The evidence-based practice (EBP) process is a powerful way of advancing improvements in health care. Identify three strategies that you will…

Evidence-Based Practice Appraisal.Assessment Description

For professional writing in nursing and health care, APA style is expected. It is also expected for the remainder of your graduate program and in doctoral programs for nursing. Discuss what you have learned, or how you have improved, by completing the \”APA Writing Checklist\” and from receiving feedback from your instructors. What aspects of APA do you still struggle with? In your response to peers, provide a resource from the Student Success Center (or in addition to something in the Student Success Center) or a suggestion for an area in which someone still struggles.

Topic 8 DQ 2

Assessment Description

The evidence-based practice (EBP) process is a powerful way of advancing improvements in health care. Identify three strategies that you will now incorporate into your practice based on this course. Explain your rationale.

Benchmark – Evidence-Based Practice Project Proposal Final Paper

Assessment Description

For this assignment, you will synthesize the independent evidence-based practice project proposal assignments from NUR-550 and NUR-590 into a 4,500-5,000-word professional paper.

Final Paper

The final paper should:

  1. Incorporate all necessary revisions and corrections suggested by your instructors.
  2. Synthesize the different elements of the overall project into one paper. The synthesis should reflect the main concepts for each section, connect ideas or overreaching concepts, and be rewritten to include the critical aspects (do not copy and paste the assignments).
  3. Contain supporting research for the evidence-based practice project proposal.

Main Body of the Paper

The main body of your paper should include the following sections:

  1. Problem Statement
  2. Organizational Culture and Readiness
  3. Literature Review
  4. Change Model, or Framework
  5. Implementation Plan
  6. Evaluation Plan

Appendices

The appendices at the end of your paper should include the following:

  1. All final changes or revisions for the drafts will be included in the appendices of your paper.
  2. Complete the \”APA Writing Checklist\” to ensure that your paper adheres to APA style and formatting criteria and general guidelines for academic writing. Include the completed checklist as the final appendix at the end of your paper. In each preceding course you have been directed to the Student Success Center for assistance with APA style, and have submitted the APA Writing Checklist to help illustrate your adherence to APA style. This final paper should demonstrate a clear ability to communicate your project in a professional and accurately formatted paper using APA style.

General Requirements

You are required to cite 10-12 peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

Benchmark Information

This benchmark assignment assesses the following programmatic competencies:

MBA-MSN; MSN-Nursing Education; MSN Acute Care Nurse Practitioner-Adult-Gerontology; MSN Family Nurse Practitioner; MSN-Health Informatics; MSN-Health Care Quality and Patient Safety; MSN-Leadership in Health Care Systems; MSN-Public Health Nursing

1.1: Translate research and knowledge gained from practice, while adhering to ethical research standards, to improve patient outcomes and clinical practice.

5.1: Design ethically sound, evidence-based solutions to complex health care issues related to individuals, populations, and systems of care.

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/health care

Benchmark -Evidence-Based Practice Project

Overcrowding in the Emergency Department (ED) and accompanying delays significantly impact the quality of care and patient outcomes. Some of the negative consequences associated with ED overcrowding include but are not limited to ambulance diversion, increased numbers and rates of patients who left without being seen, boarding in the ED, and the general inability to enjoy timely access to care (McKenna et al., 2019). Healthcare experts and scholars are aware that while the demand for hospitals continues to increase with the increasing population, this exponential growth is not matched with an increase in resources. 

As such, bed management is currently a key parameter for every healthcare organization that endeavors to provide health care that is not only of high quality but also cost-effective. Therefore, there is a need for nursing executives to put in place an efficient utilization of the available beds that captures a comprehensive and complete understanding of the facility in the context of operational behavior. Failure to optimize hospital bed utilization successfully due to the finite number of ED beds available, the long wait times adversely impact patient outcomes, public health outcomes, poor patient and staff satisfaction levels, and depressing hospital revenue. Consequently, this paper outlines the development of proposed evidence-based practice (EBP) project for a large acute care medical facility targeting to improve the process of throughput by implementing a novel bed assigning system using a bed ahead concept as the desired operating procedure.

