Explain the need for creating an organizational policy or practice to address a shortfall in meeting a prescribed metric benchmark. 

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A Policy to Enhance Quality and Performance at the Emergency Department

Introduction:

The emergency department (ED) is essential to provide immediate, lifesaving treatment for patients. EDs are faced with significant challenges which affect patient care and lead to longer wait times, increased overcrowding and lower satisfaction. Door-to-provider is a key benchmark metric in EDs. This is how long it takes from the time a patient arrives at the ED until they’re seen by a provider. Our hospital’s door-to provider time is currently 45 minutes. This time falls below the benchmark of 30 minutes established by the Centers for Medicare & Medicaid Services (CMS). This proposal aims at developing policy and practices guidelines to improve our ED’s quality and address this issue.

Need for Change

Longer wait times between patients and providers can lead to patients not being seen, which increases the likelihood of negative outcomes, dissatisfaction among patients, and lower revenue. Moreover, waiting times increase the risk of overcrowding, straining resources and the staff, resulting in poor morale.

Recommendations for Strategies

To reduce the time between patient and provider, it is possible to use several strategies that are based on evidence. The strategies are based on optimizing triage, implementing lean methodology, team-based patient care and improving communication. To streamline the triage and improve flow, one solution could be to use nurse initiated protocols. The solution is shown to significantly reduce door-to provider time. Lean methods such as waste reduction and value stream mapping can also help streamline ED processes by identifying inefficiencies. Teams of care providers, including advanced practice providers and medical writers, are also a great way to improve the door-to provider time. Implementing a communication and collaboration tool can ensure that providers and staff are able to coordinate and hand off patients on time.

Implementation Guideline:

We recommend following these guidelines to implement the strategies:

1. Set up a task force multi-disciplinary to oversee the implementation of policies and guidelines.
2. Establish clear and concise guidelines and protocol for triage and patient flow.
3. Nurse-initiated protocol can be used to reduce door-to provider time and improve the flow of patients.
4. Use Lean methods such as waste reduction and value stream mapping to reduce waiting times and streamline processes.
5. Use advanced practitioners and medical scribes in order to see more patients.
6. Create a platform for communication and collaboration to improve provider coordination and transfer.

Environmental Factors:

These strategies can be affected by a number of environmental factors, including CMS regulations, personnel, finance, logistics and support services. To ensure compliance, the implementation of these strategies requires a comprehensive review of current regulations and policies. In addition, the introduction of advanced practitioners and medical scribes could require extra staffing or resources that would affect the financial viability. These strategies are proven to increase efficiency, decrease waiting times and ultimately improve revenue.

Stakeholders:

The following stakeholders should be involved with the implementation and development of these guidelines: senior management, ED personnel, nursing staffs in advanced practices, medical scribes (medical scribes), patient advocates and regulatory agencies like CMS.

Conclusion:

Our ED can be significantly improved by implementing evidence-based methods to decrease the door-to provider time. Establishing policies and guidelines can help streamline processes and reduce waiting times. This will also improve the patient experience. The strategies proposed are culturally and ethically inclusive, and they aim to improve quality care for everyone. We can achieve a successful implementation and sustainability of the policies and guidelines by involving all relevant stakeholders.