How to decrease wait times in the EMR rooms

Make all necessary revisions and corrections to previous assignments completed in Topics 1- 7. Combine all elements into one cohesive evidence-based proposal.

Although recommendations will vary in length depending upon the problem or issue addressed, the paper must be between 2,500-2,750 words and formatted in APA style. The title page, appendixes, and references are not included in the word limit. The final paper should clearly describe the methods used to identify and retrieve the evidence as well as the rationale for exploring the clinical issue chosen. Clearly articulated recommendations for practice based on research evidence are essential to a successful paper.

Use section headings for each section component and address responses in narrative form. Sections of the final paper must include all of the components written to date (incorporating revisions), as well as the remaining sections. These sections include:

Title Page
Introduction
Problem or Issue
Proposed Solution
Implementation Plan
Timeline
Evaluation Plan
Dissemination Plan
Conclusion/Summary
Reference Page
Appendices (i.e., Literature Evaluation Table)
The final capstone project paper requires that you support your position by referencing at least nine scholarly resources. At least six of your supporting references must be from peer-reviewed resources.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

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

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Benchmark Information

This benchmark assignment assesses the following programmatic competencies:

BS Organizational Management

1.5: Propose a change initiative to resolve issues within a health care organization.

BS Health Care Administration

5.2: Engage in professional development, learning, and mentoring to maintain competence within one’s profession and scope of practice.

5.3: Demonstrate professionalism by adhering to institutional guidelines and accredited professional standards.

ANSWER

Decreasing Wait Times in the EMR Room

Introduction

The issue of wait times in various fundamental sections of health organizations continues to persist, even as the hospital technological advances continue to be implemented in various health sectors. Wait times contribute to many problems, specifically the EMR rooms (Electronic Medical Records). The EMR room and adopted system play a significant role in many healthcare facilities (Ewing et al., 2017). The applicable EMR system enables physicians to record patient histories, take and display various medical test results, write the patient prescriptions, receive various clinical reminders, apply decision-support tools, and other important activities. However, according to Ewing et al. (2017), the Electronic Medical Records section is the highest section that is faced with the problem of wait times. Many patients complain of long queues, shortage of staff, and getting medical attention after waiting for several hours.

Hence, the issue of wait times in hospitals is an issue that needs to be addressed, considering the problems it causes. Emergency patients who do not get the medical attention that they promptly require often die while waiting for medical attention. In addition, frustrated patients that have been waiting in lines for a long time leave the hospital without getting any medical attention (Ewing et al., 2017). Wait times also cause stress for both the waiting patients and the present medical staff, leading to inaccurate prescriptions frustration and further delay. Hence, the need for an evidence-based and peer-reviewed approach to combating wait times in MER is of utmost importance. This essay analyses the approach of applying a queue management system to reduce wait times in MER sections. It also analyses the implementation plan, timeline needed for the fruition of the plan, and both the evaluation and dissemination plan of the queue management system.

Problem of the Issue

The problem of wait times in the EMR section narrows down to systemic failures that can be easily avoided. However, many hospitals continue to struggle with the issue as the main problems that cause wait times to continue to be overlooked. There are various problems that lead to the development of the issue of wait times (Lauks et al., 2016). For instance, inadequate EMR staff leads to overcrowding, as there are not enough medical personnel to attend to the numerous patients, especially experienced in public hospitals. The staff shortage means that only a few patients can receive medical attention and processing, as the others continue to wait in line. For instance, if a doctor takes approximately 30 minutes with every single patient, a line of 50 patients is likely to lead to long wait times.

Another problem that leads to the persistence of the issue is limited resources in the EMR section. Along with the issue of shortage of staff, the lack of proper resources to address patients’ medical issues also leads to long wait lines (Lauks et al., 2016). Hospitals that have limited resources often suffer from looking for alternatives that can give relief, especially to patients who require urgent medical attention. Furthermore, the problem of unnecessary visitors to medical facilities also overwhelms the medical staff, leading to long queues and long wait lines. Visitors that constantly visit their loved ones admitted in hospitals often contribute to the long wait lines. The combination of visitors and patients requiring medical attention leads to confusion, overwhelming medical staff, and, ultimately, long lines. This contributes to the frustration of patients who legitimately require attention and who often leave after long hours of waiting in line without any success (Lauks et al., 2016).

