Quality Improvement Initiative to Reduce Waiting Time and Crowding at the Emergency Department

The emergency department plays a central role in saving lives, promoting health, and enhancing access through timely interventions, proper diagnosis, care, and treatment. However, the emergency department at the hospital based in Maryland is experiencing significantly long waiting times and crowding. Long waiting times and crowding adversely affect healthcare quality, safety, access, effectiveness, efficiency, and patient experiences (Imhoff et al., 2022). Crowding and long waiting time are also associated with increased risks of adverse events, ineffectiveness, and inefficiency. They also adversely affect healthcare workers’ well-being, including increased safety risks, high stress levels, and low morale, resulting in poor care quality and outcomes (Oullet et al., 2022). Thus, there is a need for a quality improvement initiative to reduce crowding and waiting time at the emergency department and improve care quality, safety, and effectiveness. Therefore, the purpose of this presentation is to request the hospital board for funding approval to support the successful implementation of the quality improvement program.

The Purpose of the Quality Improvement Program

The hospital serves a large and broadly diverse community within Maryland, including referrals from other healthcare providers. However, the emergency department currently operates above capacity leading to long waiting time, crowding, avoidable referrals, and difficulties in accessing appropriate care (Austin et al., 2020). These challenges adversely affect quality, patient safety, staff well-being, and overall outcomes (Imhoff et al., 2022). Accordingly, the quality improvement initiative aims to reduce waiting time and crowding at the emergency department by ensuring timely attention to all patients. Thus, the primary aim is to address the long waiting time and crowding and the associated adverse effects on healthcare quality, safety, access, effectiveness, efficiency, and overall outcomes.

The Target Population or Audience

The quality improvement initiative targets to benefit the local population served by the hospital within Maryland, especially patients seeking emergency health care. The target population is broadly diverse and includes people from different racial, ethnic, cultural, and social-economic backgrounds. The program also aims to improve healthcare workers’ well-being, including increasing their safety, effectiveness, morale, and job satisfaction (Imhoff et al., 2022). Accordingly, the audience includes all healthcare workers, leaders, and managers.

In addition to the patients, other audience includes nurses, clinicians, physicians, nursing managers, leaders, audit teams, and hospital administrators. The quality improvement program will also require the approval of the hospital board of management for funding and effective implementation. Some critical components of the quality improvement program will include adopting advanced and innovative healthcare management information and communication technologies, acquiring additional equipment, and staff training (Oullet et al., 2022). They will also include adopting evidence-based and more effective care and treatment approaches, methods, and techniques to enhance quality, safety, efficiency, and cost-effectiveness.

The Benefits of the Quality Improvement Initiative

The quality improvement initiative has significant potential benefits. The expected benefits include reduced waiting time and crowding, smooth flow of patients, and effective and efficient health care service delivery. Other benefits include improved healthcare quality and safety, reduced adverse events, and patient experiences (Jones, Vaux, & Olsson-Brown, 2019). They also include increased staff morale, job satisfaction, productivity, cost-effectiveness, and efficiency (Imhoff et al., 2022). The quality improvement program will also enhance the operational capacity of the emergency department, reducing boarding and the likelihood of some patients leaving before receiving appropriate care.

Additionally, implementing the quality improvement program will considerably improve the quality of health care and patient and staff safety. It will increase operational and cost-effectiveness and service delivery efficiency, enhancing access, affordability, patient and staff experiences, and overall outcomes (Imhoff et al., 2022). It will also improve patient documentation and processing, communication effectiveness, collaboration, and coordination, enhancing timely decision-making, care quality, and patient participation (Austin et al., 2020). Moreover, the quality improvement program will reduce the risks of adverse events, including documentation and medication errors, misdiagnosis, hospital-acquired infections, prolonged admission, re-admissions, deteriorating conditions, and mortality (Oullet et al., 2022). It will also enhance the hospital’s ability to attract and retain healthcare staff, serve more patients, and promote health and overall outcomes. Therefore, it is instrumental for the hospital board to approve funding for the program and offer appropriate leadership and managerial support.