Proposed Project Overview

The overarching purpose of the proposed project is to develop and implement an EBP change within the selected facility to improve the throughput in the ED with a specific focus on the admitting unit of medical-surgical patients using a bed ahead concept. The paper highlights emergency overcrowding and ineffective bed assigning as the nursing practice problem and explores the organizational culture and readiness for change. There is also a review of the available evidence followed by Lewin’s change model as the guiding model and change theory before a concise summary of the proposed implementation plan. The project outcomes evaluation plan follows before concluding with the project’s main highlights. Because many terms and definitions exist to describe particular aspects of nursing practice and healthcare service provision, the following subsection gives a contextual meaning of key terms and concepts. According to Van Mill & Herman (2016), the list of words ensures the reader aptly understands the essence of the meaning in the given context.

Contextual Definition of Key Terms

Patient Throughput: The movement of patients from the time they arrive at a health care facility to the time they are discharged, detailing the care, resources, and decision-making utilized to ensure the patients move through a health care facility.

Length of stay (LOS): Time elapsed in minutes for patients between the times they arrive at the time they depart.

A bed ahead concept: A streamlined and standardized patient admission workflow from the ED through hospital bed optimization to the admitting inpatient units in a bed assigning concept that ensures there is always a minimum of one bed available for the next evaluated patient.

Pull model system: A service delivery system where the timely transition of work from one step within the process to another is the primary responsibility of the downstream or subsequent operation. For example, in this context, the medical-surgical unit orchestrates the transfer of the patient from the ED.

Push model system: A supply chain model uses demand to forecast and predict consumer demands so that products sourcing, production, and shipping occur before demand materializes. Essentially, the required product/ service becomes available as soon as the client in the case of healthcare a patient demand is presented.

Emergency overcrowding: A scenario where the demand for emergency services outstrips the ability and capacity of healthcare professionals present to offer quality care within a reasonable time.

Problem Statement

In the selected healthcare facility, ED overcrowding is an endemic problem with situations constantly arising where the ED function gets impeded due to the high number of patients who exceed the available staffing and physical capacity of the ED. This overcrowding occurs as patients wait to be seen, undergo assessment and treatment, or wait for departure. The problem identified is significant because overcrowding in the ED leads to increased LOS, which further cascades to increased healthcare costs for the patient. Patient throughput problems in the ED are suggestive hospital-wide- inefficiencies and therefore require a system-wide approach to improve hence the proposed intervention. To guide the proposed EBP intervention, the formulated PICOT framework question states ‘For ED patients aged 18 years or more and admitted to the medical-surgical unit of a healthcare organization offering acute care (Population-P), does the implementation of bed ahead con pt-based system(Intervention-I) compared to the current system of bed assigning (Comparison-C) lead to decreased delays at the time of admission and subsequent LOS (Outcome-O) within four months of the project’s implementation? Time-T)’

Organizational Culture and Readiness

            Healthcare researchers and practitioners agree that initiatives that seek to implement new EBP projects introducing new changes in either practice, program, or policy tend to fail since the lead change agent and other change champions had not established the readiness for change in their organization. Lindig et al. (2020) define organizational readiness for change as the magnitude to which staff in a given organization are prepared to implement the desired modification at the psychological behavioral level. These scholars also aver that implementing new interventions within health care systems remains a guiding value for those facilities that target to lower health care access costs, quality of care improvement, increased efficiency, and better patient satisfaction. The proposed interventions align with emerging healthcare technologies, new market dynamics, and the ever-changing public policies.