However, the ultimate problem of the issue of wait times is the lack of proper research in the management of wait time using medical informatics. Medical informatics comprises various data related to patient-doctor interaction in terms of the time spent per patient and the time spent per patient while waiting in line. It also includes the issue of shortage of medical staff and medical resources. Proper research and implementation into the management of wait times is the fundamental issue of the problem. This essay analyses some of the ways queue management can significantly reduce wait times (Arha, 2017). Queue management will allow every patient to receive proper medical attention and significantly reduce stress levels and frustration for both the staff and the patients.

Methodology

The methodology applied to get more information about wait times in EMRs depended on various factors. First, information was collected using medical informatics concerning the time spent by doctors on each patient (Glogovac et al., 2020). It also included the number of patients visiting the EMR section every day and how much time was spent on each patient before checking it from the hospital. More information was also gathered from various peer-review articles dating back to the last six years, as they had the most recent information regarding the issue of wait times in EMRs. More information was also gathered online with certain keywords used, including wait times in hospitals, problems associated with wait times in EMRs, the effect of prolonged wait times in ERs and solutions to prolonged wait times in ERs and the Impact of medical informatics on wait times in hospitals (Glogovac et al., 2020).

The keywords helped give a broader perspective of the issue, the problems and the impact of wait times on the physician’s abilities to execute their responsibilities. The peer-reviewed articles helped to elaborate the issue and consequences of long wait times in hospitals, not only limited to EMRs but the whole health sector. All this information paved the way for appropriate findings that gave a fundamental insight into the wait times approach and the ways to decrease them.

Discussion of Findings

Emergency Departments and Emergency Records

According to the findings of the research, the emergency departments (ED) and the emergency Medical Records department (EMR) were the two most affected departments regarding the issue of long wait times. One of the causes of the long wait times was found to be the purpose of the department and the duration of activity (Gaughan et al., 2020). Emergency departments were found to be open 24/7, receiving every patient-facing complicated medical issues, with most of them being life-threatening. This purpose of emergency departments attracts many patients, as they are the first stop before being referred to other doctors or departments concerning the continuation of their medication. Hence, many patients found themselves queuing due to a high number of patients visiting at any time of the day needing urgent medical attention.

Another factor contributing to the long wait in ED is other non-emergency-related factors in the ED. For instance, according to the 1986 Emergency Medical Treatment and Labor Act, all patients reporting to the ED in the United States be medically screened whether they can pay or not (Glogovac et al., 2020). This means that physicians are not allowed to screen whether the patients can pay or not, hence only obligated to attend to any patient that visits the ED. This issue, compounded with the problem of being understaffed, led to many hospitals receiving many patients with few doctors to attend to them. Many patients hence resorted to looking for other options like clinics or self-imposed over-the-counter medications.

According to the findings, additional effects of long wait lines in emergency rooms and departments were found to result from the patient’s perception of wait lines. According to Rezaei Damavandi (2018), emergency departments experience patients with irrational behavior that depend on their own perception of how ‘a long wait time’ is to them. Some patients exercised a varying degree of patients compared to others. Some patients who had spent only 30 minutes showed restlessness and aggressive behavior towards medical staff compared to others who patiently waited for two hours. Rezaei Damavandi (2018) defines a patient’s perception as an interpretation of what goes on in his or her own environment. What other patients considered a long wait might not be the same case for other patients.

Another finding was the incorporation of technology in healthcare that impacted the waiting line in hospitals. Quite specifically, medical informatics played a vital role in helping reduce wait lines only if they were implemented correctly. Medical informatics has been defined as a discipline at the intersection of information science, computer science, and health care. It encompasses all areas of the resources, devices, and methods required to improve the acquisition, storage, retrieval, and use of information in health care and biomedicine. Examples of medical informatics are electronic health records (EHR), personal health records (PHR), population health management (PHM) and telemedicine (Rezaei Damavandi, 2018).

