Practicum Project Proposal.edited

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Enhancing ED Efficiency 1 Enhancing Emergency Department Efficiency to Reduce Overcrowding Name: Institution: Course: Instructor: Date:
Enhancing ED Efficiency 2 Contents Introduction ............................................................................................................................................... 3 Literature Review ...................................................................................................................................... 3 Gap Analysis .............................................................................................................................................. 9 Project Charter, Scope, and Objectives ................................................................................................. 11 Project Charter: Alignment with the Organization's Vision and Mission ....................................... 11 Project Scope ........................................................................................................................................ 12 Project Objectives ................................................................................................................................ 13 Implementation Plan ............................................................................................................................... 14 Best Practices ....................................................................................................................................... 14 Task, actions, deliverables. .................................................................................................................. 14 Metrics that will determine success .................................................................................................... 15 Timeline and schedule ............................................................................................................................. 15 Budget and Cost Benefit Analysis ........................................................................................................... 17 Budget ................................................................................................................................................... 17 Cost-Benefit Analysis ........................................................................................................................... 18 Resources Needed for the project ....................................................................................................... 19 Risk Management Plan ........................................................................................................................... 21 References ................................................................................................................................................ 24
Enhancing ED Efficiency 3 Introduction In today's fast-paced world, healthcare is a cornerstone of our society, ensuring that the well-being of individuals is upheld and protected. Within the vast expanse of healthcare services, the emergency department (ED) serves as a vital gateway to timely and critical care. However, overcrowding in the ED has become a pressing issue, posing challenges for patients and healthcare providers. Overcrowding in the ED is a significant issue faced by healthcare facilities nationwide. A compromised patient flow, insufficient staffing, and increasing patient demands primarily cause it. The consequences of ED overcrowding are dire. Patients endure longer wait times, resulting in poor clinical outcomes. Healthcare providers face burnout, job dissatisfaction, and increased stress levels. Mortality rates in overcrowded EDs are higher, emphasizing the urgency of addressing this issue. This project has been initiated to create a profound impact on our community's well- being, healthcare delivery, and the overall quality of care we provide. This project aims to address this issue by streamlining the patient flow, optimizing resource allocation, and ultimately enhancing the efficiency of emergency care. This endeavor is not just about reducing wait times; it's about saving lives, improving patient experiences, and aligning with our organization's vision and mission. Literature Review Overcrowding in the emergency department is characterized as a situation in which the demand for emergency services exceeds a department's ability to deliver quality care within acceptable periods. The problem of ED congestion is caused by a mix of causes, including an increase in the number of patients seeking emergency care, a lack of resources inside the ED, and a backlog of patients awaiting transfer to hospital wards. Overcrowding has immediate
