Connecting Chronically Ill, Uninsured Patients Who Use the Emergency Department as a Medical Home: A Process Improvement Project

The risk of a needle stick or sharps injury in the operating room (OR) is high due to conditions such as minimal physical protective measures, frequent transfer of sharps, and reliance on human attention and skill for injury avoidance. An ergonomic process improvement project was initiated at a large metro teaching hospital to identify ergonomic risk factors for these OR injuries. To maximize the engagement of the front- end users, an ergonomic process improvement (EPI) team was developed, consisting of representatives from participating OR teams, an employee health nurse and two ergonomists. Surveys, observations, and interviews were conducted to quantify injury risk for the OR teams, evaluate barriers to best practice adherence, and identify opportunities for targeted interventions. Risk mapping was completed for the surgeons, surgical techs and OR nurses identifying double gloving and safe passing zone as areas in need of improvement. Through observation and interviews, researchers identified physical factors relating to musculoskeletal pain and cognitive factors leading to distractions as safety risk concerns. The overall success of the EPI was the engagement of the OR teams and surgeons in the process of identifying risk factors and potential opportunities for ergonomic solutions related to cognitive workload, physical workload, teamwork, and work design for injury prevention. The risk factors identified will provide the basis for developing targeted, effective interventions for eliminating injuries from needles and sharps within the OR.

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627 Strategies for Reducing Emergency Department Lengths of Stay for Admitted Pediatric Burn Patients

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.277 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S169-S169

Author(s):

Lisa M Shostrand ◽

Brett C Hartman ◽

Belinda Frazee ◽

Dawn Daniels ◽

Madeline Zieger

Keyword(s):

Emergency Department ◽

Gap Analysis ◽

Burn Patients ◽

Improvement Project ◽

Burn Trauma ◽

Charge Nurse ◽

Lengths Of Stay ◽

Burn Unit ◽

Set Up ◽

Trauma Activation

Abstract Introduction Various strategies to reduce emergency department (ED) lengths of stay (LOS) for admitted pediatric burn patients may be employed as a quality improvement project. Decreasing ED LOS may promote patient outcomes and reduce morbidity. Initial discussions were brought forth during trauma and burn multidisciplinary peer review rounds in March 2019 and have persisted to present day. Methods Several strategies, such as preparation of the burn unit staff within one hour of patient arrival in ED, notification to the burn unit by the burn attending of an incoming pediatric burn patient, allowing the PICU charge nurses or advisors to assist with room set up and admissions, and creating a checklist to assist PICU nurses and advisors in helping prepare for anticipating inpatient admissions. These strategies were designed and enforced in March/April 2019. In addition to these action plans, trauma activation alerts were added in December 2019 to the burn charge nurse phone for pediatric burn trauma one and trauma alerts for more expedient notifications. Finally, communication efforts between ED and burn leadership teams were conducted in June 2020 to help with additional mitigating of ED LOS, such as discussing the appropriateness of specialty consults while in the ED. Results Initial ED LOS was reduced from 209 minutes in March 1019 to 150 minutes in June 2019. Increased trends were noted in early 2020, with a peak at 244 minutes in July 2020. Additional interventions, such as trauma activation alerts and ED/Burn team communications, did not provide sustainable long-term reductions. Conclusions Recent strategies to reduce overall ED LOS trends have been beneficial, but not consistent, in sustaining downward trends. Action to perform a gap analysis to discover persistent barriers and to introduce additional structure, such as a burn trauma one algorithm, may provide stability to this metric.

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Estimating performance from capabilities in business process improvement

Business Process Management Journal ◽

10.1108/bpmj-09-2015-0129 ◽

2016 ◽

Vol 22 (6) ◽

pp. 1099-1117 ◽

Cited By ~ 4

Author(s):

Boyd A. Nicholds ◽

John P.T. Mo

Keyword(s):

Process Improvement ◽

Business Process ◽

Expected Improvement ◽

Management Decision ◽

Published Data ◽

Performance Gain ◽

Data Set ◽

Business Process Improvement ◽

Improvement Project ◽

Content Type

Purpose The research indicates there is a positive link between the improvement capability of an organisation and the intensity of effort applied to a business process improvement (BPI) project or initiative. While a degree of stochastic variation in applied effort to any particular improvement project may be expected there is a clear need to quantify the causal relationship, to assist management decision, and to enhance the chance of achieving and sustaining the expected improvement targets. The paper aims to discuss these issues. Design/methodology/approach The paper presents a method to obtain the function that estimates the range of applicable effort an organisation can expect to be able to apply based on their current improvement capability. The method used analysed published data as well as regression analysis of new data points obtained from completed process improvement projects. Findings The level of effort available to be applied to a process improvement project can be expressed as a regression function expressing the possible range of achievable BPI performance within 90 per cent confidence limits. Research limitations/implications The data set applied by this research is limited due to constraints during the research project. A more accurate function can be obtained with more industry data. Practical implications When the described function is combined with a separate non-linear function of performance gain vs effort a model of performance gain for a process improvement project as a function of organisational improvement capability is obtained. The probability of success in achieving performance targets may be estimated for a process improvement project. Originality/value The method developed in this research is novel and unique and has the potential to be applied to assessing an organisation’s capability to manage change.