Organizational Culture Support for Change

The healthcare facility selected as the implementation site of the proposed evidence-based intervention is Los Angeles Medical Center (LAMC), part of a healthcare system meeting the demands of healthcare service consumers who require primary care, inpatient care, and specialty care. Clients in need of long-term care as geriatrics and mental & psychiatric health services also enjoy the facility’s top-of-the-range patient care services as for the health care staff at this facility. This nurse researcher doubles as the lead change agent, and the author of this paper reports that at LAMC, both staff and hospital executives hold the value of transparency in high esteem. At the same time, they exhibit a connected organizational culture. Every stakeholder, whether they are workers or patients looking for services at this medical center, feels appreciated and feel valued. The whole leadership structure of LAMC embraces the culture of nurse practitioner and patient autonomy so that the worker does feel micro-managed. In contrast, the patient feels they are part and parcel of decision-makers in a treatment process where they are primary beneficiaries and not passive recipients of healthcare services.

Every hospital staff at this medical facility lives true to the organization’s mission that seeks is ‘To improve the health of our patients and our communities by offering high-quality care’ besides while the shared vision of LAMC targets recognition at the federal, state, and local level as a model of an integrated healthcare system. Combining the mission and vision statements seamlessly absorb the organization’s core values of inclusivity, compassion, excellence, accountability, welcoming, and innovation underpin LAMC’s readiness for the proposed intervention. AS the guiding tenets of this healthcare entity, the mission, vision statement, and core values can be identified as critical factors that have continued to promote a progressive culture that is always on the lookout for innovations and the operationalization of new concepts. Effective communication that ties to active team engagement makes the staff at the medical center be role models in interprofessional collaboration. There was a meeting of LAMC leadership and executive management where the need for the proposed project was agreed upon since serving an annual patient population of over 100 000 and increasing has resulted in patient throughput issues as the hospital seeks to optimize hospital bed utilization of its 24-bed medical-surgical unit together with 12 bed in each of the ED and ICU.

Organization Culture and Readiness for System-wide Integration of Evidence-Based Practice (OCRSIEP) Tool

Many organizational cultures and organizational readiness for change assessment tools exist, with the OCRSIEP tool being selected to assess LAMC readiness for change. The over 500 –bed (24 of them found in the medical-surgical unit) acute care hospital will use this tool developed by Fineout- Overholt in the mid-2000s. The OCRSIEP scale is a 19 –object instrument that concentrates on nurses’ perception of their organization and workplace culture and readiness for change. The tool’s scoring guide uses a 5 point Likert Scale with a score of 1 representing powerfully agree, two agree, three neither agree nor disagree, four disagree, and five strongly disagree. Once it was conducted, the standard deviation fell between 0.00 and 319. The majority of the respondents (50-59%) posted counter to strongly agree on how LAMC as an organization had aligned its goals to the stated mission, vision, and core values. Respondents with scores of 75-130 points indicated nursing staff who reported devotion to physician teams that were slightly inclined towards administrators. In general, the OCRSIEP survey tool results demonstrated LAMC readiness for implementing a bed ahead concept.

Information and Communication Technologies Required for Implementing the Desired Change

To successfully implement a bed ahead concept, LAMC will also expand its electronic medical data storage to strengthen the organizational culture and readiness for change. The rationale for developing the electronic storage of patient data is that electronically stored patient data is easy to retrieve and transfer among healthcare providers quickly (Jiva, 2019). Studies also exist whose findings indicate that care delivery improves once there is the effective utilization of ICT communication due to easy connections, two-way- communication, and proper utilization of resources.

Literature Review

The formulated PICOT framework question was used to conduct a literature review of relevant articles using an electronic search of databases available at the University library portal, the PubMed database, Cumulative Index to Nursing and Allied Health Literature (CINAHL) database, Medline Database, and ProQuest database. Key search terms and phrases used initially included bed ahead, bed assignment, pull model, ED, emergency department, ER, emergency room, and medical-surgical unit. Other terms used were inpatient, admission, and LOS or length of stay. English language, year of publication between 2016- 2021, scholarly articles, and peer-reviewed were used to limit the search. There were also variations of these phrases with the Boolean expression of each term being used. The search yielded 128 citations, with seven shared between CINAHL and ProQuest, eight on PubMed, 113 from PubMed. A review of titles and abstracts followed for relevance to ascertain if it answered any part of the PICOT question. The inclusion criteria required the article be published in English over the last five years with interventions whose content involved patient flows, specifically using bed ahead models in any inpatient department/unit. The final list had 18 articles, eight included in the Literature Evaluation Table. Following an evaluation, three major themes emerged from the available evidence, with each further having three sub-themes.