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Enhancing ED Efficiency 4 implications, such as medication delays and higher mortality rates among admitted patients. Furthermore, it causes several indirect issues, such as longer wait times, lower patient satisfaction, and financial losses for healthcare organizations (Jung et al., 2021, p. 2). Studies have indicated that overcrowding in EDs has many detrimental effects. According to Hsu et al. (2019, p. 187), these include a rise in medical errors, insufficient care of acute pain, delays in treating critically sick patients, and discontent among patients and staff. Overcrowding in emergency departments (EDs) has been linked to several issues for both patients and staff, including longer wait times, more ambulance diversion, longer stays, higher rates of medical errors, higher patient mortality rates, and more financial losses for hospitals (Salway et al., 2017, p. 214). To address the urgent issue of emergency department (ED) overcrowding, it is imperative to forecast ED demand and optimize resource allocation. The authors of a study by Harrou et al. (2020) stress the need of precise forecasting to effectively manage patient flow and distribute resources in emergency departments to reduce overcrowding. They emphasized that to effectively manage the overcrowding issues and enable appropriate resource management, precise modeling and forecasting of ED visits are essential. This study emphasizes how crucial resource optimization and forecasting are to raising ED productivity and lowering overcrowding. In a 2019 study, Moskop et al. clarified the serious consequences of overcrowding in emergency departments (EDs), including worsened patient outcomes, more medical errors, and provider distress. Several approaches, such as improved resource allocation, point-of-care testing, deferring low-risk patients, and creating observation units, have been suggested by researchers to address this problem. To discover effective solutions for this huge global health concern,
Enhancing ED Efficiency 5 emergency physicians, policymakers, hospital administrators, and healthcare professionals urgently need to collaborate (Moskop et al., 2019, p. 362). The researchers discovered several acknowledged contributing factors to patient safety incidents in emergency departments during their systematic review of the international literature on the subject. They aimed to ascertain what lessons could be drawn from the reported incidents to guide and enhance practice. These can serve as a foundation for creating efficient instruments that methodically pinpoint incident risk. Removing obstacles to safe care requires active participation in initiatives to reduce risk and enhance patient safety through appropriate incident reporting. As this analysis suggests, identifying the root causes of practice errors and developing safety improvement plans can improve patient care and help reduce congestion by guaranteeing efficient, error-free procedures (Amaniyan et al., 2020, p. 240). Long stays and crowding in ERs are seen globally as two of the biggest problems facing contemporary emergency medicine, according to a qualitative study by Eriksson et al. (2017). An emergency room is not set up to offer care for a long time. It also needs to be staffed to do so. Patient safety in the clinical setting has challenges that include working procedures and routines' impact and flaws in patient safety (Eriksson et al., 2018, p. 2). In addition, nurses frequently face emotional reactions stemming from a sense of being in control of their work, which presents a challenge in juggling the demands of providing critical nursing care with the real burden. The systematic review conducted by Maninchedda et al. (2020) offers useful insights into improving emergency department efficiency in the context of overcrowding. With an emphasis on the widespread problem of overcrowding in ERs, the study provides a thorough investigation of several tactics meant to enhance patient flow, cut down on wait times, and ease overcrowding. Five major categories of solutions are identified by the review: using mathematical algorithms to
Enhancing ED Efficiency 6 implement predictive simulation models, introducing new specialized professional roles, investing in primary care, restructuring, and work organization (Maninchedda et al., 2023, p. 265). The results demonstrate that, regardless of the type or location of the hospital, the best ways to optimize patient flow are to increase the effectiveness of human resources and implement predictive mathematical models. The study emphasizes the significance of customizing solutions to the particular demands and difficulties of each emergency department to achieve efficiency improvements and, consequently, reduce the problem of overcrowding, given the distinctive characteristics of overcrowding and its site-specific causes. According to a study looking into the causes of overcrowding in emergency departments, factors like poor design and operational inefficiencies within the ED itself can contribute to overcrowding, but larger problems with hospital capacity that result in patient boarding in the ED can also make the situation worse (McKenna et al., 2019, p. 193). The results highlight the need for a multimodal strategy to address this issue, including ED process enhancements and institution-wide measures to increase capacity. The study sheds light on the necessity of taking hospital-wide and ED-specific elements into account while looking for practical solutions to the overcrowding problem in EDs. Scholars have emphasized the significance of promptly identifying and screening high-risk patients upon ED admission. This approach not only enhances patient care efficiency but also manages the spread of antibiotic resistance, ultimately leading to better patient safety in the congested ED (Salomão et al., 2017, p. 242). As early and efficient care of such cases can lead to more efficient patient flow and, eventually, improved patient outcomes in a busy emergency department, this is in keeping with the larger goal of improving ED efficiency and reducing congestion.
