Purpose of Advanced Nursing Practice

Because of the rapid changes in health industry standards, as well as the observed practice format used to actualize and implement the necessary adjustments, nursing consultancy is evaluated by companies to assist in meeting the needs of their customers and promoting efficiency, effectiveness, services provided, and safety. To carry out the foregoing, nursing consultants do both an external and internal assessment of the organization and how to provide the offered services.

Furthermore, the needs of the community are intended to be assessed. The HCAHP scores will be used in the evaluation of the organization (Hospital Consumer Assessment of Healthcare Provider and Systems). The results analysis will be carried out by authorized institutes like TJC (Joint Commission), and the impact will be determined by interviewing the workers from the staff although the feedback may also be obtained through surveys.

Nurses will evaluate the organizational readiness in cases where the institution is focusing on achieving the Magnet status; this will facilitate in determining the possible problem areas. The analysis from the community will be formatted according to the public perception, county health rankings, and community demographics and, finally, through neighborhood health profiles.

Therefore, this report will assess the process and structure of The Brooklyn Hospital Center (TBHC). The report will be inclusive of findings from the analysis of the community and, eventually, give the recommendations that will be provided to the Hospital Executive Board for scrutiny and approval.

Purpose and Overview

The primary objective of this consultation report is to assess the requirements for improvements and adjustments of the TBHC health center. A variety of database will be examined for the compilation of the recommendations. HCAPS scores will be used for comparison between the organization and the scores of the New York Presbyterian Hospital as well as identifying the possible weaknesses of the organization. The organization will be benchmarked against the New York Presbyterian Hospital because it is among the top competitive health centers in the United States (World Report, 2017).

Community evaluation and health profiles information will be derived by the aid of the county health rankings and website to ascertain the health requirements of the community being served. Additional information for evaluation of the community will be obtained from the Mount Sinai, Neighborhood Health Profiles 2015 and TBHC. An assessment of the latest procedures and practices of the organization will also be conducted provided that it relates to the results of the surveys.

The leadership of the nursing will be assessed to discuss the latest states of the enterprise and energy being directed towards improving the quality activities that are still in progress and on planning phases. The response from the key stakeholders will be accessed through web workers surveys and via phone calls made to the patients.

Organizational Analysis.

The Brooklyn is a constituent clinical center of both Icahn School of Medicine and Sinai Hospital from Sinai. The organization is located in Fort Greene Community in New York. The organization is considered to be acute community teaching health care center. Brooklyn had the bed capacity of more than 464 beds, and approximately 300,000 patients being served annually. The organization provides tertiary, diagnostic and specialty care.

The agencies employed more than 3,000 professionals to cater for the services offered by the organization ranging from dentistry, women’s health, outpatient, emergency department, oncology, psychiatry, oral surgery, surgical, radiology, and neuroscience (Brooklyn Hospital Center, 2017). Additionally, the organization provides services like park slope, Fort Greene, Brooklyn Heights and DUMBO.

People from the community around also enjoy services at the main hospital and its affiliates such as outpatient, specialty clinics, and family practice. The average age of the older adults in that community is 35 years (New York City Census). Health Situation Room (2015) indicates the median income to range from $42,434 - $ 93,693. The census can be well illustrated by the chart shown below indicating the community demographics.

Source: (City New York, 2017)

The chief executive officer is answerable to the Board of Trustees and is in charge of both administration and executive teams.

A chart showing the TBHC Leadership Structure

Primary population needs.

The population need of this organization is ranked at 29 out of 62 in the entire health industry in the US. The residents in this community is prone to risks and hazards such as obesity, sexually transmitted infections (STI) and smoking. The statistics indicate that 22% of the residents are obese, 16% smoke and majority are adults, and there are more than 694 cases of Chlamydia occurring per every 100,000 individuals. The data also shows that the organization is ranked to be 61 out of 62 in the state; 33% of children are living in poverty, the unemployment rate is at 7.7%, and at least 633 out of 100,000 residents are victims of violence. 35% of the residents are homeless, and 15% of the residents are exposed to risks having an adverse effect on their health (County Health Ranking, 2016).

