You are the unit director of the emergency department and part of an ad hoc interdisciplinary committee newly formed to address a 30% rise in arrival-to- provider time over the past six months. Six months ago, the ED consistently recorded an arrival-to-provider time less than the national benchmark of twenty minutes. The arrival-to-provider time is presently over one hour. A root cause analysis study finds that arrivals to the ER have increased by 50% and the lobby is usually filled to capacity. Often patients must stand due to lack of adequate seating. FTEs have not been added and staffing is consistently short due to call-offs. Patients are not being discharged from inpatient beds in a timely manner. The task for the committee is to propose a solution for the problem. Looking at this through the lens of an evidence-based quality improvement process, what would you propose as the PICOT for this initiative? Who are the stakeholders represented in your group? (Remember, this is an internal organizational issue, and while patients are impacted by the issue and are the beneficiaries of the work done, they would not be included in this type of task force)
(for your review, see the example for developing a PICOT below or refer to the Nurse Executive Track CGE Academy webinar located in resources and announcements)
Discuss how the perspectives for the PICOT differ depending on the discipline represented by each stakeholder? What impact will they have on the group process and in team building? How is the group process and team building effected by the organization’s culture and climate of transparency and safety? How will the outcomes of the committee be impacted?
Part 1 I don’t see this as an ER issue entirely. I believe they are appropriately staffed; they are having staff calling off likely due to increased stress of the workload in their department and what has become an unhealthy work environment. Adding more FTE’s won’t fix the problem of throughput, which is where I believe the problem lies; not moving patients out in a timely manner upon discharge from the inpatient beds on the nursing units. It flows from the top down, not the bottom up. I think most people see the ER as the problem, when, many times, not necessarily all, it is because patients are not discharged timely. According to Cleak et al. (2022)….Kindly click the purchase icon to purchase the full solution at $5