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Enhancing ED Efficiency 7 Three major themes emerge from a study investigating the views and experiences of emergency department (ED) workers during the Four-Hour Rule or National Emergency Access Target policy (4HR/NEAT) implementation in Australia: intergroup dynamics, stress and morale, and patient interactions (Forero et al., 2019, p. 12). These concepts clarify the organizational and psychosocial aspects of Eds. This study emphasizes how critical it is to comprehend how policy initiatives impact ED personnel, since their perspectives and experiences have a substantial impact on the department's effectiveness and capacity to address problems such as overcrowding. Therefore, a crucial component of the suggested project to improve emergency department efficiency and lessen overcrowding is taking into account the opinions of the personnel and addressing their problems. Empirical evidence indicates that overcrowding in emergency departments (EDs) might result in unfavorable patient outcomes and challenges following treatment protocols. According to the report, to reach timely patient disposition targets and expand primary care hours, solutions should involve whole-system activities. The necessity for system-wide solutions specifically designed to address the causes of overcrowding is highlighted by identifying the growing number of older patients with complex conditions as a major driver of ED crowding (Morley et al., 2018, p. 33). A evaluation of overcrowding techniques in emergency departments revealed that team triage, point-of-care testing, ideal ED patient journey models, streaming, and fast track are among the strategies that work well to alleviate overcrowding in these settings. Adopting ideal ED patient journey models, which comprise ten interconnected sub-strategies, is the most thorough method (Rezaei et al., 2017, p. 2). ED leaders should concentrate on these strategies to reduce overcrowding. These strategies prioritize assigning patients to various care channels according to their clinical status and the practitioners who are needed. In the end, this streamlines
Enhancing ED Efficiency 8 the ED process and offers continuous care within the department, which lessens the need for outside services. A study that summarized systematic reviews on interventions to mitigate the problem of overcrowding in emergency departments (EDs) found four primary categories of interventions: improving the ED team, establishing new care zones, fortifying the triage service, and modifying ED work procedures. The results showed that these interventions regularly improved patient duration of stay, and one study also found that they positively affected other metrics. There has been a noticeable increase in the caliber and emphasis of study on this subject over the years despite the methodologically mixed quality of the examined studies. This overview serves as a valuable resource for understanding the current state of scientific knowledge on addressing ED overcrowding, aligning with the objectives of the proposed project to enhance emergency department efficiency and reduce overcrowding (Bittencourt et al., 2020, p. 10). Nonetheless, the following macro-level tactics can reduce boarding and crowding in the emergency department: streamlining the admissions process; creating a flow management center; stepping up the outpatient experience, integrating coordination and assistance to facilitate a more effective patient transfer within the hospital; shifting elective and non-emergent work to the outpatient setting; integrating patient navigation programs and coordination of assistance within the hospital; improving communication and connections between hospital wards; and developing hospital emergency plans (Savioli et al., 2022, p. 13). In the past few decades, hospital emergency departments (ED) congestion has become a global public health concern. The number of patients requiring hospital admissions and those seeking care in the ED have increased, worsening this issue. Numerous detrimental effects of ED overpopulation have been demonstrated by research. These include a rise in medical errors, a
Enhancing ED Efficiency 9 delay in treating critically sick patients, patient and staff discontent, insufficient management of acute pain, and greater rates of patient complications and mortality (Hsu et al., 2019, p. 187). Predicting ED demand and allocating resources as efficiently as possible is crucial in resolving the pressing problem of ED congestion. The authors of a study by Harrou et al. (2020) stress the need for precise forecasting to effectively manage patient flow and distribute resources in emergency departments to reduce overcrowding. They emphasized that to effectively manage the overcrowding issues and enable appropriate resource management, precise modeling and forecasting of ED visits are essential. This study emphasizes how crucial resource optimization and forecasting are to raising ED productivity and lowering overcrowding. Long stays and crowding in ERs are seen globally as two of the biggest problems facing contemporary emergency medicine, according to a qualitative study by Eriksson et al. (2017). An emergency room is not set up to offer care for a long time. It is also not staffed to do so. Patient safety in the clinical setting has challenges that include working procedures and routines' impact and