Emergency department (ED) at the healthcare organisation

PATHWAY 1- Prepare a report for a new project or service to be operated by the host
organisation. (This is likely to be the easiest for most people).
Pathway 2 – prepare a report proposing a new funding strategy for the host organisation.
Pathway 3 – An appraisal of an existing funding strategy or project for the host
organisation.
Pathway 4 – An evaluation of a customer /service user demand for new services and an
examination of how this could be delivered. (This might be suitable for some people in
residential care/ home care/ and or other visiting services.
Your learning outcome for CW1 is: You must meet this irrespective of the pathway you
choose.
�Critically apply knowledge and demonstrate the ability to appraise the project funding
process”
“Your report should include information about the host agency and the context of a
specified campaign, project or programme” If the host requires confidentiality then you
need not disclose the host name because you will have to respect their confidentiality.
Your report should also include: “Details of the aims/objectives outputs and outcomes of a
specified programme or of a specified campaign project or programme”.
“A needs assessment, finance and funding plan”
This is a 2000 word report

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Assignment CW 1

Table of Contents

Introduction 3
The host agency: name withheld for confidentiality purposes 3
Needs assessment 4
Details of the aims/objectives and outcomes of the project 4
Outputs and outcomes of the specified programme 5
Finance and funding plan 6
Conclusion 8
Reference 9

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Introduction

Emergency department (ED) at the healthcare organisation that is discussed in this paper has
been exasperated by the problems of long waiting times and overcrowding. Waiting time is
simply the period from the time a patient is registered in the emergency department to the time
that they are seen by a physician (Chan et al., 2005). In the recent past, the hospital implemented
a programme designed to reduce patient wait times and improve patient satisfaction. In this
paper, a report is provided of the new project/service that is to be operated by the host
organisation. This report includes information regarding the host organisation, and the context of
a specified project/programme. The host in this situation requires confidentiality and therefore
the host name will not be disclosed given that I have to respect their confidentiality. The pathway
covered by this report is pathway three, whereby an existing funding hospital strategy for a
project for the host organization is discussed.

The host agency: name withheld for confidentiality purposes

The hospital is located in Oxfordshire, England, United Kingdom. When the doors of the general
hospital were opened on September, 16, 1879, the hospital had just 14 beds, a dispensary, and a
small infectious room. Two superintendents and 3 nurses offered care, and they also worked in
the laundry, switchboard, kitchen, and did housekeeping. Presently, the hospital is a
comprehensive and dynamic acute care facility that provides a complete range of services to the
170,000 inhabitants of Oxfordshire and surrounding areas. Services offered by the healthcare
organisation include advanced technology and diagnostic support, 24-hour emergency coverage,
as well as specialty programs like vascular surgery. The hospital is governed by a volunteer
Board of Directors. The hospital has a total of 191 beds: 26 Critical Care and Step Down; 69
Surgery; 12 Paediatrics; 65 Medicine; and 19 Obstetrics. The hospital has a workforce of 1,233
staff members. Over 208 hospital volunteers contribute 1,600 hours of work every month. It is
notable that volunteers operate in various patient care and support service areas and they
organise activities for fundraising. The hospital has roughly 320 professional staff including

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dentists, midwives and physicians (Levsky et al., 2008). Recently, this hospital implemented a
process improvement project intended to streamline the hospital’s emergency department (ED)
patient flow.
Needs assessment
Waiting time within the ED has been a key source of patient dissatisfaction at the hospital.
Triage strives to have patients who are most critically sick seen first with an overall decrease in
waiting times. In this hospital, the triage team consists of trained nurses only, there is no
specialised physician. Due to long waiting times for the patient at present, there is a high walk-
out rate as patients often decide to leave the hospital without being seen by a doctor.
Details of the aims/objectives and outcomes of the project
A process improvement program (PIP) was carried out in the ED of the hospital in July 2013.
The project entailed working to streamline processes in the ED in order to improve quality,
reduce crowding of patients, and boost satisfaction of patients. A senior emergency doctor was
placed into triage rather than a consultation cubicle. The hospital strived to attain these
objectives by not only redesigning processes, but also implementing new technology and
expanding the emergency department. In essence, the healthcare organisation undertook a lean
manufacturing approach to improve emergency department patient flow to eradicate waste and
add value for the patient. This approach will substantially help in reducing wait times and overall
emergency department length of stay and lead to increased satisfaction of patients (James et.al,
2011).
The hospital utilised Kaizen, which is simply a strategy for process improvement in lean
manufacturing. This process improvement project at the hospital comprised a 3-day workshop
where front-line employees within the ED worked with a lean professional to understand non-
value-added and value-added processed. Emergency department employees and clinicians
initially mapped out the steps within the present emergency department process and then went
into groups to identify the steps which were non-value-added. The emergency department team
then redesigned the process with the aim of eliminating the non-value-added steps, reduce the
process, and ensure that patients get care that is timely (Hopkins et al., 2008). One of the alters
made by the system is that it streamlined the triage process by bringing the patients immediately