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Process-Improvement Cost Model for the Emergency Department

Journal of Healthcare Management ◽

10.1097/00115514-201511000-00011 ◽

2015 ◽

Vol 60 (6) ◽

pp. 442-457 ◽

Cited By ~ 8

Author(s):

Sheila R. Dyas ◽

Eric Greenfield ◽

Sherri Messimer ◽

Swati Thotakura ◽

Sampson Gholston ◽

...

Keyword(s):

Emergency Department ◽

Process Improvement ◽

Cost Model

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Quality improvement primer part 2: executing a quality improvement project in the emergency department

CJEM ◽

10.1017/cem.2017.393 ◽

2017 ◽

Vol 20 (4) ◽

pp. 532-538 ◽

Cited By ~ 9

Author(s):

Lucas B. Chartier ◽

Antonia S. Stang ◽

Samuel Vaillancourt ◽

Amy H. Y. Cheng

Keyword(s):

Health Care ◽

Emergency Department ◽

Emergency Medicine ◽

Quality Improvement ◽

Improvement Project ◽

Emergency Department Setting ◽

Pdsa Cycle ◽

Time To Antibiotics ◽

Final Article

ABSTRACTThe topics of quality improvement (QI) and patient safety have become important themes in health care in recent years, particularly in the emergency department setting, which is a frequent point of contact with the health care system for patients. In the first of three articles in this series meant as a QI primer for emergency medicine clinicians, we introduced the strategic planning required to develop an effective QI project using a fictional case study as an example. In this second article we continue with our example of improving time to antibiotics for patients with sepsis, and introduce the Model for Improvement. We will review what makes a good aim statement, the various categories of measures that can be tracked during a QI project, and the relative merits and challenges of potential change concepts and ideas. We will also present the Model for Improvement’s rapid-cycle change methodology, the Plan-Do-Study-Act (PDSA) cycle. The final article in this series will focus on the evaluation and sustainability of QI projects.

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Resistance factors in the implementation of software process improvement project

2008 International Symposium on Information Technology ◽

10.1109/itsim.2008.4631933 ◽

2008 ◽

Author(s):

Mohd Hairul Nizam Md. Nasir ◽

Rodina Ahmad ◽

Noor Hafizah Hassan

Keyword(s):

Process Improvement ◽

Software Process ◽

Software Process Improvement ◽

Improvement Project ◽

Resistance Factors

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Process improvement project failure: a systematic literature review and future research agenda

International Journal of Lean Six Sigma ◽

10.1108/ijlss-02-2020-0022 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Jiju Antony ◽

Bart A. Lameijer ◽

Hans P. Borgman ◽

Kevin Linderman

Keyword(s):

Literature Review ◽

Process Improvement ◽

Systematic Literature Review ◽

Future Research ◽

Research Directions ◽

Improvement Project ◽

Project Failure ◽

Content Type ◽

Future Research Directions ◽

Research Propositions

Purpose Although scholars have considered the success factors of process improvement (PI) projects, limited research has considered the factors that influence failure. The purpose of this paper is to extend the understanding of PI project failure by systematically reviewing the research on generic project failure, and developing research propositions and future research directions specifically for PI projects. Design/methodology/approach A systematic literature review protocol resulted in a total of 97 research papers that are reviewed for contributions on project failure. Findings An inductive category formation process resulted in three categories of findings. The first category are the causes for project failure, the second category is about relatedness between failure factors and the third category is on failure mitigation strategies. For each category, propositions for future research on PI projects specifically are developed. Additional future research directions proposed lay in better understanding PI project failure as it unfolds (i.e. process studies vs cross-sectional), understanding PI project failure from a theoretical perspective and better understanding of PI project failure antecedents. Originality/value This paper takes a multi-disciplinary and project type approach, synthesizes the existing knowledge and reflects upon the developments in the field of research. Propositions and a framework for future research on PI project failure are presented.

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Why Parents Use the Emergency Department Despite Having a Medical Home

Clinical Pediatrics ◽

10.1177/0009922818809447 ◽

2018 ◽

Vol 58 (1) ◽

pp. 95-99 ◽

Cited By ~ 4

Author(s):

Kalpana Pethe ◽

Allison Baxterbeck ◽

Susan L. Rosenthal ◽

Melissa S. Stockwell

Keyword(s):

Emergency Department ◽

Low Income ◽

Medical Home ◽

Medical Problem ◽

Community Based ◽

Phone Line ◽

Medical Homes ◽

Medical Home Model ◽

After Hours ◽

Publicly Insured

Despite having a medical home, pediatric patients continue emergency department (ED) utilization for various reasons. This study examines parental reasons associated with the decision to seek ED care in a group of low-income, inner-city, publicly insured children. Surveys were conducted with parents of children (age = 0-19 years) presenting to a community-based clinic, which has an established medical home model with enhanced access. Most patients (88.3%) had a pediatrician, and nearly all (93.3%) reported a visit to the ED; most (75.7%) were aware of clinic walk-in hours, but less than half (42.6%) were aware of an after-hours phone line. There was no difference in those who were aware of walk-in hours or an after-hours phone line and a reported ED visit. Half of the parents (52.5%) thought their child’s medical problem was serious. In addition to providing enhanced efforts, medical homes should strive to make families aware of increased access.

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