Nurse Leader Interview Summary.

The organization quality assurance manager will interview the nurse leader to gain some insight regarding the latest and the proposed QI activities of the organization. The quality assurance is obligated with assessing the organization updated operations and ensuring the regulations of the organization are met and, also, ensuring that the evidence-practice is integrated into the care delivery. The TBHC quality assurance manager develops and prepares the plans to put in place rules and regulations depending on the needs of the organization. He also makes an adjustment that suits the practice of improving the patient’s results or increasing the efficiency of the care.

The quality assurance manager performs the following tasks: data analysis, auditing, policy review, surveying, and researching on the significant roles that promote the actual identification of the problematic areas the organization faces or evaluating the results of previously implemented policy adjustments or practice. During the addressing of the quality improvement effort the nurse leader usually interacts with the pool of professionals from different specialties when they meet during the operations presentations. The QA manager also makes sure that the organization is compliant with the state, federal, and regulatory needs together with the norms established by the authorizing agencies.

The quality assurance manager reviews the survey results from time to time. These results serve as the guidelines for the quality assurance manager to implement the adjustments or improvements to the updated practices. The quality assurance manager typically feels that she is being offered support by the chief officer of the organization when she reports directly to the CNE.The QA Manager works in close relationship with the department of the nurse educators, updating them with current information as well as the information regarding the quality improvements, requirements and possible adjustments.

The relationship between the QA manager and the nurse educators is converse; the QA is in a position of obtaining the practical recommendations from nurse educators concerning their evaluation of quality standards and the requirement for incorporating the evidence-based practice into the care industry.

Nurses are expected to demonstrate the crucial elements as outlined in the essentials of education in nursing even if they have not mastered their preparedness well. The primary role of the nurse leader includes putting the evidence-based research in practice through leading functional and policy changes that enhance the quality of the provided care. The QA manager consistently collaborates with other professionals of different disciplines together with the executive staff who can design reasonable regulations that are innovative and efficient.

The readings of the nurse leader should allow being committed and directed towards the publications and the books related to the healthcare research and quality. The QA manager is also determined to ensure that the delivery care shows the best updated regulations and evidence-based research. The QA manager of TBHC is well informed about the significance of the role she plays to the shareholders. Quality leads to effective and efficient care. The experienced health care nurses lead to happier and healthier patients hence healthier patients lead to improved HCAHPS scores.

Characteristics of the Organization

Strengths

TBHC has been the recipient of some awards acknowledging its efforts in enhancing best in patient care. Accurate by using the New York Kingdom Department of fitness as a Stroke Center, for 6 consecutive years, TBCH is still recognized by the American Heart Affiliation/American Stroke Association through awarding the organization with getting the rule of thumb Stroke Gold Plus first-class fulfillment Award with goal: Stroke Honor Roll Elite (The Brooklyn Health Center Middle, n.d.).

The organization has also been offered the Get with The Suggestions Heart Failure Silver plus find fulfillment Award with the aid of the American Core Affiliation/American University of Cardiology basis (The Brooklyn Clinic Center, n.d.). Those awards acknowledge TBHC’s accomplishments in extraordinary development measures with the aid of implementing and continuously practicing particular protocols for advanced health consequences.

The organization had located itself in a financial disaster ensuing in contracting the new CEO/President in 2016. His hiring became, in part due to his revel in turning, a financially failing healthcare device right into a thriving corporation. TBHC’s newly appointed CEO/President recognizes that a key to the employer’s fulfillment is to look at the surrounding network and determine what the particular healthcare wishes of the populace (Storr, 2016) are. The satisfaction of the employer is more than physically expanding the health center via constructing new places. However, it is far by way of searching at and taking note of the community and addressing their unique fitness care needs. Having a leader who knows this is the first electricity for the corporation.