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back to the triage room to be assessed by a nurse and then consult a doctor. An employee records
the registration information of the patient whilst he/she walks to the room, thereby removing the
separate step that formerly utilised in collecting registration data. After that, the patient would
then either go back to the waiting room or stay within the exam room depending on the acuteness
of her/his condition (Brousseau & Gorelick, 2012; Melon, White & Rankin, 2013). It is
estimated that this redesign would reduce the length of the triage process by roughly 9 to 14
minutes. It is notable that Kaizen along with the execution of a redesigned process is usually a 3-
month project at hospitals; it took this amount of time implement this project at the host
healthcare organisation.
This project undertaken by the hospital also entailed putting a senior emergency doctor into
triage rather a consultation cubicle. The TRIAD team now comprised team triage system that
incorporated three people that consisted of a healthcare assistant, a nurse, and a physician. The
nurse will triage the patients by documenting important signs, taking a brief history of the
patient, and then assigning patient to triage categories. The physician will assess the patients
simultaneously and will initiate appropriate investigations as well as treatments. The healthcare
assistant assists the nurse to carry out observations and direct patients to the radiography
department or designated cubicles. In implementing the project at this healthcare organisation, a
single emergency doctor with an experience of 10years in emergency medicine was employed to
take the role triage physician. More equipment were procured and introduced at the triage area
and they included a computer workstation with printer, blood-sampling equipment, facilities for
brief physical exam such as a screen and a couch, and a complete set of document trays (Phillis,
2012).
Outputs and outcomes of the specified programme
The outcomes of the Kaizen process at the hospital will show improvements in door-to-doctor
time – that is, the amount of time that it takes for a patient to be seen by a doctor as soon as the
patient enters the room – total time within the emergency department, as well as physician and
patient satisfaction. Before Kaizen, or before the implementation of the project, the average
door-to-doctor time at the hospital was roughly 40 minutes to over 1 hour. Following the
redesign, the wait time is expected to be decreased to an average of 9 to 14 minutes. Moreover,
total time within the emergency department would be decreased from an average of 2 to 4 hours,

6
to roughly 100 minutes. Patient satisfaction is expected to increase greatly within the initial 3
months after the project implementation. Patients and doctors, in essence would all be happier
and patients would actually be receiving better care (Soremekun et.al, 2011).
Improving patient flow at the hospital called for commitment by the leadership of the healthcare
organisation in supporting efforts to reduce wait time and move patients through the system in a
more efficient manner. The other vital element used to improve patient flow is educating both
doctors and staff members on patient tracking technology and patient boards. Basically, this
education at the hospital extended beyond the emergency department to other departments for
instance radiology and laboratory, so that everyone is conscious of time-related anticipations. It
is of note that as soon as the other departments in the hospital have the understanding that time is
ticking, and that the ED is truly a priority, the hospital would lose time there as well (Soremekun
et.al, 2011).
In essence, at the hospital, triage was formerly run by experienced nurses and the notion of
physician triage was never thought of. Although it is new in this hospital, the idea of
incorporating a doctor in the triage area is not new in the healthcare system. Earlier researches
have covered the subject of triage, and they all share the common goal of improving the service
by decreasing the processing time or wait time (Wu et.al, 2009). In this particular hospital, a
significant improvement in processing time was to some extent offset by the moderately high
cost of employing a triage officer, who was essentially a senior emergency department physician.
Finance and funding plan
The entire project as undertaken by the healthcare organisation is budgeted to cost a total of
£298,500 from beginning to completion. This budget is broken down as follows: (i) a
professional emergency doctor would be hired by the hospital and put at the triage area in order
to reduce waiting times. It is notable that the patient in this project, the patient will see the
emergency physician even before being registered. Hiring this experienced physician is expected
to cost £90,000 per year. (ii) Refurbishing and expanding the ED and triage area. This
refurbishment and expansion is anticipated to cost the hospital a total of £150,000. (iii) In
addition, the hospital plans to purchase a number of equipment which include the following:
computer workstation with printer £22,000; blood sampling equipment £14,000; facilities for

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brief physical exam such as a screen and a couch £15,000; and a complete set of document trays
£7,500. Thus in total, the plan is planned to cost £298,500. This figure is rather high for this
particular hospital and the hospital cannot raise the entire amount on its own. This is primarily
because the hospital does not make much profit. As such, the hospital would seek sources of
funding from other areas. In essence, the hospital plans to fund £110,000 of the total planned
budget by itself and raise the remaining amount from other sources. The hospital seeks to raise
£90,000 from the government; it will solicit this amount from the government. In regards to the
remaining £98,500, the hospital seeks to £60,000 from donations which would be given by
various donors including both individual as well as corporate donors; that is, the hospital expects
to get donations from companies and individuals amounting to £60,000 that will go toward the
funding for this particular project. Finally, the last portion of the budget £38,500 would be raised
through loans from financial institutions. The healthcare organisation plans to seek this funding
from a local bank situated in Oxfordshire, England. The raised funds would be utilised in a
manner that is both efficient and transparent to ensure that the project is completed within the
defined time frame, that is, 3 months. Upon full implementation of the program, it is anticipated
that there would be improved patient satisfaction, reduced wait times, improved quality of
patient care, as well as improved physician satisfaction (Xie & Youash, 2011).