Main Themes and Subthemes That Emerged From the Available Evidence Evaluation

The major themes were that ED patient throughput is a hospital–broad issue, pull model systems improve ED patient throughput, and barriers & facilitators to bed ahead project implementation existed. 

The Theme of ED Throughput as A Hospital Wide Issue

Under the central theme of ED throughput as a hospital-wide issue, the subthemes that surfaced were delays in output led to corresponding in input, that ED delays adversely affect patient outcomes, and that the healthcare organization financial outcomes were also decreased. Scholars have reported findings where ED throughput is considered a singular problem in the ED despite other studies indicating that many other factors outside the ED affect its throughput. These factors include inpatient discharge times, housekeeping, and radiology unit turnaround. 

  1. Subtheme of Delays in output leads to Delays in input 

Simple Mathematical model illustrates that delays and long wait times will emerge the moment ED input happens faster the patient discharge or production. Due to the unpredictable nature of ED input, hospital systems must have in-built capacity and flexibility to take in any surge in patient numbers if the facility provides efficient and timely emergency care (Mashao et al., 2021).

  • ED Delays Lead to Adverse Patient Outcomes

ED overcrowding effects stretch beyond ED patient throughput metric to include patient outcomes. This is because extended wait times in the ED lead to treatment postponement, which in turn translates to extra LOS in the admitting uni(McKenna et al., 2019). Other adverse patient outcomes are low patient satisfaction levels and increased mortality.

  • ED Delays Lead to Decreased Hospital Financial Outcomes

Extended wait times directly impact the number and rates of patients who left the ED without being seen. As an opportunity cost to the hospital, the patients not seen translate to lost earnings, which eventually affects the hospital’s revenue base (Mckena et al., 2019). The organization may find itself operating at a loss with time if it continues losing its market share.

The theme of Pull models and Enhancement of ED Throughput

The following central theme that pulls models enhance ED throughput had the subthemes of bed ahead concept in bed assigning, that technology through the use of a patient flow software. Intradepartmental and interdepartmental meetings can also help boost the success of the proposed bed ahead, a pull model system of bed assigning (Kelendar, 2020). Several studies have found that applying pull methods to implement interventions that pull patients to the next area of treatment is beneficial and leads to decreased delays in the ED. Therefore, changing from the current push model to a pull model will significantly affect patients’ throughput metrics in the ED.

  1. Subtheme Of A Bed Ahead Concept In Bed Assigning

Creating a bed ahead process entails the bed control nurse identifying the next available inpatient bed in the medical-surgical unit as a pull model system to decrease ED throughput delays. Since this is a proactive process, the union leadership has adequate time to comprehensively evaluate nurse workload before assigning the work leading to fewer changes than situations where the work assignment occurs reactively (Mathews & Long, 2015). The proactive approach would decrease delays, confusion, and anxiety accompanying admission time.

  • Subtheme Use of Patient Flow Software

Using the pull method of bed assigning with health information technology like incorporating a patient flow software bolsters the intervention’s chances of success California Healthcare Foundation, 2011). This success stems from the fact that this single technology offers a platform for managing every bed in the medical-surgical unit and other inpatient units across the entire medical center. The rationale of this technological success rests with task automation and real-time data reporting.

  • Subtheme of Regular Meetings Improve Chances of Success Methods that Enhance ED Patient Throughput

Another component that needs integration into the proposed intervention to increase the project’s success rates is having regular meetings at the intra- and inter-departmental levels. Holding daily bed meetings where nurse managers and charge nurses from all units attend a ten-minute meeting to review overall demand and capacity is critical in developing action plans to definitively deal with patient flow issues (Lovett & Sweeney, 2016). The project lead should also impress the facility leadership to have weekly operational meetings that bring together nursing leadership, bed management, and ED, amongst other services.

