PurdueGlobal Improving Discharge Procedures for Return Visits ED Paper its only to correct what is indicated on attachment and paste this info. Please just

PurdueGlobal Improving Discharge Procedures for Return Visits ED Paper its only to correct what is indicated on attachment and paste this info. Please just follow the comments in the paper attached it tells u what to fix. 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 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 address 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. Initially meant to be implemented at a standalone emergency department in Polk County in the state of Florida, the procession of this project has shifted significantly because of the Covid-19 pandemic that has affected healthcare facilities all over the country, and the world over. The facility has been forced to lay off most of its staff, while the percentage of ED visits has reduced by 80%. For these reasons, the project will be implemented in different ways without the use of patients and emergency room staff. The success of this method of implementation has already been proven as it is in use in New York. The discharge procedures are managed through an epic electronic medical record system. After being deployed as a Covid-19 responder for NYC H+H hospital system, I have been working with this discharge procedure which include preferred patient language materials, appointment for follow up with primary care, specialists and ambulatory free clinics or private clinics. Even though it is yet to be implemented in Florida, this project has been proven to work effectively and yield positive results such as higher rates of patient outcomes and satisfaction, higher quality care, and reduced rates of unnecessary return visits to the ED. This project will therefore improve the quality of care and will reduce unnecessary return visits to the emergency department. Running head: IMPROVING DISCHARGE PROCEDURES
Improving Discharge Procedures to Reduce Unnecessary Emergency Department Return Visits
Purdue University Global
May 29, 2020
IMPROVING DISCHARGE PROCEDURES
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Abstract
Unnecessary return visits to the emergency room (ER) has prevailed as a critical problem for
healthcare institutions and their staff members, as well as the patients. While the hospitals might
spend a significant amount of money and resources in caring for returning ER patients, the patients
also accrue increasing healthcare costs. To address this issue, this project explores the
implementation of a discharge tool that will help medical staff to better communicate with patients
resulting in patients’ better understanding of the discharge instructions and procedures.
Initially meant to be implemented at a standalone ER in Polk County, Florida, this project has
shifted significantly because of the Covid-19 pandemic’s nation- and world-wide affect on
healthcare facilities. The facility was forced to lay off most of its staff, while the percentage of ED
visits has decreased 80%. For these reasons, the project will be implemented in different ways
without the use of patients and emergency room staff. The potential success of a highly organized
discharge process, has already proven useful in New York City (NYC) during the COVID-19
pandemic response. The discharge procedures are managed through an EPIC electronic medical
record system. After being deployed as a COVID -19 responder for the NYC H+H hospital system,
I have been working with this discharge procedure, which includes preferred patient language
materials, and follow-up appointments with primary care, specialists and ambulatory free or
private clinics. The patients, therefore, get high quality of care and receive effective discharge
instructions that not only prevent them from returning to the ER but also reduces the number of
ER visits during these trying times.
Keywords: Unnecessary return visits, EPIC electronic medical record system, high-quality care
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Table of Contents
Improving Discharge Procedures to Reduce Unnecessary Emergency Department Return Visits 4
Purpose …………………………………………………………………………………………………………………………………. 4
Expected Outcomes………………………………………………………………………………………………………………… 4
Negative Outcome ………………………………………………………………………………………………………………….. 5
Background …………………………………………………………………………………………………………………………… 5
Advanced Practice Relationship ……………………………………………………………………………………………… 6
DNP Essentials ………………………………………………………………………………………………………………………. 7
Population and Setting …………………………………………………………………………………………………………… 9
Project Alignment with Practice Site Mission and Goals ………………………………………………………… 10
Target Population ………………………………………………………………………………………………………………… 10
Key Stakeholders …………………………………………………………………………………………………………………. 11
Benefit of Project………………………………………………………………………………………………………………….. 12
Needs Assessment …………………………………………………………………………………………………………………. 12
Literature Review ………………………………………………………………………………………………………………… 13
Literature Synthesis ……………………………………………………………………………………………………………… 14
Causes of Unnecessary ED Return Visit ………………………………………………………………………………… 14
Impacts of Unnecessary ED Return Visits ……………………………………………………………………………… 16
Reducing Rates of Unnecessary ED Return Visits ………………………………………………………………….. 17
Theoretical Framework ………………………………………………………………………………………………………… 17
The Rationale for the Choice of the Conceptual Framework ………………………………………………….. 18
Relationship of the Theory/Framework …………………………………………………………………………………. 19
Identify Change Theory ……………………………………………………………………………………………………….. 20
Project Implementation Plan ………………………………………………………………………………………………… 20
Preparation ………………………………………………………………………………………………………………………….. 20
Protection of Human Subjects ………………………………………………………………………………………………. 21
Project Budget ……………………………………………………………………………………………………………………… 21
Implementation ……………………………………………………………………………………………………………………. 21
Data Collection …………………………………………………………………………………………………………………….. 22
Pretest for providers …………………………………………………………………………………………………………….. 23
Posttest for providers ……………………………………………………………………………………………………………. 23
Project Timeline …………………………………………………………………………………………………………………… 24
Data Analysis ……………………………………………………………………………………………………………………….. 24
Project Evaluation ……………………………………………………………………………………………………………….. 25
Formative Evaluation …………………………………………………………………………………………………………… 26
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Summative Evaluation………………………………………………………………………………………………………….. 26
Project Sustainability……………………………………………………………………………………………………………. 27
Conclusion …………………………………………………………………………………………………………………………… 27
References ……………………………………………………………………………………………………………………………. 29
Appendix ……………………………………………………………………………………………………………………………… 33
List of Figures
Figure 1: Andersen framework of health utilization ……………………………………………………………………….. 37
Figure 2: Discharge checklist tool ……………………………………………………………………………………………….. 38
Figure 3: Questionnaire for patients upon discharge ………………………………………………………………………. 39
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Improving Discharge Procedures to Reduce Unnecessary Emergency Department Return
Visits
Unnecessary return visits to the emergency department are a problem that 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 gaps in continuity of care for patients resulting in an inadequate or incomplete emergency
department discharge. Healthcare providers must realize that inadequate discharge negatively
impacts patient compliance with care, treatments, and follow-ups. Providing verbal and preformatted written discharge instructions to the patient does not guarantee that the patient
understands the 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, beliefs, 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-level providers, and nurses on how to utilize the discharge
tool, they should be able to provide patients higher quality discharge instructions. Most
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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.
•
Increase patient satisfaction.
•
Strengthen 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 specific 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 strive to cut costs, this goal has not been satisfactorily addressed due
to unnecessary return ED visits. 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 the 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,
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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. The
majority of the ED has 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 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 the 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
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patients from heading off to the ED once more. Moreover, the 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 costs (Rushforth, 2015). The nurse practitioner can provide training that points
towards upgrading the nurses and doctor roles that incorporate patient engagement.
DNP Essentials
This DNP project is supported by the eight DNP Essentials. The essential I is 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 discharged 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
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out of the ED and prevent them from returning because they did not understand
discharge/aftercare 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 inpatient 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 monitor 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 a patient’s quality of care and the utilization of patient care
technology. Findings represent an opportunity to evaluate the return visits to the ED for
inappropriate discharge.
Essential V refers to engagement with 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 policymakers regarding patient outcomes, policy
change, and the correct way of discharging a patient from the ED. Additionally, it would address
and facilitate health care needs in the 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 collegiality within the community of knowledgeable people from different
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professions in the 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, it 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 Americans, Hispanics, 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
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dimensions relate to the type of treatment, the perception of suf…
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