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Caitlin

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Professor and Class,My PICOT is as follows:P (patient, population, or problem): younger (30-40s) patients in overall good health with new problemI (Intervention): implement best practices in nursing operations of purposeful rounding and bedside reporting.C (comparison with other treatment or current practice): Current practiceO (desired outcome): reduction in the left without being seen (LWBS) rate by 2%T (time frame): 90 daysMy PICOT question is: For younger (30-40s) patients in overall good physical health presenting to the emergency room with a new problem, does implementing bedside reporting and purposeful rounding improve the left without being seen rate?Within the Chamberlain ER scenario, there seems to be many problem areas. One problem area that is noted is the number of patients that are leaving without being seen (LWBS) which is 4.6% with a national benchmark for 2%. Developing a PICOT question to direct the change project is crucial to the research process. This approach will allow for better communication and understanding of the problem and research question being asked (Riva, Malik, Burnie, Endicott, & Busse, 2012). Utilizing a PICOT question when doing research allows for the best evidence available to be used. This will ensure that the impact on nursing practice is done with evidence based research (Echevarria & Walker, 2014). Within the scenario, patient satisfaction surveys provides evidence of longer wait times from time arriving to time being seen but reflects that nurses and providers displayed the knowledge and competencies to provide the care respectfully. There is an observed lack in effective communication along the process from triage to discharge between nurses and providers. Nursing were observed giving report at the nursing station, not rounding on patients but being on their cell phones, and avoiding discharging patients during busiest times to avoid admissions at end of shift. Bedside reporting can help to improve patient education and allow for discussion regarding diagnosis and related treatments (Muck, McNeil, McHugh, Bebarta, & Adams, 2015). Implementing purposeful rounding is a best practice in nursing that ensures patient safety, decreases adverse events like falls, and allows for patient needs to be meet. In this scenario, utilizing purposeful rounding in the Chamberlain ER will help the patient satisfaction score which will help the LWBS rate if patient needs are being met. Rounding will improve the communication and satisfaction with the patients (Daniels, 2016). Collapse SubdiscussionRobert DavisRobert DavisYesterdayMay 6 at 1:09pmManage Discussion EntryHi Caitlin and thank you for your PICOT draft. I greatly appreciate your attention to a lot of details provided in the Chamberlain ER scenario that you took into account in developing a PICOT. Nice work! I have some questions and feedback below for your consideration:P (patient, population, or problem): younger (30-40s) patients in overall good health with new problemThis is a well-defined patient population and I’m OK with this. I have a question as to how and why you focused in on this age group. Most students evaluating the scenario choose to address the overall population of ER patients. As CNO or CEO, or in my role as SVP for this project, I’d likely question the financial impact it would have by limiting our focus on such a small group. Tell me a little more about this when you have a chance.I (Intervention): implement best practices in nursing operations of purposeful rounding and bedside reporting.As I said in the narrative of my response, you picked up on some key details in the scenario that many don’t which is awesome. I think this is a legitimate intervention.C (comparison with other treatment or current practice): Current practiceIf you’re familiar with the situation you would know what the current practice is. Often, each part of a project will be reviewed by persons or teams that aren’t as familiar. It’s important to define what current practice is. Even if it seems obvious to you, it might not to a key person reviewing this. Briefly describe the current practice here that isn’t acceptable. You have it in your narrative, but many times people won’t read that so you’ll want it very clear in your PICOT.O (desired outcome): reduction in the left without being seen (LWBS) rate by 2%This is a good start. See my comments in my launch post and my feedback to others about how the outcome should be stated. You need direction, a baseline figure and a goal (actual numbers). If you stick with your limited population you might not have those specific numbers in the scenario. You might be able to extrapolate the numbers from the demographic data from the web site for your metro area.T (time frame): 90 daysThree months is a little ambitious but it might be reasonable so this is good.You’re off to an excellent start and you just have few minor things to work on. Please post your revisions here when you have a chance.Dr. DavisReplyReply to CommentProfessor,Thank you for the feedback on my PICOT question. To respond to your feedback, I focused on this population because when looking up the demographics for Albany-Schenectady-Troy, NY Metro area, the average age is 39.9 years old. When reviewing the Chamberlain ER scenario, the patient survey noted that 27% of patients are presenting for an accident or injury, 45% with a new health issue, and only 28% with an ongoing issue. Also, the majority of patients, 78%, do not arrive by ambulance and 42% reported in overall good health as being good. Additionally, 36% have only visited the ER one time in the last 6 months and 21% two times. Given all this information, I concluded my population for the PICOT to be younger patients in overall good health with a new problem. I do agree that most times the focus is on the elderly population and this does provide a limited group of patients. To revise this, I would say the population would be patients under the age of 65 with overall good health presenting with a new problem to the Emergency Department.Professor, I understand that the comparison within the PICOT should be stated out instead of just stating current practice. So, to revise this, the comparison would be the current practice with lack of communication and no rounding being done by nursing staff. To revise the desired outcome I would state that there will be a decrease in the LWBS rate from baseline of 4.6% to 2.6%P (patient, population, or problem): patients under the age of 65 with overall good health presenting with a new problem to the Emergency DepartmentI (Intervention): implement best practices in nursing operations of purposeful rounding and bedside reporting.C (comparison with other treatment or current practice): the current practice with lack of communication and no rounding being done by nursing staff.O (desired outcome): decrease in the LWBS rate from baseline of 4.6% to 2.6%.T (time frame): 90 daysRevised PICOT question: For patients under 65 years of age, in overall good physical health presenting to the emergency room with a new problem, does implementing bedside reporting and purposeful rounding improve the left without being seen rate?Robert Davis9:04amMay 7 at 9:04amManage Discussion EntryHi Caitlin, what an awesome job on your response ! I posed my questions to you just as I would as your supervisor in this scenario and I love the way you justified your position with the data. Great job in using the demographics and the survey to support your intervention. I love it! I see you changed your population a bit and that’s fine. What you have here is great and I would approve this PICOT for the scenario. I look forward to seeing you use the Hopkins EBP planned change and the course Project Change models to get experience with tools that will help you lead practice change in your leadership roles.Dr. Davis