The theme of Barriers and Facilitators of the EBP Project

The third and last of the main themes touched on barriers and facilitators to the evidence-based intervention. According to Murphy et al. (2021), the project lead should address the issues of stakeholder engagement, capacity building, and delivery of quality patient care by identifying the likely barriers and facilitators of the EBP project implementation. This theme also has three sub-themes outlined in the following subsections.

  1.  Contextual Considerations Barriers And Facilitators

Subjects taking part in an earlier study on barriers to EBP project implementation identified several contextual factors that act as barriers to major stakeholders’ engagement. These factors comprised competing for health priorities, limited funding and infrastructure, and unexpected crises like epidemics, natural diseases, and even political instability.

  • Relationships Barriers and Facilitators

The absence of reciprocity or shared vision in partnership among the various hospital units was another barrier while building on existing relationships and taking adequate time 

to nurture long-term relationships was described as a facilitator.  

  • Participation, Uptake, and Empowerment Barriers and Facilitator

Finally, the third and last subtheme on barriers focused on participation, uptake and empowerment, where subjects in previous studies identified the challenge of securing active involvement of major stakeholders as a barrier. The solution to overcoming this barrier required that the change management team create opportunities for meaningful participation in programs that enhance active engagement.

Change Model, or Framework

Organizations have to adopt the EBP models that best serve their care context, fit their improvement goals, and consider priority clinical issues. These models play a vital role in determining the failure or success of any given change in nursing practices. According to Lewin’s model, the change processes constitute three stages: creating a perception that there is a need for change, then shifting towards the admired level of behavior, and making the new behavior a norm. At the same time, the IOWA model has eight stages. The first one is identifying a trigger where an EBP change is required (Hanrahan et al., 2021). The second stage is determining the present problem. This step involves forming a team to develop, evaluate, and implement the required EBP change. At stage 4, research on the preferred practice change information is gathered and analyzed.

In contrast, at stage 5, the researchers realize that the literature search is critiqued and synthesized when carrying out the literature search. Stage 6 involves stopping and deciding if the available research is sufficient to implement a change, while in the next stage, there is change implementation into a pilot program. At this stage, one needs to adjust either one or two smaller areas of evaluation. Finally, at stage 8, evaluate the results. If the change is inappropriate for full adoption in the concerned organization or department, go ahead with the careful evaluation and new research. If the difference is feasible and results in outcome improvement, introduce it across the organization, practice or the department.

Lewin’s Change Model

Different organizations adopt Lewin’s 3-step unfreezing, changing and freezing stages to find solutions to problems, performance improvement, and reframing shared perceptions. At the first step, an organization may have challenges that the organizational members in the system suffer ‘disconfirmation’ process and thereby resist change (Rahmayanti et al., 2020). To solve this problem, the organization prioritizes the importance of the attitude and beliefs of the organization’s members, which play a vital role in enhancing the success of an organizational change. In this case, with the application of this stage, members become more willing to embrace change which increases the likelihood of the success of any organization. Similarly, stage 2 can be applied where leaders learn to realize their new role of acting as designers, teachers, and stewards in developing new skills. In so doing, the leaders can assist everyone gains more insight ideas of the present reality and vision. Finally, the freezing level applies where the leaders promote a learning culture that enhances a higher level of organizational sustainability regarding learning corporate state. 

Implementation Plan

Once a proposed project has taken some theoretical form, the step that follows is its implementation outlined in a plan. The implementation process involves a variety of aspects. The whole procedure consists of phases, obstacles, people and drivers. For instance, implementing any measure to enhance the flow of patients in the ED needs a systematic approach. This is especially if the suggested intervention intends to positively impact the reduction of increased length of stay (LOS) in the hospital for any given patient.

On the other hand, change is an essential component in nursing practice. Therefore, the responsibility of the nurse leaders is to implement plans and lead change despite the challenges and complexities surrounding these activities. According to Tucker7 et al. (2020), implementation science started due to the difficulties faced in utilizing research to perform better in healthcare and other professional fields that use evidence-based practice (EBP). 