Evaluation Methodology

Evaluation is essentially understood as a process for assessing the efficacy of a particular
program or project in attaining its goals and its aim is to improve the program by modifying
current operations. Fundamentally, evaluation of the project will consider the alignment of a
project’s or programme’s outcomes to its goals and objectives. It is of note that ongoing program
evaluation is imperative.
Results Model Methodology – this evaluation model focuses on the results of a particular
project/program/campaign and they inform on whether or not the objectives have been achieved
and on every possible effect of the programme both predicted and unpredicted. There are 2
distinctive methodologies as regards to the results model: goal-bound procedure and goal-free
procedure. The evaluation of this project applies Goal-bound evaluation which basically focuses
on the relative extent to which the project effectively attains a goal that was specified earlier.

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In this case, the Results Model evaluation methodology is applied by assessing to determine
whether or not the project actually attained its goals and objectives. The project in the healthcare
organization in this case involved working to streamline processes in the ED so as to improve
quality, reduce crowding of patients, and boost satisfaction of patients.
The goal of this project was attained. Before the implementation of the project, the average door-
to-doctor time at the hospital was approximately 40 minutes to over 1 hour. However, after the
redesign, the wait time has now reduced to an average of 9 to 14 minutes. Furthermore, total time
within the emergency department has been reduced from an average of 2 to 4 hours before the
implementation of the project, to roughly 100 minutes. Patient satisfaction has increased
considerably greatly after the project implementation. Patients and physicians are much happier
and patients are in fact receiving better care because of the project. All the objectives of the
project were satisfactorily met.

Conclusion
In conclusion, the project was undertaken by a hospital in Oxfordshire; required to remain
confidentiality and its name is not disclosed. The hospital is governed by a volunteer Board of
Directors. The hospital has a total of 191 beds: 26 Critical Care and Step Down; 69 Surgery; 12
Pediatrics; 65 Medicine; and 19 Obstetrics. The hospital has a workforce of 1,233 staff members.
Over 208 hospital volunteers contribute 1,600 hours of work every month. Waiting time within
the ED has been a key source of patient dissatisfaction at the hospital. Due to long waiting times
for the patient at present, there is a high walk-out rate as patients often decide to leave the
hospital without being seen by a doctor. In the recent past, the hospital implemented a
programme designed to reduce patient wait times and improve patient satisfaction. The project
entailed redesigning and updating the ED in order to bring a new type of care and better serve its
patients by way of getting them the treatment that they require more quickly. The hospital’s
emergency department has been remodelled to allow for a lean approach that is meant to
expedite care to patients and reduce waiting times. Regarding the evaluation methodology,
Results Model evaluation methodology is applied by assessing to determine whether or not the
project actually attained its goals and objectives. Using this evaluation model, it is determined
that the objectives of the working on the new project was actually attained.

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Reference

Brousseau, D. C., & Gorelick, M. (2012). Emergency Department Wait Times. Pediatrics,
116(1), 295. doi:10.1542/peds.2005-0748
Chan, T., Killeen, J., Kelly, D., & Guss, D. (2005). Impact of rapid entry and accelerated care at
triage on reducing emergency department patient wait times, lengths of stay, and rate of
left without being seen. Annals of Emergency Medicine, 46(6), 491-497.
Hopkins, R., Tarride, J., Bowen, J., Blackhouse, G., O’Reilly, D., Campbell, K., & … Goeree, R.
(2008). Cost-effectiveness of reducing wait times for cataract surgery in Ontario.
Canadian Journal of Ophthalmology. Journal Canadien D’ophtalmologie, 43(2), 213-

  1. doi:10.3129/i08-002
    James, C., Bourgeois, F., & Shannon, M. (2011). Emergency Department Wait Times.
    Pediatrics, 116(1), 295. doi:10.1542/peds.2005-0913
    Levsky, M. E., Young, S. E., Masullo, L. N., Miller, M. A., & Herold, T. S. (2008). The Effects
    of an Accelerated Triage and Treatment Protocol on Left Without Being Seen Rates
    and Wait Times of Urgent Patients at a Military Emergency Department. Military
    Medicine, 173(10), 999-1003.
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