Weaknesses

One weak spot identified by the QA supervisor is the health facility’s preparedness for the duration of TJC surveys. In previous reviews, it was stated that the health center has been acting under the goal range for positive gadgets. Modern, high-quality development tasks include re-educating personnel on national affected Person Protection Goals (NPSG) and making active sanatorium group of workers for upcoming visits from TJC.

Created with the assistance of the QA supervisor is the TJC Survey Readiness book. This guide is distributed to all personnel to engage them and create an experience of responsibility in the enterprise’s compliance and readiness for a successful survey. Further to the booklets, the QA manager, through running with department supervisors, incorporated discussing NPSG at some stage in daily huddles and putting posters in common areas of gadgets.

Areas in which the organization had weaknesses diagnosed by way of latest HCAHPS effects person training and patient perception of the employer. Most effective 39% of admitted patients “strongly” agreed they understood their care upon discharge as compared to 51% of patients at NYP. The country wide typical range for this object is 52%. Patients rated the health center nine or 10, on a 0-10 scale, 51% of the time in comparison to NYP’s patient's score of 9 or 10 going on 73% of the time. The countrywide typical for this rating is 72%. As far as recommending TBHC, 33% of sufferers stated they might “genuinely” suggest the hospital as compared to 77% of NYP’s sufferers. The national common for “virtually” recommending is 72% (facilities for Medicare & Medicaid offerings, n.d.).

Additional weaknesses had been ED affected person wait times earlier than being seen by way of a practitioner (door to health professional) and wait for instances before the management of ache medications for sufferers with fractures. Patients waited fifty-one minutes for a healthcare provider to peer them compared to 18 minutes at NYP. The countrywide average for watching for a practitioner is the half-hour. Patients with fractures waited seventy-six minutes in comparison to 47 minutes at NYP for pain medicinal drugs. The country-wide standard is 52 % (facilities for Medicare & Medicaid offerings, n.d.).

Based totally on these results, there were some little improvement projects and evidence-based practice sports. To improve affected person education at discharge, these days was applied exercise for nurses to provide sufferers with their discharge instructions and overview with the patient and family individuals and caregivers. Nurses are to make use of the educate-lower back method with each stumble upon. While the affected person is discharged, the discharging nurse will file inside the disposition document that the patient had been supplied with care commands, remedy education and the patient’s demonstration of comprehension. This documentation is continuously audited with the aid of the QA manager.

In addressing the concern of not on time pain medication management for sufferers with fractures, practice changes had been advocated and put into effect through the collaborative efforts of the QA supervisor, ED manager, nurses, attending, and residents. There is an emphasis on the short evaluation and identification of signs and symptoms and signs of suspected long-bone harm through the triage nurse.

Upon recognizing the capacity for such injury, the affected person is without delay taken to the treatment region; an MD is right now informed of the patient’s condition. The benchmark set for ache remedy is for the patient to be medicated for pain within the half-hour of registration. Information is tracked with the aid of an ED attending who works with the QA manager to evaluate compliance and consequences.

Recommendation and Rationale

The problem of prolonged ED wait-time is an issue for plenty of healthcare corporations and principal contributor to patient dissatisfaction. TBHC has the third longest ED wait-time as compared to other hospitals in my state and is common complaint cited on numerous public assessment websites consisting of Yelp and Google (Google, n.d.; Republican, n.d.; Yelp, n.d.).

According to the organization’s QA manager, over 90% of all hospital admissions originate from emergency room visits. The ED is the primary effect of the group of patients who are admitted and the simplest influence for those sufferers who are visible and discharged from the emergency room. This trouble has a top notch impact on the patient perception of the business enterprise and willingness to use their offerings, which is evident in the public’s reviews.