flaws in patient safety (Eriksson et al., 2018, p. 2). In addition, nurses frequently face emotional reactions stemming from a sense of being in control of their work, which presents a challenge in juggling the demands of providing critical nursing care with the real burden. Gap Analysis One of the core challenges driving the initiation of this project is the compromised patient flow within the Emergency Department (ED). This issue can be traced back to several fundamental problems, including inadequate triage processes. Triage, the critical initial step in patient assessment, often falls short in identifying and prioritizing the severity of cases. As a result, patients may not receive the timely attention they require, leading to prolonged wait times. These extended wait times in the ED have detrimental consequences on patient experiences and
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Enhancing ED Efficiency 10 clinical outcomes. Patients face anxiety and frustration, and their well-being may be compromised as they wait for the care they urgently need. Moreover, inefficient bed management procedures further contribute to the bottleneck. The lack of a streamlined system for bed allocation delays patient admission and discharge, compounding the overcrowding problem. Additionally, predictive data analytics is necessary for the ED's ability to forecast patient surges and allocate resources efficiently, making it challenging to adapt to the dynamic nature of emergency care. A second critical issue driving the need for this project is the persistent problem of staffing shortages, particularly during peak periods. The ED staff is often overwhelmed by the volume of patients seeking immediate care. The resultant pressure on healthcare providers is immense, and it extends beyond the physical demands of the job. Overworked staff need help to maintain care quality and also face escalating levels of burnout and job dissatisfaction. This burnout can lead to staff turnover, further exacerbating the problem by contributing to a shortage of skilled healthcare professionals. The stress experienced by the ED staff in such challenging conditions can ultimately affect the quality of care provided, as well as staff morale. This, in turn, creates a vicious cycle where a staff shortage leads to increased workloads for those who remain, perpetuating the issue of burnout and job dissatisfaction. The third pivotal issue that has driven the initiation of this project is the escalating demands from patients seeking emergency care. The ED is experiencing a surge in the number of individuals seeking its services, and this is placing enormous strain on existing resources and infrastructure. With a growing patient load, the ED struggles to accommodate the needs of the community efficiently. The strain on resources further intensifies the overcrowding problem, making it increasingly difficult to manage patient care. The existing infrastructure and resources
Enhancing ED Efficiency 11 are often stretched to their limits, impacting the quality of care that can be delivered promptly. These challenges are not only impacting the ED's ability to provide efficient care but are also straining the entire healthcare system. The pressing need for change is evident in the need to address these challenges comprehensively and improve the overall efficiency of emergency care services. Project Charter, Scope, and Objectives Project Charter: Alignment with the Organization's Vision and Mission Our organization's vision is to provide high-quality healthcare services that enhance the well-being of our community. We envision a healthcare system that is patient-centered, efficient, and accessible to all. Our mission is to deliver exceptional care, support innovation, and promote wellness. This project directly aligns with our vision and mission by focusing on key areas: Patient-Centered Care By reducing ED overcrowding, we are putting the well-being of our patients first. We aim to enhance their experience by minimizing wait times and ensuring prompt access to the care they need. Efficiency Our organization is committed to efficient healthcare delivery. This project directly addresses the efficiency of our emergency department, ensuring that resources are allocated optimally and that patients receive timely care. Accessibility
Enhancing ED Efficiency 12 The reduction of overcrowding will lead to improved accessibility to our ED services. Patients will not be discouraged by long wait times, and we can better serve the needs of our community. Innovation The incorporation of telemedicine and predictive data analytics represents our commitment to innovative healthcare solutions. Wellness By improving the patient experience and reducing the burden on staff, this project contributes to the wellness of both patients and healthcare providers. Project Scope Who This project will impact ED patients and staff, as they are the primary stakeholders in emergency care. What The objective of this project is to reduce ED overcrowding and the associated challenges through various interventions and process improvements. Why Overcrowding in the ED has a profound impact on patient outcomes, staff well-being, and overall healthcare delivery. Lengthy stays in the ED can lead to delays in accessing specialized treatment, thus endangering patient well-being. This project is vital to address this issue comprehensively.
