Trends in emergency department use by rural
and urban populations in the United State. JAMA Network Open. 2(4), 19 Retrieved
from https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2730472
Esmailian, M., Zamani, M., Azadi, F., & Ghasemi, F. (2014). Inter-rater agreement of
emergency nurses and physicians in Emergency Severity Index (ESI)
triage. Emergency Medicine Journal. 2(4), 158.
Gallagher, R. A., Porter, S., Monuteaux, M. C., & Stack, A. M. (2013). Unscheduled
return visits to the emergency department: the impact of language. Pediatric
Emergency Care. 29(5),579-583.
Healthy People 2020. (2019). Environmental health. Retrieved from
https://www.healthypeople.gov/2020/topics-objectives/topic/environmental-health
Heider, D., Matschinger, H., Müller, H., Saum, K. U., Quinzler, R., Haefeli, W. E., &
König, H. H. (2014). Health care costs in the elderly in Germany: an analysis
applying Andersen’s behavioral model of health care utilization. BMC Health
Services Research. 14(1), 71.
Jiménez-Puente, A., del Río-Mata, J., Arjona-Huertas, J. L., Mora-Ordóñez, B.,
Martínez-Reina, A., del Campo, M. M., & Lara-Blanquer, A. (2017). Which
unscheduled return visits indicate a quality-of-care issue? Emergency Medicine
Journal. 34(3), 145-150.
Kuan, W. (2009). Emergency unscheduled returns: can we do better? Singapore
Medicine Journal. 50(11), 68-71.
Padgett DK, Brodsky B, (1992). Psychosocial factors influencing non-urgent use of
the emergency room: a review of the literature and recommendations for research
and improved service delivery. Social Science Medicine Journal. 35(9),1189–1197.
doi: 10.1016/0277-9536(92)90231-E.
Reach, G. (2014). Patient autonomy in chronic care: solving a paradox. Patient
preference and adherence. 8(1), 15-24. Doi: 10.2147/PPA.S55022. Retrieve from
https://www.ncbi.nlm.nih.gov/pmc/articles/24376345/
Rikard, V. R, Thompson, S. M, McKinney, J & Beauchamp, A. (2016). Examining
health literacy disparities in the United State: A third look at the National Assessment
of Adult Literacy (NAAL). Doi: 10.1186/s12889-016-3621-9. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5022195/
Rising, L. k, Padrez, A., B’Brien, M., Hollander, E., J. Carr, G. B & Shea, A. J.
(2014). Return visits to the emergency department: The patient perspective. Annals
Emergency Medicine. 65(4), 377-386. Doi: 10.1016/j.annemergmed.2014.07.015.
Sandman, L., Granger, B. B., Ekman, I., & Munthe, C. (2012). Adherence, shared
decision-making, and patient autonomy. Medicine, Health Care, and Philosophy.
15(2), 115-127.
Saris, W. E., & Gallhofer, I. N. (2014). Design, evaluation, and analysis of
questionnaires for survey research. Chapter 3: The Formulation of Requests for an
Answer, p. 60- 72. John Wiley & Sons, second edition.
Sauvin, G., Freund, Y., Saïdi, K., Riou, B., & Hausfater, P. (2013). Correction:
unscheduled return visits to the emergency department: consequences for
triage. Academic Emergency Medicine. 20(3), E3-E9. Doi: 10.1111/acem.12052.
Sayah, A, Rogers, L, Devarajan, K, Rocker, K. L & Lobon, F, L. (2014). Minimizing
ED waiting times and improving patient flow and experience of care. Emergency
Medicine International, 2014(1), 1-8, doi: 10.1155/2014/981472 Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4009311/
Shehab, N., Lovegrove, M. C., Geller, A. I., Rose, K. O., Weidle, N. J., & Budnitz, D.
S. (2016). US emergency department visits for outpatient adverse drug events,
2013-2014. JAMA Network Open. 316(20), 2115-2125. Doi:
10.1001/jama.2016.16201.
Sun, B. C., Hsia, R. Y., Weiss, R. E., Zigmond, D., Liang, L. J., Han, W., … & Asch,
S. M. (2013). Effect of emergency department crowding on outcomes of admitted
patients. Annals of emergency medicine. 61(6), 605-611. Doi:
10.1016/j.annemergmed.2012.10.026
Taylor, D. M. (2000). Discharge instructions for emergency department patients:
what should we provide? Emergency Medicine Journal, Vol. 17 (2), p. 86-90.
doi:10.1136/emj.17.2.86
Terrell, S. R. (2012). Mixed-methods research methodologies. The Qualitative
Report Journal. 17(1), 254-280.
Trivedy, C. R., & Cooke, M. W. (2015). Unscheduled return visits (URV) in adults to
the emergency department (ED): a rapid evidence assessment policy
review. Emergency Medicine Journal, 32(4), 324-329.
Van der Linden, M. C., Lindeboom, R., de Haan, R., van der Linden, N., de Deckere,
E. R., Lucas, C., & Goslings, J. C. (2014). Unscheduled return visits to a Dutch
inner-city emergency department. International Journal of Emergency Medicine. 7(1),
|
||||||||||||||||||||||||||||||||
GET THIS PROJECT NOW BY CLICKING ON THIS LINK TO PLACE THE ORDERCLICK ON THE LINK HERE: https://www.perfectacademic.com/orders/ordernowAlso, you can place the order at www.collegepaper.us/orders/ordernow / www.phdwriters.us/orders/ordernow |
||||||||||||||||||||||||||||||||
|