To deal with extended wait time in the ED, in particular, impacting door to doctor time, primarily based on new proof-based research, the advice is to put into effect a brand new exercise in triaging and registering patients. The previous practice shows that sufferers experienced various durations of the wait. At instances, patients may additionally wait in line to be registered, to take a seat and wait their turn to be triaged, then take a seat and expect to be located in a mattress.

As soon as in a mattress, the affected person will be visible by their nurse but may wait to be visible by a physician, who ends up in delays in remedies being ordered. This experience provides to sufferers’ anxiety and pressure stage, which became already extended because of their current fitness situation that drove them to reap emergency medical interest. The safety security experience and security that their worries can be right away addressed is compromised, leading them to sensing disregard and losing faith within the healthcare crew’s capacity or willingness to offer compassionate, green, or patient-focused care.

The brand new method reduces the time patients spend expecting care. This advice shows that patients are to be triaged within fifteen minutes of registration and are located in the remedy region right away after triage, to which the assigned nurse and physician will be present. If the out-of-doors triage nurse is not always capable of triaging the patient within this timeline because of overcrowding, triaging can be carried out by the private triage nurse or the assigned treatment region’s number one nurse at the bedside. Optimally, an ED doctor could be the gift during triage on the bedside. If it is not viable upon completion of triage, an ED health practitioner could be at the affected person’s bedside within thirty minutes to which diagnostics and interventions can be ordered right away. This practice has been encouraged through the Emergency Nurses Affiliation (ENA) to improve ED flow and decrease overcrowding (Emergency Nurses Association, 2010).

Measures to Evaluate

At the moment, there are posted countrywide benchmarks for ED wait-time or door-to-physician time. Though, the countrywide common is a half-hour, which will be the aim mounted for this exercise exchange. With this in an area, patients will revel in an ED guide that demonstrates admire for the affected person. By using putting off the various intervals of waiting, the patient will spend maximum, if not all of their time within the ED in the presence of a fitness care professional or with interventions in the vicinity.

Patients will be convinced that their concerns are vital and their well-being is the intention. The assigned ED was attending, and QA manager will monitor door-to-health practitioner instances, auditing registration instances and EMR documentation of triage and preliminary provider notes and orders. Interest may be centered at the above-made benchmarks; triage observes within fifteen minutes of record and physician to be aware of the within thirty minutes of registration rules.

The desired outcome is to look at a lower in door-to-doctor wait instances (“average (median) time patients spent in the emergency department before they have been seen by a healthcare professional”) and a standard development inside the “timely emergency branch care” category within the next HCAHPS survey. Extra favored final results from improving the ED drift might be upgrades within the HCAHPS survey class of patients’ stories, reflecting patients delight. There has to be a growth in the proportion of patients who record “yes” to recommending the organization and rating the clinic nine or 10 on a 0-10 scale. (Facilities for Medicare & Medicaid Services, n.d.).

Progressed HCAHPS ratings lead to multiplied reimbursements, referrals, and sufferers looking for care from the company. These results in upward yearly financial reporting result in a financially solid organization, consequently producing accelerated budgets ensuing in cash allocated to enhance excellent care, creating innovative practices, advancing health care, and making an investment in their personnel, network and its residents.

References

American Association of Schools of Nursing. (2011). The Necessities of Grasp’s Schooling in Nursing. Retrieved from Http://Www.Aacn.Nche.Edu/Education-Assets/Mastersessentials11.Pdf

Centers for Disorder Manage and Prevention. (N.D.). Vital Line-Associated Bloodstream Contamination (CLABSI) Retrieved Fromhttps://Www.Cdc.Gov/HAI/Bsi/Bsi.Html

Centers for Disorder Manage and Prevention. (2014) Healthcare Development Document

Retrieved from Https://Www.Cdc.Gov/Hai/Pdfs/Progress-Record/Exec-Summary-Haipr.Pdf

The Joint Fee. (2017) Retrieved from https://Www.Jointcommission.Org/Property/1/6/2017_NPSG_HAP_ER.Pdf