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Enhancing ED Efficiency 13 When This project aims to initiate immediate changes and continue improvements over time. It is an ongoing effort to ensure that the ED operates at optimal efficiency. Where The project will be implemented in the emergency department of our hospital, addressing the specific challenges and constraints faced by our facility. How The project will utilize a multifaceted approach, incorporating enhancements in the triage system, bed management, community outreach, telemedicine integration, and predictive data analytics. It will also involve collaboration with urgent care centers, fostering a culture of continuous process improvement, and improving patient navigation services Project Objectives Fast and efficient transfers to inpatient or patient discharge. Baseline: The current transfer and discharge rate is slow, creating many patients waiting for beds. Goal: Ensure service efficiency at the ED by ensuring each patient has a bed. Reduce patient mortality rates. Baseline: There are significant mortalities in the ED. Goal: Cut patient mortalities to zero through improved efficiency. Improve healthcare practitioner's working conditions.
Enhancing ED Efficiency 14 Baseline: The current working conditions are characterized by pressure and task overload due to system inefficiency. Goal: Bolster the morale of healthcare practitioners in the ED by fostering a good working environment. Implementation Plan The plan is to ensure that there is fast and efficient transfers to inpatient or patient discharge to reduce overcrowding in the ED. Best Practices Implementing a revised triage system to prioritize patients based on severity, enhancing bed management procedures for efficient admission and discharge processes, and utilizing predictive data analytics for resource allocation are crucial best practices for optimizing healthcare operations and patient care. These measures promote streamlined workflows, improve resource utilization, and enhance the overall quality of healthcare services. Task, actions, deliverables. In Task 1, we will implement a revised triage system by redesigning the process, providing staff training, and closely monitoring its effectiveness. Our deliverables will include a revamped triage system, a trained staff, and comprehensive documentation of its impact on patient flow. For Task 2, we aim to enhance bed management procedures by optimizing bed allocation, improving communication between the emergency department and inpatient units, and tracking
Enhancing ED Efficiency 15 bed turnover times. Our deliverables will include improved bed management processes, reduced bed turnover times, and enhanced inter-departmental communication. In Task 3, we will focus on utilizing predictive data analytics by implementing data analytics tools to forecast patient arrivals, optimize staffing levels, and allocate resources efficiently. Our deliverables will encompass functional data analytics tools, data-driven resource allocation strategies, and an overall improvement in emergency department efficiency. Metrics that will determine success The metrics for success in our healthcare optimization efforts encompass several key areas. We aim to achieve reduced wait times for patients needing inpatient admission or discharge, which will lead to an increased bed turnover rate and a decrease in the number of patients waiting for beds. Additionally, we seek to enhance patient satisfaction by improving scores related to waiting times. Furthermore, our success will be demonstrated through the efficient use of resources, evidenced by a reduction in resource underutilization. These metrics collectively reflect our commitment to providing timely and high-quality care while optimizing resource allocation in our healthcare facility. Timeline and schedule December 2023 - January 2024: Baseline Assessment and Planning Week 1 (December): Initiate the project and establish a cross-functional team. Week 2-3 (December): Begin data collection for baseline metrics, including wait times, bed turnover rate, and resource utilization. Week 4 (January): Analyze baseline data to identify key areas for improvement and set specific targets.