Setting and Access to Potential Subjects

The proposed EBP project will use a sizeable acute care medical center in Los Angeles County, California. The proposed project will involve adult patients’ participants who are highly likely to be admitted to the medical-surgical unit after their evaluation in the ED. It is the responsibility of everyone, right from the physician, housekeeper and the patient, to reduce the facility’s admission delay time. All the participants will be notified of all the ongoing interventions in the implementation process. The participants will also have total access to the primary investigator and the preceptor. LAMC possesses sufficient resources to use teleconferencing technologies in case of further needs. The new EBP projects will have to seek and acquire approval from the EBP committee of the facility. The study also aims to develop a lasting, valuable solution to the population in question and beyond.

The implementation of the proposed project at LAMC requires a specific time frame of 8 weeks before and after the project’s implementation for comparison purposes (Eyisi, 2016) to compare the outcome before and after the execution of the proposed EBP project. Amongst the resources to implement the bed ahead concept is financial resources outlined in a budget. Another resource required is the human resource which is the person-hour to train the nurses. This training is scheduled to take 40 minutes, and it will consist of 12 sessions, nine planned to cover all the staff in all shifts and all rotations (Eyisi, 2016). The PI has also adhered to prudent financial accounting practices so that the actual budget does not overly exceed the intended budget.

Use of Quantitative Design to Collect Data and Evaluate the Effectiveness of the Evidence-Based Project Proposal

           In the entire duration of implementation, I will utilize a quantitative data collection method. Similarly, evaluation of the proposed project will also use a quantitative approach as it involves gathering visible information to come up with a clear resolution by using mathematical, computation and statistical ways that are more accurate than the qualitative approach (Eyisi, 2016). Thus, the project will utilize a quantitative method of data collection in admission delay before and after the implementation and later use a T-test for data analysis and conclusion making. As stated in the preceding section of this paper, both Lewin’s Change Theory and IOWA Model of EBP implementation will guide the implementation of this project. Additionally, a group of experts will help in the unfreezing procedure by offering education to colleagues on the necessity of change. They will also discuss issues related to the researcher, monitor procedure and the outcome, and encourage other team members to give updates on the project’s progress. Different stakeholders are expected to participate in the implementation of the proposed project. Include nurse in charge of the Medical;-surgical unit takes the central part. This is the person who will assign beds in that unit and admit nurses after a change of shifts (Tucker et al., 2020). Additionally, the charge nurse has to update the bed flow coordinator on the availability of any three beds.

Potential Barrier or Challenges to the Plan and Ways to Address Them

           The primary challenge in the study is the worker’s resistance to change. Mathieson et al. (2019) explain how some staff members believe in their old ways of doing things. Subsequently, the stakeholders educate and create awareness of the various benefits of change. Another challenge is the high training cost (Mathieson et al. 2019). Extra beds may be required during the exercise period, which will require additional money to implement. In addition, the lack of adequate structures in the facility is yet another barrier. Since the whole implementation process will use existing infrastructure and allocated resources, it will have no direct impact on the hospital’s budget. Other benefits of this system-wide implementation will commence in the ED and the Medical-surgical unit (Kok, 2020). The overall result concludes that the proposed projects fit the selected site’s organizational vision, mission, and core values perfectly.

Evaluation Plan

The implementation of EBP in healthcare is regarded as a core competence to enhance quality healthcare. The main aim of this implementation is to ensure that the proposed intervention leads to the intended change within the selected organization. Therefore, evidence-based interventions improve the quality of healthcare services offered to patients leading to positive patient outcomes. Thus, evaluation is essential in evaluating whether the organization implemented the desired changes effectively. The primary investigator must use an evaluation technique to measure the proposed change in healthcare settings. 

The Expected Outcome for the Evidence-Based Practice Project Proposal

The expected outcome of the EBP project is the reduction of ED stay time and admission delays. The primary purpose of the proposed EBP project is to execute a bed ahead process system at LAMC. The proposed project also envisages that LAMC will consider changing the bed assigning process from the current push model to an updated model, improving the ED to the advised receiving unit. By so doing, LAMC will achieve customer and staff satisfaction, better patient outcomes and more importantly, lower general healthcare costs. In the end, the proposed project should reduce the Medical-Surgical Unit LOS and delay admission to this unit by a minimum of 15%.

