Improvement and Efficiency in Patient Care
Kelley Schlosshan
Background
Healthcare organizations are confronted with numerous
challenges to deliver safe, effective and quality patient care.
The Institute of Medicine, the Joint Commission, and the
Centers for Medicare & Medicaid Services necessitate
continuous improvement in delivery of patient care. In
healthcare today, nurses are expected and required to use
evidenced-based clinical practice guidelines and contribute
to ongoing quality improvement i efforts, ensuring a safer
healthcare environment and providing excellent patient
care (Balakas & Smith, 2016). Prevention of medical errors
and omissions in patient care are essential. Hospitals have
reported reduced patient harm after investing in a quality
improvement program with lower hospital readmission
rates, decreased hospital acquired conditions, improved
patient mobility and decreased falls, and improved hand
hygiene and access to care (Sarff & O’Brien, 2019).
Introduction
Over the past several months, the preadmission testing
department has noticed a larger number of patients arriving
late to the joint replacement class. The nurses in our
department are responsible for getting the patients to class
on time. There has also been instances where patients
were left in the surgical waiting area because the nurse
forgets to take them up to class. Other components
contributing to patient tardiness include time management
challenges such as interruptions, phone calls, distractions,
and unforeseen variables.
Bon Secours Memorial College of Nursing
Graph 1 – % of Joint Patients Late to Class Results
60.0%
During the pre-data phase of the project, I observed data Two PDSA cycles were completed and the results did show
from August 12–September 10, 2019 and 52 patients were continued improvement. Following phase 2, the date
50.0% 50.0%
40.0%
37.5%
registered for class and of these patients 13 were late, 25%. indicated the percent of patients registered late is the same
30.0%
33.0%
25.0% 25.0%
During the first PDSA cycle from September 16-23, 2019, percent of patients arriving late to class, 14.3%. The next
20.0%
25.0%
20.0%
changes were implemented with the charge nurse in an phase would include working directly with the patient
10.0%
attempt to increase on-time arrival to class, resulting in a registrar to identify reasons patients are registered late and
0.0%
0.0% 0.0%
3% increase in on –time arrival. During this time, the charge also to track the amount of time it is taking to register
12-Aug 13-Aug 19-Aug 20-Aug
1
26-Aug 27-Aug 3-Sep 9-Sep 10-Sep
nurse made out the assignment by 4:30 pm on Fridays and patients. This process has show me that clear and
Additionally, the surgery center has only one registrar to Mondays a majority of the time. I listened to her make consistent communication can have a huge impact in
register surgery and preadmission testing patients, which reminder phone calls in which she communicates specific patient care and learning to identify other avenues of
the surgery patients take precedence. As a part of my directions to the preadmission testing location and time of changes to implement for continued process improvement.
quality improvement project, I chose to work on increasing arrival. The second cycle consisted of data from September Small incremental steps towards improvement can make a
on-time arrival to the joint replacement class to enable 30-October 8, 2019 and increased on-time arrival by 11%. difference and effective communication will contribute to
patient learning, improve patient outcomes, and staff Graph 2 – Challenges & Patients Late better outcomes.
efficiency. 45.0% 42.9%
References
40.0%
35.0% 33.3%
Balakas, K., & Smith, J. R. (2016). Evidence-Based Practice
Method 30.0%
25.0%
25.0%
28.6%
28.6%
and Quality Improvement in Nursing Education. The Journal
20.0%
15.0%
14.3% 14.3%
14.3%
of Perinatal & Neonatal Nursing, 30(3), 191-194.
In working with our charge nurse, there were several 10.0% 14.3%
https://doi.org/10.1097/JPN.0000000000000197
interventions initiated. In the reminder call, the charge 5.0%
0.0%
0.0%
0.0%
0.0%
0.0% 0.0%
0.0%
0.0%
Sarff, L., & O’Brien, R. (2019). Evidence-Based Quality
9/30/19 10/1/19 10/7/19 10/8/19
nurse gave specific instructions on location of appointment % of patients registered late % of time management challenges % of patients requiring a wheelchair % Patients Late
Improvement Training Programs: Building Staff Capability
to ensure the patients came to the correct location for Measures taken during this second cycle included and Organizational Capacity. Journal of Nursing Care
appointment. She increased the patients time of arrival to implementation of a Joint Replacement Class Checklist and Quality, 00(00), 1-7. https://doi.org/
appointment from 20 minutes to 30 minutes to allow for ensuring equipment such as two wheel chairs and EKG 10.1097/NCQ.0000000000000416
more time to register the patient. She agreed to make out machine were readily available on Mondays and Tuesdays.
the patient assignment by 4:30 pm on Fridays and Mondays
to allow time for nurses to review their charts. The only
changes implemented from the first cycle to the second was
a joint replacement class checklist and focusing on
Conclusion
equipment needs. The checklist served as a reminder for In summary, patients tardiness to the joint replacement
nurses of essential tasks and prevention of omission of care. class can affect patient’s learning and outcomes because
To improve efficiency, a nurse was assigned to get two they can miss vital information. Nurses are expected to
wheelchairs the day before and to ensure EKG machine is deliver high quality and safe care. In an effort to improve
available during the time of 8 am to 9:30 am on Mondays on-time arrival, it is necessary to review and implement
and Tuesdays. No unusual findings . new process measures.