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Enhancing ED Efficiency 16 February - May 2024: Triage System Implementation February 2024: Redesign the triage system and develop new protocols. March - April 2024: Train staff on the revised triage process and monitor its initial effectiveness. May 2024: Assess the impact of the new triage system on reducing wait times and patient flow. June - August 2024: Bed Management Enhancements June 2024: Optimize bed allocation processes and streamline communication between departments. July 2024: Track bed turnover times and make necessary adjustments. August 2024: Measure the increase in bed turnover rate and reduction in patients waiting for beds. September - November 2024: Patient Satisfaction Improvements September 2024: Implement strategies to enhance patient satisfaction related to waiting times. October 2024: Continue to collect and analyze patient satisfaction scores. November 2024: Report on the improvements achieved and gather feedback for further enhancements. December 2024 - February 2025: Resource Allocation and Efficiency December 2024: Implement predictive data analytics tools to forecast patient surges and optimize resource allocation.
Enhancing ED Efficiency 17 January 2025: Continuously monitor resource utilization and adjust based on data-driven insights. February 2025: Measure the reduction in resource underutilization and overall improvements in ED efficiency. Budget and Cost Benefit Analysis Budget Personnel Costs Project Manager: $80,000 Data Analysts: $60,000 (2 analysts at $30,000 each) Training and Implementation Staff: $40,000 Technology and Software Predictive Data Analytics Software: $50,000 Triage System Redesign Software: $30,000 Telemedicine Integration: $20,000 Training and Workshops Training for Staff (Triage and Bed Management): $10,000 Data Analytics Workshops: $15,000
Enhancing ED Efficiency 18 Consulting and Expertise Healthcare Process Improvement Consultant: $30,000 Infrastructure and Equipment Necessary Infrastructure Improvements: $50,000 Additional Beds and Equipment: $40,000 Marketing and Community Outreach Marketing Campaign: $15,000 Community Engagement Events: $10,000 Contingency and Unforeseen Costs 10% of the total budget: $26,500 Total Estimated Project Budget: $366,500 Cost-Benefit Analysis The cost-benefit analysis aims to evaluate the financial impact of the project against the anticipated benefits. The benefits may include both direct and indirect factors. Here is a simplified breakdown for the project: Direct Benefits The healthcare optimization project promises significant advantages. It includes reduced patient wait times, increased bed turnover, and enhanced patient satisfaction. These factors can lead to higher revenue due to improved efficiency and resource allocation, ultimately reducing operational costs. The project's data analytics can reduce resource waste, resulting in cost
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Enhancing ED Efficiency 19 savings. Altogether, these benefits demonstrate the potential for improved patient care and financial health for the healthcare facility. Indirect Benefits: The healthcare optimization project offers not only direct benefits like reduced wait times and improved resource allocation but also valuable indirect advantages. These include a potential reduction in patient mortality rates, which can lead to lower malpractice claims, improved working conditions for healthcare practitioners resulting in reduced staff turnover and recruitment costs, and an enhanced reputation for the healthcare facility. These indirect benefits collectively contribute to the project's positive impact on financial and operational aspects while enhancing community well-being. Cost Benefit Analysis The direct and indirect benefits of the healthcare optimization project, including increased revenue, cost savings, risk mitigation, staff stability, and an enhanced reputation, are projected to surpass the project's initial costs. By attracting more patients through reduced wait times and enhanced care quality, the facility's revenue is expected to rise. Simultaneously, efficient resource allocation and lower operational costs can lead to financial savings. The reduction in patient mortality rates can mitigate potential malpractice claims. Improved working conditions should lower staff turnover and recruitment costs, maintaining an experienced workforce. Lastly, a bolstered reputation within the community is likely to foster patient retention and attract new clientele, contributing to long-term financial success. Resources Needed for the project Tangible Resources
Enhancing ED Efficiency 20 Funding Adequate financial resources are essential to cover project expenses, including personnel costs, technology and software, training, infrastructure improvements, marketing, and contingency funds. Physical Infrastructure Upgrades and improvements in the physical infrastructure of the emergency department, including bed additions and equipment enhancements. Technology and Software Predictive data analytics software, triage system redesign software, and telemedicine integration tools. Training and Workshops Resources for training staff on the revised triage system and bed management procedures, including materials, trainers, and training facilities. Consulting Services The engagement of healthcare process improvement consultants to provide expertise and guidance. Marketing Materials
Enhancing ED Efficiency 21 Resources for marketing campaigns and community outreach, including promotional materials, advertisements, and event planning. Intangible Resources Healthcare Expertise The knowledge and experience of healthcare professionals, including physicians, nurses, and administrative staff, to implement process improvements and deliver high-quality care. Data and Information Access to patient data, historical ED performance data, and healthcare research and best practices to inform decision-making and project implementation. Collaborative Partnerships Establishing collaborative relationships with urgent care centers and other healthcare providers to improve patient care coordination and resource sharing. Community Engagement Engaging with the local community to understand their needs, gather feedback, and build support for the project. Patient Trust and Satisfaction Building and maintaining trust among patients, as well as improving patient satisfaction scores through enhanced care quality and reduced wait times.