Proposed Solutions

Emergency departments (EDs) in hospitals are areas that can be exceptionally stressful and chaotic. Considerably, healthcare providers encounter workload challenges that hinder efficiency in healthcare provision. It has been estimated that ED physicians and nurses manage over 200 patients per day on average. With such a high patient load, it becomes increasingly difficult to ensure all patients receive the proper attention and care they require when they present in an ED. Adequate staffing is the most suitable intervention to reduce delays in emergency departments and boost performance (Recio-Saucedo et al., 2015). Adequate staffing is a solution to the issue of long wait times in emergency rooms. Adequate staffing entails placing nurses, physician assistants, and doctors at the point of care based upon each patient’s understanding or severity. Adequate staffing in the emergency department means having sufficient nurses and other providers (including physicians and physician assistants) to provide quality care. The exact number of patients a nurse can adequately care for at any one time varies depending on the patient’s understanding, but research shows that higher numbers of nurses result in better outcomes for patients. By having enough staff on duty, hospitals can limit the variability in nursing skill mix and team structure, affecting the flow, safety, and satisfaction.

Adequate staffing in emergency rooms will improve patient safety, satisfaction, and clinical outcomes due to reduced wait times and better healthcare. Adequate staffing maintains the flow of patients through the emergency department, limits waiting times for patients, and reduces stress on staff. Ideally, emergency department flow relies upon many factors, including nursing skill mix, team structure, staffing ratios, and patient acuity (Liu and Xie, 2018). Therefore, the number of healthcare providers determines the number of patients seen, waiting times, and patient satisfaction. Emergency departments that do not meet these minimum staffing ratios can experience increased infection rates, accidents, falls, increased patient wait times, poorer quality of care, and adverse events.

The incorporation of medical informatics like the EHR will allow doctors to save time significantly while trying to access the medical history of their patients. According to the findings, much time is spent in the diagnosis process. Doctors try to disseminate whether their patients can remember their current medications and the symptoms that led to such prescriptions. However, with electronic health records, physicians can retrieve the medical history of their patients and save time significantly while assessing their current and medical histories. Doctors can also quickly refer their patients to other departments, hence reducing wait times in other departments, and a snowball effect ensures that the hospital at large remains with minimal congestion, not only the emergency department. Electronic Health Records ensure that minimal time is wasted on patient interaction, especially for diabetic patients, whose medical history gives a quick, broader, and time-reducing perspective regarding their situation.

Implementation Plan

For the change to be implemented, there is a need to have a clear vision for the external and internal stakeholders. The most important thing is to ensure that all the stakeholders understand the change and their part in the change process. Clear communication of the health issue, the solution, and the benefits will be paramount to gaining support from stakeholders. Therefore, communicating the vision will need creating a schedule of dates, meetings, and communication plans. Indicating to the stakeholders the concrete targets for the vision will create a clear understanding of how the vision will be achieved.

The proposed change will require financial resources, recruitment resources, training resources, and a staffing model. The recruitment resources will be used to source high-quality healthcare providers. For instance, the employee referral program, a structured and organized program, will be used to recommend suitable candidates for positions in the emergency departments. The training resources will include online and onsite education programs for the healthcare providers and nurses to improve their skills and knowledge, which will reduce the amount of time they spend on offering care for a single patient. The staffing model is designed to ensure that the nursing staff qualification, managers, and clinical expertise are consistent with the patient care needs and quality of care. This will also offer guidance on the nurse-patient rations. Ideally, the staffing model will offer guidelines and rules determining the nurses required to offer patient care in emergency rooms.

Various stakeholders will be required for strategizing, implementing, and monitoring the change (Rezaei Damavandi, 2018). These stakeholders will include the government, healthcare organizations, healthcare professionals, pharmaceutical firms, insurance companies, patients, and the community. Each of these stakeholders will help address the problem of long wait times in ED and offer the best solutions and approaches for this problem. The stakeholders will work in groups depending on their knowledge, skills, and scope of practice.

Timeline of the Plan

The timeline of the pan depends on the approach taken by the stakeholders to train various medical staff across different departments, especially the emergency room department. The training will entail teaching them about queue management and some of the issues that lead to long wait lines. The training will also entail providing them with information regarding their own contributions, such as patient-physician interaction. This will help them develop a broader sense of their contribution to the long lines and how they can manage time effectively to avoid many people waiting to see them simultaneously. As some of the training will be conducted physically and online, the appropriate time for queue management will be within one month. During this time, physicians and other medical personnel will be taught about line management and how they can properly deal with patients who are impatient and display irrational behavior. This will be under the ways of deescalating patients’ irrational behavior and how best to quickly assist them before other patients start portraying the same behavior.

