Care Improvement

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Care Improvement

Constant assessment and modification of processes is necessary in order to improve and maintain quality within healthcare systems. Any improvement interventions have to consider all healthcare systems i.e. the care team, the patient, the organization and the environment of care. Another way to improve healthcare systems and outcomes is the use of information technology to organize, share and analyze health records. By applying clinical reasoning and critical thinking, care providers can identify reliable methods of improving healthcare systems. This paper discusses a clinical practice system in need of improvement using the aspects mentioned above.
While working at a Psych department in a hospital, I noticed that the time a patient waited in the Emergency department before being placed in an inpatient psych unit sometimes took too long. After presenting and registering, depending on the patient’s condition, the patient is referred to an attending Doctor for consultation then placed in the emergency department awaiting placement. During this time, the patient’s privacy is invaded and they are exposed to hygiene risks. There was also a lack of a standard consultation process and inadequate feedback systems showing the work load of attending doctors in real-time. In the busy emergency department, staff can easily get lost in different task before seeing a new patient. Lengthy wait durations have been linked to lower patient satisfaction, higher mortality and higher morbidity thus the need for improvement(Shen & Lee, 2018).
By applying system thinking, a root cause analysis can be used to identify what are the causes for the lengthy wait. This can be obtained by observing and documenting the entire consultation process detailing the time elements, process flows and limitation analysis. An actual state evaluation can be done to identify the issues encountered on the ground.  For example, on the issue of inadequate real-time feedback, a system that enables senior physicians to see which junior doctors have a bigger workload or working with complex conditions can be created to reduce the backlog of patients waiting. Data analytics can play a crucial role in tracking doctor output and patient wait times(Snyder et al., 2011). The patterns identified from patient arrivals enables matching high patient loads to departmental resources. Based on frequently updated data, work output expectations can be communicated to staff ensuring reasonable workload. The findings and results from analysis of this baseline data can be shared to staff, including the stakeholders, in order to recognize best practices and aid in the compliance and acceptance of the imposed interventions.
Emergency department crowding is frequently caused by inpatient issues, administrators should work together with inpatient stakeholders in developing crowding reduction strategies. For example, this can be addressed through moving admitted patients into hallway spaces if there are no inpatient beds ready. Crowding cannot be solved by one individual. Staff have a responsibility and opportunity to impact quality care in hospital waiting rooms while keeping patients safe and in a timely fashion. Some methods to achieve this include improving triage accuracy, expediting care and monitoring patients in the waiting room. In a psych ward where interprofessional and interdisciplinary coordination is warranted, effective communication and teamwork is needed for high quality health care. Shared goals, situational awareness and closed loop communication are some tools that help strengthen communication and teamwork.
The root cause for prolonged waiting time require interventions from different perspectives. The healthcare system in question can be enhanced through actionable interventions and stakeholder engagement to additionally address and improve the issues discussed(Sayah et al., 2014).




Sayah, A., Rogers, L., Devarajan, K., Kingsley-Rocker, L., & Lobon, L. (2014). Minimizing ED Waiting Times and Improving Patient Flow and Experience of Care. Emergency Medicine International2014, 1-8. doi: 10.1155/2014/981472

Shen, Y., & Lee, L. (2018). Improving the wait time to consultation at the emergency department. BMJ Open Quality7(1), e000131. doi: 10.1136/bmjoq-2017-000131

Snyder, C., Wu, A., Miller, R., Jensen, R., Bantug, E., & Wolff, A. (2011). The Role of Informatics in Promoting Patient-Centered Care. The Cancer Journal17(4), 211-218. doi: 10.1097/ppo.0b013e318225ff89