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Enhancing ED Efficiency 22 Risk Management Plan For the project, a risk management plan involving 3 key aspects will be important. Below is the Breakdown of the plan Risk Identification Our healthcare optimization project will likely encounter several specific risks that demand our attention. First, there's the risk of scope creep, a common challenge in projects where the initial objectives and boundaries may gradually expand, potentially leading to delays and increased costs. To address this, we will focus on clearly defining and adhering to our project scope and objectives. Secondly, we anticipate potential technology challenges, which could manifest as compatibility issues or system failures while implementing new technologies and software. To mitigate these challenges, we will prioritize comprehensive testing, preparedness, and effective troubleshooting protocols. Another risk on our radar is staff resistance. Implementing changes in processes and technologies can often face resistance from healthcare staff accustomed to existing practices. To address this, we will proactively implement a robust change management strategy that involves staff, addresses their concerns, and provides training to facilitate a smoother transition. Lastly, data security is a critical concern, with the risk of data breaches and security vulnerabilities associated with using healthcare data and analytics. To safeguard patient information and mitigate this risk, we will implement stringent data security measures, including encryption, access controls, and regular audits.
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Enhancing ED Efficiency 23 Risk Assessment We will assess the likelihood and potential impact of each identified risk. We will also rank risks based on their severity and probability. Risk Mitigation To mitigate the identified risks, we have a comprehensive strategy in place. We will rigorously manage project scope by regularly reviewing and validating it, preventing scope creep, and carefully documenting any requested changes to assess their impact. Technology preparedness will be a priority, ensuring thorough testing and integration of all technology and software components before deployment, along with contingency plans for potential technology failures. We will implement a change management strategy to engage healthcare staff, address their concerns, and provide necessary training to facilitate a smooth transition. Robust data security measures, including encryption, access controls, and regular audits, will be implemented to safeguard patient information throughout the project.