An additional one month will be needed to train and introduce physicians and hospitals about the use and effectiveness of EHR systems. This will depend on the managing stakeholders and the kind of technology they would need suitable for EHR to improve their performance. Once the decision is made on the type of EHR technology required, medical staff will be taught how to use them, especially in receiving their patients, retrieving their medical history, and updating any perception recommended for the future. This will allow long wait lines to be avoided and little time spent between doctor-patient interactions. Overall, the training will require three months, two for training, and a month for mock applications for the training to be complete.

Evaluation Plan

Evaluation of whether the training on line management was successful will depend on the medical informatics after the training. A specialized team will be responsible for monitoring the progress of applying the effectiveness of line management and whether or not they are working. This will entail asking for feedback from patients using the hospital’s website and various questionnaires, including suggestion boxes, for patients to express their concerns. The key issue to be evaluated will be whether their wait time was against their expectation and how the medical staff addressed their concerns. The main aim will be to evaluate whether the approach of line management and implementation of HER helped reduce the frustration with time. Patients will be given an opportunity to express their views and offer suggestions on how best they would want the hospital to address their situations.

The stakeholders will also be responsible for monitoring their physician’s operations. During annual or biannual meetings, the agenda of line management will be given a priority, as the stakeholders seek to evaluate whether the training levied on their staff was successful. The patient log-ins retrieved from the medical informatics will give a broader perspective on the effectiveness of the training, and the relevant adjustments will be implemented depending on the success or failure of the initial training.

Conclusion

The frustration and stress associated with long lines in emergency rooms and departments are logically understandable. However, the probe of long wait lines is avoidable if the concerned parties are accountable for their actions and take the necessary steps to reduce them. One of the most effective ways of reducing ling lines is to ensure proper training to the medical staff and the appropriate technologies applied in reducing time-wasting. As training may be a form of change, challenging and time-consuming (considering the businesses of the department), the outcomes are bound to be significant and problem-reliving. Hence, training physicians on the ways of decreasing long wait lines in EMR rooms is one of the most effective ways of reducing the menace.

References

Arha, G. (2017). Reducing Wait Time Prediction In Hospital Emergency Room: Lean Analysis Using a Random Forest Model.

d’Ettorre, G., Mazzotta, M., Pellicani, V., & Vullo, A. (2018). Preventing and managing workplace violence against healthcare workers in Emergency Departments. Acta Bio Medica: Atenei Parmensis, 89(Suppl 4), 28.

Ewing, A., Rogus, J., Chintagunta, P., Kraus, L., Sabol, M., & Kang, H. (2017, April). A systems approach to improving patient flow at UVA Cancer Center using Real-Time Locating System. In 2017 Systems and Information Engineering Design Symposium (SIEDS) (pp. 259-264). IEEE.

Gaughan, J., Kasteridis, P., Mason, A., & Street, A. (2020). Why are there long waits at English emergency departments?. The European Journal of Health Economics, 21(2), 209-218.

Glogovac, G., Kennedy, M. E., Weisgerber, M. R., Kakazu, R., & Grawe, B. M. (2020). Wait times in musculoskeletal patients: What contributes to patient satisfaction. Journal of Patient Experience, 7(4), 549-553.

Lauks, J., Mramor, B., Baumgartl, K., Maier, H., Nickel, C. H., & Bingisser, R. (2016). Medical team evaluation: effect on emergency department waiting time and length of stay. PloS one, 11(4), e0154372.

Liu, R., & Xie, X. (2018). Physician staffing for emergency departments with time-varying demand. INFORMS Journal on Computing, 30(3), 588-607.

Ramsey, Z., Palter, J. S., Hardwick, J., Moskoff, J., Christian, E. L., & Bailitz, J. (2018). Decreased nursing staffing adversely affects emergency department throughput metrics. Western Journal of Emergency Medicine, 19(3), 496.

Rezaei Damavandi, T. (2018). Analysis of Emergency Departments Prolonged Waiting Time and its Possible Solution (Doctoral dissertation, California State Polytechnic University, Pomona).