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Case study3-4 pages is fine! case study based off of document attached. Its basically taking the data and saying does it show improvement or not
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DID THEY IMPROVE?
For this case, we once again return to the story of Carla.
You will recall, Carla sat in the emergency room for hours before her blood was drawn for laboratory
tests. Issues of overcrowding and delays in treatment had longed plagued the emergency room. The
hospital quality department was asked to oversee a project to address this issue.
After the initial step of forming an improvement team, a preliminary literature review was conducted. It
was noted that evidence-based studies reveal that excessive stays in the Emergency Room for patients
requiring admission are associated with worse outcomes when compared with patients admitted in a
timely manner. Specifically, the literature indicated that patient who stayed in the emergency room less
than 4 hours did better than those who had longer stays.
Baseline data was collected retrospectively using the time stamps in the electronic record. The accuracy
of these time stamps was validated by the quality improvement team to ensure that the data was
correct. The team decided to evaluate the performance of the ER in terms of percent of patients
discharged within discrete 30-minute blocks. The team felt this information would best be presented in
a bar chart. The results of the baseline data were observed below.
Percent of Patients Discharged Per Minute
Before Intervention
60
50
40
30
20
10
0
0-30
31-60
61-90
91-120 121-150 151-180 181-210 211-240
>240
The improvement team created a Key Performance Indicator (KPI) which they shared with the
Emergency Room Staff. They set a goal that patients should be discharged- either admitted or sent
home- from the emergency room within 4 hours from the time of registration. The team provided
information on the percent of patients who were discharged within the same 30 minute blocks.
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The Emergency Room staff would be rewarded with a small financial bonus if an increased percentage of
patients were discharged before 240 minutes. The Emergency Room staff initiated an improvement
plan. The results of the improvement effort are shown below.
Percent Of Patients Dischared per Minute After
Intervention
60
50
40
30
20
10
0
AVERAGE MINUTES FROM
REGISRATION TO DISCHARE
0-30 minutes
31-60 minutes
61-90 minutes
91-120 minutes
121-150 minutes
151-180 minutes
181-210 minutes
211-240 minutes
>240 minutes
PERCENT OF PATIENTS
DISCHARGED
(Before QI Project)
PERCENT OF PATIENTS
DISCHARGED
(After QI Project)
15%
10%
20%
15%
5%
55%
55%
30%
The team was quite happy with the results and eagerly presented them at the Quarterly Board Meeting.
One member of the Board had recently spent several hours waiting in the Emergency Room after his
daughter had fallen on the playground and needed stitches. He was interested to learn if this
improvement meant his wait would be less in the future should he ever have to make a return visit.
Knowing your reputation as an esteemed MCPHS graduate, you have been asked to review the data to
determine if the emergency room really did improve and by how much?
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I.
DISCHARGE BY AGE GROUP
You are interested in learning more details about the time from registration to discharge. One piece of
information you ask to see is discharge time per different age groups that come to the Emergency
Room. You are given the following data. The data shows, for example, that ¼ of the patients seen in the
Emergency Room are pediatric patients—less than 18 years old.
PATIENT AGE GROUP
64
AS PERCENT OF TOTAL NUMBER OF PATIENTS
SEEN IN THE EMERGENCY ROOM
25%
15%
25%
35%
You are also shown the percent of patients discharged in less than 240 minutes by age group. The data
is as follows
PATIENT AGE GROUP
64
PERCENT DISCHARGED IN LESS
THAN 240 MINUTES
(Before QI Project)
15%
10%
10%
10%
PERCENT DISCHARGED IN
LESS THAN 240 MINUTES
(After QI Project)
25%
15%
15%
15%
A nursing student who has been doing a quality improvement project for one of her classes approaches
you and mentions she has some additional data on this same group of patients that she has been
collecting but is not sure how to interpret. She has validated the data and is certain it is accurate. She
shows the following data in which she has collected from a retrospective review. She asks for your help
in analyzing this data.
PATIENT AGE GROUP
< 18
18-35
36-64
>64
3
AVERAGE TIME FROM
ADMISSION TO DISCHARGE
(BEFORE INTERVENTION)
In minutes
270 minutes on average
150 minutes on average
360 minutes on average
380 minutes on average
AVERAGE TIME FROM
ADMISSION TO DISCHARGE
(AFTER INTERVENTION)
In minutes
250 minutes on average
180 minutes on average
420 minutes on average
880 minutes on average
II.
PEDIATRIC PATIENTS
The young nursing student also has collected more detailed data on discharge times within the pediatric
patient population. She reviewed data for 5 weeks before the start of the Emergency Room
improvement project, as well as for the 51 weeks during and immediately after the improvement
project.