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Enhancing ED Efficiency 24 References Amaniyan, S., Faldaas, B. O., Logan, P. A., & Vaismoradi, M. (2020). Learning from patient safety incidents in the emergency department: A systematic review. The Journal of Emergency Medicine , 58 (2), 234-244. https://doi.org/10.1016/j.jemermed.2019.11.015 Bittencourt, R. J., Stevanato, A. D., Bragança, C. T., Gottems, L. B., & O’Dwyer, G. (2020). Interventions in overcrowding of emergency departments: An overview of systematic reviews. Revista de Saúde Pública , 54 , 1-13. https://doi.org/10.11606/s1518- 8787.2020054002342 Eriksson, J., Gellerstedt, L., Hillerås, P., & Craftman, Å. (2018). Registered nurses’ perceptions of safe care in overcrowded emergency departments. Journal of Clinical Nursing , 27 (5- 6). https://doi.org/10.1111/jocn.14143 Forero, R., Nahidi, S., de Costa, J., Fatovich, D., FitzGerald, G., Toloo, S., McCarthy, S., Mountain, D., Gibson, N., Mohsin, M., & Man, W. N. (2019). Perceptions and experiences of emergency department staff during the implementation of the four-hour rule/national emergency access target policy in Australia: A qualitative social dynamic
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Enhancing ED Efficiency 25 perspective. BMC Health Services Research , 19 (1), 1- 14. https://doi.org/10.1186/s12913-019-3877-8 Harrou, F., Dairi, A., Kadri, F., & Sun, Y. (2020). Forecasting emergency department overcrowding: A deep learning framework. Chaos, Solitons & Fractals , 139 , 1- 13. https://doi.org/10.1016/j.chaos.2020.110247 Hsu, C., Liang, L., Chang, Y., & Juang, W. (2019). Emergency department overcrowding: Quality improvement in a Taiwan Medical Center. Journal of the Formosan Medical Association , 118 (1), 186-193. https://doi.org/10.1016/j.jfma.2018.03.008 Jung, H. M., Kim, M. J., Kim, J. H., Park, Y. S., Chung, H. S., Chung, S. P., & Lee, J. H. (2021). The effect of overcrowding in emergency departments on the admission rate according to the emergency triage level. PLOS ONE , 16 (2), 1- 9. https://doi.org/10.1371/journal.pone.0247042 Maninchedda, M., Proia, A. S., Bianco, L., Aromatario, M., Orsi, G. B., & Napoli, C. (2023). Main features and control strategies to reduce overcrowding in emergency departments: A systematic review of the literature. Risk Management and Healthcare Policy , 16 , 255- 266. https://doi.org/10.2147/rmhp.s399045 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 Medicine , 6 (3), 189- 195. https://doi.org/10.15441/ceem.18.022 Morley, C., Unwin, M., Peterson, G. M., Stankovich, J., & Kinsman, L. (2018). Emergency department crowding: A systematic review of causes, consequences and solutions. PLOS ONE , 13 (8), 1-42. https://doi.org/10.1371/journal.pone.0203316
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Enhancing ED Efficiency 26 Moskop, J. C., Geiderman, J. M., Marshall, K. D., McGreevy, J., Derse, A. R., Bookman, K., McGrath, N., & Iserson, K. V. (2019). Another look at the persistent moral problem of emergency department crowding. Annals of Emergency Medicine , 74 (3), 357- 364. https://doi.org/10.1016/j.annemergmed.2018.11.029 Rezaei, F., Yarmohammadian, M., Haghshenas, A., & Tavakoli, N. (2017). Overcrowding in emergency departments: A review of strategies to decrease future challenges. Journal of Research in Medical Sciences , 22 (1), 1-9. https://doi.org/10.4103/1735-1995.200277 Salomão, M., Guimarães, T., Duailibi, D., Perondi, M., Letaif, L., Montal, A., Rossi, F., Cury, A., Duarte, A., Levin, A., & Boszczowski, I. (2017). Carbapenem-resistant Enterobacteriaceae in patients admitted to the emergency department: Prevalence, risk factors, and acquisition rate. Journal of Hospital Infection , 97 (3), 241- 246. https://doi.org/10.1016/j.jhin.2017.08.012 Salway, R., Valenzuela, R., Shoenberger, J., Mallon, W., & Viccellio, A. (2017). Emergency department (Ed) overcrowding: Evidence-based answers to frequently asked questions. Revista Médica Clínica Las Condes , 28 (2), 213- 219. https://doi.org/10.1016/j.rmclc.2017.04.008 Savioli, G., Ceresa, I. F., Gri, N., Bavestrello Piccini, G., Longhitano, Y., Zanza, C., Piccioni, A., Esposito, C., Ricevuti, G., & Bressan, M. A. (2022). Emergency department overcrowding: Understanding the factors to find corresponding solutions. Journal of Personalized Medicine , 12 (2), 1- 13. https://doi.org/10.3390/jpm12020279
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Enhancing ED Efficiency 27
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