The Inter-Professional Collaboration that would be Required to Implement the Quality Improvement Initiative

The successful implementation of the quality improvement initiative will require effective inter-professional collaboration. The inter-professional collaboration will involve effective communication, close coordination, relations, teamwork, and support among the different healthcare teams, professionals, and departments (Imhoff et al., 2022). Accordingly, the successful implementation of the quality improvement program will require inter-professional collaboration among nurses, clinical officers, physicians, managers, leaders, and administrators (Jones, Vaux, & Olsson-Brown, 2019). It will also require collaboration with other support staff and professionals working in crucial departments, including the ICT, finance, admissions, and records departments. Moreover, implementing the quality improvement initiative will require collaborating with the hospital’s board of management, top leadership, and management to ensure adequate funding, effective resource allocation, policy, and other support.

The Cost or Budget Justification

Adequate funding and effective resource allocation will be instrumental in ensuring the successful implementation of the quality improvement program. The estimated budget and allocations are tabulated below.

The estimated cost of acquiring advanced and innovative healthcare management information and communication technology is US $ 14,500. Adopting the latest healthcare management information and communication technology will improve the hospital’s ability to collect, process, analyze, share, and access patient and other relevant data for timely and effective decision-making (Imhoff et al., 2022). It will also support artificial intelligence and analytics to predict patient flow and improve planning accurately. Technology will also improve communication and information management, sharing, and access to enhance inter-professional collaboration, patient engagement, and decision-making. The emergency department requires additional health care equipment like beds, wheelchairs, laboratory kits, and personal protective equipment at an estimated cost of US $16,800 to increase the operational capacity and safety.

The estimated budget for staff training and retention is US$ 21 700. Staff training, development, and retention are central to improving healthcare quality, safety, access, effectiveness, and efficiency (Oullet et al., 2022). Recruiting, training, and retaining a highly skilled and motivated workforce also increase staff satisfaction, productivity, effectiveness, quality, staff, patient engagement, health, and well-being (Imhoff et al., 2022). Additionally, the budget includes US$ 2,000 to support sustainable operations and maintenance. Significantly, approving the funding will help to address the identified problems and improve overall quality and outcomes.

The Basis for Evaluating the Quality Improvement Program

Effective monitoring and evaluation will be integral in promoting successful program implementation. The specific basis for evaluating the quality improvement program will include adherence to the budget, timeliness, and other identified targets. It will also include assessing the specific changes, outcomes, and benefits accruing from implementing the program (Jones, Vaux, & Olsson-Brown, 2019). Thus, the evaluation parameters will include changes in the average waiting time, the number of patients waiting for service, and referrals to other healthcare providers following the program implementation (Imhoff et al., 2022). They will also include the time taken to diagnose, treat, admit, and discharge a patient (Oullet et al., 2022). Other evaluation parameters will include the number of staff trained, improvements in staff and patient satisfaction levels, the rate of employee turnovers, and reported adverse incidences.

Conclusion

The quality improvement initiative seeks to reduce the waiting time and crowding at the emergency department. Addressing the long waiting time and crowding will significantly improve healthcare quality, effectiveness, safety, and access. It will also increase staff retention, satisfaction, and productivity, positively impacting patient engagement, experiences, and overall health promotion and outcomes. Therefore, the board’s approval for the quality improvement program funding and implementation support will considerably improve the health care quality, safety, cost-effectiveness, efficiency, and overall outcomes at the emergency department and the entire hospital.

References

Austin, E.E., Blakely, B., Tufanaru, C., … & Clay-Williams, R. (2020). Strategies to measure and improve emergency department performance: a scoping review. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 28(55). https://doi.org/10.1186/s13049-020-00749-2

Imhoff, B., Marshall, K., Nazir, N., Pal, A & Parkhurst, M. (2022). Reducing time to admission in emergency department patients: a cross-sectional quality improvement project. BMJ Open Quality, 11(3):e001987. doi:10.1136/bmjoq-2022-001987

Jones, B., Vaux, E. & Olsson-Brown, A. (2019). How to get started in quality improvement. BMJ, 364:k5408. doi: https://doi.org/10.1136/bmj.k5437.

Oullet, S., Galllian, M.C.,Gelinas, C., … & Berube, M. (2022). Strategies to improve the quality of nurse triage in emergency departments: A realist review protocol. Nursing Open. https://doi.org/10.1002/nop2.1550