Review of the Various Data Collection Tools Associated With the Proposed Selected Research Design

The heart of credible research and essential decisions in EBP lies in the trustworthiness of data used in the decision-making process. When the information is untrustworthy, its conclusion must be favorable. On the other hand, a trustworthy decision will lead to an informed decision. The result can never be desirable without reliable data, even if an EBP specialist carries out the implementation process. The proposed EBP uses a quantitative research approach of quasi-experimental design.

Conclusion

In conclusion, many health care systems identify ED overcrowding as a significant problem that elicits poor patient outcomes on many inpatient units like the medical-surgical, telemetry, burns, and ICU. This paper has established the need to recognize the pull model approach to improving the proposed site ED throughput using a bed ahead concept. This bed ahead protocol implementation in the medical-surgical unit will lead to the facility having a definite pathway that ensures quick transfer for adult patients evaluated in the ED and recommended for admission in the medical-surgical unit. As outlined in the evaluation plan, the outcome measures concisely capture the project’s intent of streamlining the abed assignment process in ways that increase efficiencies lower workload while at the same time improving patient and staff satisfaction leading to a general improvement in the capacity of LAMC ED. Utilizing a pull model system to enhance the movement of patients holds the key to patient outcomes improvement, ensures the timeliness of emergency services, and helps this healthcare organization meet the national l benchmarks for the ED throughput.

Similarly, the project lead’s opinion is that successful implementation of the project can enhance patient outcomes for those patients admitted to the medical-surgical unit. It would significantly reduce admission process delays without demanding changes to the medical center’s existing infrastructure. Neither would the project deplete the scarce resources in the name of increased numbers in staffing, nor would it require significant capital resources. Put differently, the proposed project implementation would help bring the desired improvement at no extra costs and minimal risks.

References

California Healthcare Foundation (2011) Using Tracking Tools to improve patient flow in hospitals URL” https://www.chcf.org/wp-content/uploads/2017/12/PDF-UsingPatientTrackingToolsInHospitals.pdf Accessed Jan 14, 2022.

Eyisi, D. (2016). The usefulness of qualitative and quantitative approaches and methods in researching problem-solving ability in science education curriculum. Journal of Education and Practice, 7(15), 91-100.

Hanrahan, K., Fowler, C., & McCarthy, A. M. (2019). Iowa model revised: Research and evidence-based practice application. Journal of pediatric nursing, 48, 121-122

Hanrahan, K., Fowler, C., & McCarthy, A. M. (2019). R., Fischer, S., Walpola, R. L., Chauhan, A., Babalola, T., Mears, S., & Le-Dao, H. (2021). Where Do Models for Change Management, Improvement and Implementation Meet? A Systematic Review of the Applications of Change Management Models in Healthcare. Journal of healthcare leadership, 13, 85.

Jiya, T. (2019). Stakeholders’ contribution towards responsible innovation in information and communication technology research projects. Journal of technology management & innovation14(3), 93-102.

Kelendar, H. (2020). Lean thinking from Toyota manufacturing to the health care sector. Res Med Eng Sci8(5), 913-923.

Kok, A. G. S. (2020). Enhancing social feasibility of the implementation of measures inducing reduced demand:-.

Lindig, A., Hahlweg, P., Christalle, E., & Scholl, I. (2020). Translation and psychometric evaluation of the German version of the Organisational Readiness for Implementing Change measure (ORIC): a cross-sectional study. BMJ Open10(6), e034380.

Lovett, P. B., Illg, M. L., & Sweeney, B. E. (2016). A successful model for a comprehensive patient flow management center at an academic health system. American Journal of Medical Quality31(3), 246-255.

Mashao, K., Heyns, T., & White, Z. (2021). Areas of delay related to prolonged length of stay in an emergency department of an academic hospital in South Africa. African Journal of Emergency Medicine11(2), 237-241.