Her data is listed below
WEEK
Week 1
Week 2
Week 3
Week 4
Week 5
Week 6 IMPROVEMENT PROJECT STARTED
Week 7
Week 8
Week 9
Week 10
Week 11
Week 12
Week 13
Week 14
Week 15
Week 16
Week 17
Week 18
Week 19
Week 20
Week 21
Week 22
Week 23
Week 24
Week 25
Week 26
Week 27
Week 28
Week 29
Week 30
Week 31
Week 32
4
AVERAGE TIME
(IN MINUTES)
260
300
280
240
285
270
290
320
240
295
260
240
280
290
310
280
220
300
260
270
290
230
280
280
280
180
290
230
270
250
220
210
Week 33
Week 34
Week 35
Week 36
Week 37
Week 38
Week 39
Week 40
Week 41
Week 42
Week 43
Week 44
Week 45
Week 46
Week 47
Week 48
Week 49
Week 50
Week 51
Week 52
Week 53
Week 54
Week 55
Week 56
260
210
190
190
260
220
210
270
230
260
170
220
260
300
190
220
270
220
230
190
260
210
230
210
She also has plotted the data in a line graph. She asks your advice on how to determine if the graph
demonstrates an improvement
5
Improvement Project Started
Finally, you attend a Quality Improvement Meeting where some other QI Groups Report on their
improvement projects.
One group has been looking at a Quality Indicator that measures “Return to the Emergency Room within
24 hours.” This is a very important indicator because it might indicate that patients were discharge too
quickly. In addition, many insurers will not pay hospitals for this second Emergency Room Visit. The QI
team reports they have been seeing an increase in the number of patients returning to the Emergency
Room within 24 hours in the last year.
In addition, several of the Medical Wards have been noticing an increase in the number of falls. Incident
report data suggests patients are being sent to the ward before a bed is actually ready which results in
patients sitting in the hallways waiting for their bed.
Please consider the following:
Based on the available data, do you think the Emergency Room improved?
6
Please write an essay explaining and supporting your thoughts on this question. Please provide a
rationale for your position. Your rationale should include a discussion of the data from the case and
should demonstrate an understanding of the quality improvement concepts discussed this semester
such as choice of performance improvement metrics, measurement selection, and understanding of
variation.
The paper should be 4-5 pages long, double spaced. APA format should be used for any references.
Grading Rubric:
Thesis/Position
Statement
(2 Points)
Supporting
Evidence (2
points)
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EXCELLENT
There is a clear
thesis
statement clearly
identifies the
topic of
the essay and
outlines the main
points to be
discussed. The
author’s position
on whether the
emergency room
improved is
strongly and
clearly
stated.
2 points
Includes
Evidence from the
case
that
supports the
position
statement. In
addition, the
writer anticipates
concerns,
biases or
alternative
viewpoints
arguments
and has provided
at
least 1
counterargument
(2 points)
GOOD
The thesis
statement names
the topic of the
essay. The
author’s
position on
whether the
emergency room
improved is
stated
FAIR
The thesis
statement
outlines
some or all of the
main points to be
discussed but
does
not name the
topic.
UNSATISFACTORY
The thesis
statement does
not
name the topic
AND does not
preview what will
be discussed.
0 points
1 point
1.5 points
Includes evidence
From the case
that
supports the
position
statement.
Includes
evidence from the
case but does not
link the evidence
to the position
statement.
(1.5 points)
(1 point)
Does not include
evidence from the
case
(0 points)
Demonstration of
Quality
Improvement
Concepts (2
points)
Organization (2
points)
Mechanics (2
points)
8
The paper
demonstrates an
excellent
understanding of
Quality
Improvement
Concepts
including the
correct
terminology.
Principles are
defined and a
relationship to the
essay thesis is
drawn.
(2 points)
Arguments and
support are
provided
in a logical order
that makes it easy
and interesting to
follow the
author’s
train of thought.
The introductory
paragraph has a
strong hook or
attention grabber
that is
appropriate
for the topic. The
conclusion is
strong and leaves
the reader solidly
understanding the
writer’s position.
(2 points)
Piece is clearly
written with no
grammar,
spelling,
The paper
demonstrates an
understanding of
Quality
Improvement
Concepts but
there are some
errors in
terminology or
understanding of
the concepts.
Improvement
principles are
related to the
essay thesis
(1.5 points)
Arguments and
support are
provided in a
fairly
logical order that
makes it
reasonably easy
to
follow the
author’s
train of thought.
The introductory
paragraph has a
hook or attention
grabber, but it is
weak, rambling or
inappropriate for
the topic. The
conclusion is
recognizable. The
author’s position
is
restated within
the
closing
paragraph.
.
(1.5 points)
There are minor
errors in
grammar,
spelling,
The paper
demonstrates a
limited
understanding of
the Quality
improvement
concepts with
terminology being
used incorrectly
and concepts
being incorrectly
understood.
Relation to the
thesis is unclear.
(1 point)
The paper
demonstrates no
understanding of
Quality
Improvement
Concepts.
A few of the
support details or
arguments are
not
in an expected or
logical order,
distracting the
reader and
making
the essay seem a
little confusing.
The author has an
interesting
introductory
paragraph but the
connection to the
topic is not clear.
There is a
concluding
paragraph but the
author’s
position is not
clearly restated
within the closing
paragraph
Many of the
support
details or
arguments are
not
in an expected or
logical order,
distracting the
reader and
making
the essay seem
very confusing.
The introductory
paragraph is not
interesting AND is
not relevant to
the
topic. There is no
concluding
paragraph; the
essay just ends.
(0 points)
(0 points)
(1 point)
Errors may be
present and may
slightly take away
Errors make it
difficult to read
and/or
understand
punctuation, or
capitalization
errors.
(2 points)
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punctuation or
capitalization but
they do not
distract from the
meaning.
(1.5 points)
from the clarity;
yet,
the writer’s
meaning can be
determined.
(1 point)
the paper.
( 0 points)
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