Walden Improving Discharge Procedures to Reduce Unnecessary Emergency Department Return Visits Proposal I need a well done abstract of the project proposal

Walden Improving Discharge Procedures to Reduce Unnecessary Emergency Department Return Visits Proposal I need a well done abstract of the project proposal attached. please add everything in the same paper.

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This DNP project is unable to be implemented in the facility chosen due to covid19 pandemic that cause that facility laid off employees due to dropping census to an 80% of the ED visits. The project will be worked in a different way which will not include staff or patients participation in questionnaires due to covid19 events. However, this project is already in use in the state of New York. I was activated to be deploy as a covid19 responder for NYC H+H hospital system were epicenter started. Now, the way that the discharge procedures are managed in NYC is through Epic electronic medical record system and is proven to work. I had the experience to work with this discharge procedure and this includes preferred patient language materials, appointment for follow up with primary care, specialists and ambulatory free clinics or private clinics. Patient gets high quality of care and discharge instructions. The way it works is when you discharge a patient from the ED you will had the preferred language, add diagnosis this diagnosis prompts out education material regarding etiology, treatments and enough material to keep patient inform of their current condition after finishing this step, you get to chose with whom patient will follow up if is an specialist, primary care or clinic, you click on any of these options and it will prompt an appointment and a scheduler phone number for the patient to call and confirm their follow up appointment. The next step is to add treatment antibiotics etc this will prompt information of the prescribed medication and the pharmacy for medication pick up. I learned that discharge procedures in NYC is all online and patient only gets copy of what is needed to follow up. This discharge procedures shows the way every provider in NYC is communicating. The patient plan of care is not changed in the contrary it continues because all the providers are in the same track since they have access to everything that was done in the ED and the plan to follow for their expedite recovery and helps patients to be compliant. My project is with the same focus and vision. I understand this was reduces unnecessary visits to ED just because patient couldn’t follow up for not having an appointment or appropriate treatment etc. This reduces overcrowding ED, reduces health care cost and reduces poly-pharmacy since all providers are communicating. NYC data cannot be share with my project since it was not the facility of intended practice it just happened to be the facility that is actually providing high quality of discharge to their patients. Running head: IMPROVING DISCHARGE PROCEDURES
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Improving Discharge Procedures to Reduce Unnecessary Emergency Department Return Visits
IMPROVING DISCHARGE PROCEDURES
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Improving Discharge Procedures to Reduce Unnecessary Emergency Department Return 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
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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
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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
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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 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 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
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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
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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
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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 poorquality 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.
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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
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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.
Needs Assessment
The volume of patients’ received in the ED from December, 2019 to March, 2020 ranges
anywhere from 72 to 98 patients per day, with 35% of these patients returning back to the ED
because they did not obtained instructions for follow up, unexplained diagnoses, and not given
test results so they can provide to their primary care provider for continuity of care. This issue
has caused primary care providers to referred patients back to ED for further treatments or
follow-up care. From that 35% of unnecessary return visits, 12% ends up being admitted to the
hospital due to the failure to complete treatment and to the lack of instructions in care after they
had been discharged from the ED. There are several information gaps which occur due to the
unavailability of patient information that were previously collected by physicians. Information
gaps were present in around one-third of the visits to the emergency department. These gaps
meant that physicians were not able to provide high quality care to patients upon their first visit,
increasing the chances of unnecessary return visit to the emergency department (Hayward et al.,
2018).
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Return visits to the ED are presently a metric of the adequacy of ED discharge activities.
The short returns to the ED are constantly monitored with metrics. This metric mirrors the ED
quality, particularly in situations where patients need re-hospitalization. Nonetheless, there issues
embracing unnecessary return visits as proportions of value since it is unsure and connected with
unpredictable results. The ED offers care for a blend of the patient population. A considerable
number of patients are released home after treatment without appropriate education related to
follow-up care. This analysis distinguished the issue in relation with adult population in the ED.
This investigation recognizes the challenges that address the difficulties related with unnecessary
return visits. The doctors in the ED must realize how to adjust expected hospitalization benefits
against costs related with hospital stay and clinical vulnerability when settling on choices
concerning patient hospitalization.
Literature Review
A literature search conducted in the current body of research for this topic. This included
online library search of peer reviewed evidence-based articles, site library, and journals. The
identified documents were reviewed and collected as part of evidence. References listed of each
document for the identification of relevant publications. The research conducted online for the
purpose of this investigation were reliable sources such as Cochrane library, MEDLINE, and
CINAHL. The irrelevant articles were limited by using accurate terms.
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,
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emergency department discharge policies, high quality discharge, best discharge process in the
emergency department, improve emergency department discharge process.
Literature Synthesis
Return visits to emergency departments in medical facilities are one of the mo…
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