Mathews, K. S., & Long, E. F. (2015). A conceptual framework for improving critical care patient flow and bed use. Annals of the American Thoracic Society12(6), 886-894.

Mathieson, A., Grande, G., & Luker, K. (2019). Strategies, facilitators and barriers to implementing evidence-based practice in community nursing: a systematic mixed-studies review and qualitative synthesis. Primary health care research & development, 20.

McKenna, P., Heslin, S. M., Viccellio, P., Mallon, W. K., Hernandez, C., & Morley, E. J. (2019). Emergency department and hospital crowding: causes, consequences, and cures. Clinical and experimental emergency medicine6(3), 189.

Murphy, J., Qureshi, O., Endale, T., Esponda, G. M., Pathare, S., Eaton, J., … & Ryan, G. (2021). Barriers and drivers to stakeholder engagement in global mental health projects. International Journal of Mental Health Systems15(1), 1-13.

Rahmayanti, E. I., Kadar, K. S., & Saleh, A. (2020). Readiness, Barriers and Potential Strenght of Nursing in Implementing Evidence-Based Practice. International Journal of Caring Sciences, 13(2), 1203-1211.

Thomas Schneider, A. J., Luuk Besselink, P., Zonderland, M. E., Boucherie, R. J., van den Hout, W. B., Kievit, J., … & Rabelink, T. J. (2018). Allocating emergency beds improves the emergency admission flow. Interfaces48(4), 384-394.

Tucker, S. J., Gallagher-Ford, L., & Jang, E. (2020). EBP 2.0: Implementing and Sustaining Change: The Evidence-Based Practice and Research Fellowship Program. AJN The American Journal of Nursing, 120(2), 44-48.

Van Mil, J. F., & Henman, M. (2016). Terminology, the importance of defining. International journal of clinical pharmacy38(3), 709-713.

APPENDIX

APA Writing Checklist

Use this document as a checklist for each paper you will write throughout your GCU graduate program. Follow specific instructions indicated in the assignment and use this checklist to help ensure correct grammar and APA formatting. Refer to the APA resources available in the GCU Library and Student Success Center.

☒ APA paper template (located in the Student Success Center/Writing Center) is utilized for the correct format of the paper. APA style is applied, and format is correct throughout.

☒  The title page is present. APA format is applied correctly. There are no errors.

☒ The introduction is present. APA format is applied correctly. There are no errors.

☒ Topic is well defined.

☒ Strong thesis statement is included in the introduction of the paper.

☒ The thesis statement is consistently threaded throughout the paper and included in the conclusion.

☒ Paragraph development: Each paragraph has an introductory statement, three or four sentences as the body of the paragraph, and a transition sentence to facilitate the flow of information. The sections of the main body are organized to reflect the main points of the author. APA format is applied correctly. There are no errors.

☒ All sources are cited. APA style and format are correctly applied and are free from error.

☒ Sources are completely and correctly documented on a References page, as appropriate to assignment and APA style, and format is free of error.

Scholarly Resources: Scholarly resources are written with a focus on a specific subject discipline and usually written by an expert in the same subject field. Scholarly resources are written for an academic audience.

Examples of Scholarly Resources include: Academic journals, books written by experts in a field, and formally published encyclopedias and dictionaries.

Peer-Reviewed Journals: Peer-reviewed journals are evaluated prior to publication by experts in the journal’s subject discipline. This process ensures that the articles published within the journal are academically rigorous and meet the required expectations of an article in that subject discipline.

Empirical Journal Article: This type of scholarly resource is a subset of scholarly articles that reports the original finding of an observational or experimental research study. Common aspects found within an empirical article include: literature review, methodology, results, and discussion.

Adapted from “Evaluating Resources: Defining Scholarly Resources,” located in Research Guides in the GCU Library.

☒ The writer is clearly in command of standard, written, academic English. Utilize writing resources such as Grammarly, LopesWrite report, and ThinkingStorm to check your writing.

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