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[ANSWERED] You are the unit director of the emergency department and part of an ad hoc interdisciplinary committee newly formed to address a 30%

You are the unit director of the emergency department and part of an ad hoc interdisciplinary committee newly formed to address a 30% rise in arrival-to- provider time over the past six months. Six months ago, the ED consistently recorded an arrival-to-provider time less than the national benchmark of twenty minutes. The arrival-to-provider time is presently over one hour. A root cause analysis study finds that arrivals to the ER have increased by 50% and the lobby is usually filled to capacity. Often patients must stand due to lack of adequate seating. FTEs have not been added and staffing is consistently short due to call-offs. Patients are not being discharged from inpatient beds in a timely manner. The task for the committee is to propose a solution for the problem. Looking at this through the lens of an evidence-based quality improvement process, what would you propose as the PICOT for this initiative? Who are the stakeholders represented in your group? (Remember, this is an internal organizational issue, and while patients are impacted by the issue and are the beneficiaries of the work done, they would not be included in this type of task force)

(for your review, see the example for developing a PICOT below or refer to the Nurse Executive Track CGE Academy webinar located in resources and announcements)

Group:

Discuss how the perspectives for the PICOT differ depending on the discipline represented by each stakeholder? What impact will they have on the group process and in team building? How is the group process and team building effected by the organization\’s culture and climate of transparency and safety? How will the outcomes of the committee be impacted?

PICOT Writing Review

Situation:

Sunnybrook Health System has started the process for acquiring Magnet status. They have scheduled multiple planning and process meetings over the next year that require attendance of all staff. Staff must attend at least 70% of the meetings live. After three meetings, live attendance of night shift staff has been about 5%. There is concern that with the small amount of interest shown from this group, the benchmark of 70% for live attendance may be jeopardized. Currently, the meeting schedule is communicated to all staff via email and posted announcements. Suzie thinks an incentive of a free meal for live attendance might improve attendance of the night shift crew.

How could a PICOT be developed with this information?

P = Population – Describes the group upon which the intervention will have an effect.

Ex: night shift staff

I = Intervention – What we want to do that is different from what we currently do; the thing that is goingto impact the population identified

Ex. coupons for a free meal in the cafeteria

C = Comparison – Here the comparison is a before and after the intervention (incentive in this case)

Ex: communication of scheduled meetings via email and posted announcements

O = Outcome – What we want to see happen as a result of the intervention. The outcome should meet three criteria: direction (increase, decrease, etc), a baseline, and a goal.

Ex: increased mandatory meeting live attendance from 5% to 50%

T = Timing or Timeframe

Expert Answer and Explanation

Leadership in Healthcare Organization

Group

The arrival-to-provider time is a critical timeframe that needs to be addressed when dealing with patients in the emergency department. Different interventions can be used to improve the arrival-to-provider time (Lira, & Rocha, 2019). The following PICOT question can be used to identify the preferred interventions for the arrival-to-provider time. “Among the nurses working in the ED (P), how does the collection of patient information before the appointment (I), compared to making the patients queue at the reception upon arrival (C), help reduce the arrival-to-provider time (O) over time (T)?” The main stakeholders represented in the include the ED nurse, nurse leaders, and hospital management. The nurses are key to the group since they are the first constant with the patient to facilitate the admission process. The nurses also bridge the gap between the patient and the internal stakeholders (Febriani & Yancey, 2019). The role of the nurse in the group is paramount and the PICOT question is based on their intervention.

The nurse leaders are also key to the group as they coordinate the processes and strategies made by the nurses in the group. Nurse leaders can advocate for the provision of policies and procedures to help improve the operations of the nurses and other junior staff. The hospital administration is also critical as they would provide the required finances and resources needed for the attainment of the desired outcome. The perspective of the PICOT question differs based on the discipline represented by the different stakeholders. The nurses are the key players since they help facilitate the physical process. The nurse leaders are also essential as they provide a conducive environment for the nurse to perform their roles (Bianchi et al., 2018). The hospital management on the other hand ensures that the process can be facilitated through the availability of resources and finances. Each of the players is important towards the attainment of the outcomes stated within the PICOT question.

Concerning the team-building process, the nurses can help with peer motivation and education. Nurses are key to the attainment of improved arrival-to-provider time and they can help each other in the adoption of the new system to help achieve the desired outcome (Bianchi et al., 2018). The nurses can also help provide feedback and evaluation of the intervention to assist in making the needed amends and other key policy changes. The feedback can be used to create strategies to reduce the arrival-to-provider time and improve the transition stage without causing major differences. The nurse leader can also offer insights and leadership to the team as they transition (Bianchi et al., 2018). Offering evidence-based guidance can improve how the nurses interpret the PICOT question and attain the required outcome. These processes are key to ensuring a seamless group process. Working together as a team can improve the nature in which the issue is addressed and the attainment of the outcome.

Collaboration between the different healthcare teams is a key milestone for the committee (Bianchi et al., 2018). Through the intervention of each discipline, the committee can facilitate transparency of the team’s activities and the safety of the patients. Playing the different roles makes it easier for the committee to work together.

Situation

Based on the provided situation, the following PICOT question can be used to determine the interventions and outcomes (Fandino, 2019). Concerning all staff (P), how does the inclusion of benefits and incentives (I), compared to general announcements only (C), increase the level of staff attendance (O) in the next year’s meeting (T)?

References

Bianchi, M., Bagnasco, A., Bressan, V., Barisone, M., Timmins, F., Rossi, S., … & Sasso, L. (2018). A review of the role of nurse leadership in promoting and sustaining evidence‐based practice. Journal of Nursing Management26(8), 918-932.

Fandino, W. (2019). Formulating a good research question: Pearls and pitfalls. Indian journal of anaesthesia63(8), 611.

Febriani, D. M., & Yancey, G. B. (2019). The effect of integration approaches and human resources initiatives on changes in organizational culture and employee attitudes during a merger. The Psychologist-Manager Journal22(2), 108.

Lira, R. P. C., & Rocha, E. M. (2019). PICOT: Imprescriptible items in a clinical research question. Arquivos Brasileiros de Oftalmologia82, 1-1.

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