Johnathan Robertsen, RN, MSHA is the Senior Director of the Emergency Department at the Care Excellence Medical Center. He is known around the facility for his inclusive leadership and partnership with clinicians (e.g., physicians, ancillary staff, etc.). Since taking over the department 3 years ago, the patient satisfaction scores have increased year over year and are at their highest since it opened. His clinical staff is diverse (in terms of gender and cultures) with an average annual turnover rate of less than 2.5%. A new electronic health record (EHR) module has been implemented in the Emergency Department (ED). One of the objectives of the implementation will be to capture clinical data that is necessary for quality improvement. Financial data will not be captured in the EHR and is being manually entered on logs that are stored for about 8 years. This storage requirement is for regulatory purposes. The nurses are working hard to input clinical data into the new EHR. However, the average patient hold time has increased by more than 30% due to the nurses having difficulty in entering data into the EHR. Management predicted an increase in ED wait time during the EHR implementation but was optimistic that the trend would decrease in a few weeks. After 2 months, however, the learning curve continued, and the recovery nurses were still having difficulty. As a result of the EHR input difficulty, delays in routing patients from the ED to nursing units and the intensive care unit (ICU) have been reported. Hospitalists are extremely upset about the delay and maintain cautious concern over patient safety. The average delay time is 30 to 95 minutes. Bed management nurses document the delays in a multifunctional software system that captures data for both clinical and financial purposes. (This system is separate from the newly implemented EHR.) Patients on the day shift tend to make it to units in a timely manner. After day shift, about 40% of patients experience delayed entry upon leaving the ED. Performance indicators have been showing unfavorable results. Declining staff productivity for both the ED and the bed management area is one of the unfavorable performance outcomes. The current staff productivity rate is 75%, but the target percentage is 95%. Productivity is measured by patient volume and the number of hours worked by staff. Despite the declining volume, staffing patterns for both areas have remained unchanged. Discussion Questions How should the leadership team develop a plan to address the declining performance measures? What data requirements will be needed to make informed decisions? What data requirements do you think are needed to improve staff productivity? Why are performance indicators important and how should they be used to support decision making? How often should performance indicator data be reported and used for management purposes?
Situation
Johnathan Robertsen, RN, MSHA is the Senior Director of the Emergency Department at the Care Excellence Medical Center. He is known around the facility for his inclusive leadership and
A new electronic health record (EHR) module has been implemented in the Emergency Department (ED). One of the objectives of the implementation will be to capture clinical data that is necessary for quality improvement. Financial data will not be captured in the EHR and is being manually entered on logs that are stored for about 8 years. This storage requirement is for regulatory purposes. The nurses are working hard to input clinical data into the new EHR. However, the average patient hold time has increased by more than 30% due to the nurses having difficulty in entering data into the EHR. Management predicted an increase in ED wait time during the EHR implementation but was optimistic that the trend would decrease in a few weeks. After 2 months, however, the learning curve continued, and the recovery nurses were still having difficulty.
As a result of the EHR input difficulty, delays in routing patients from the ED to nursing units and the intensive care unit (ICU) have been reported. Hospitalists are extremely upset about the delay and maintain cautious concern over patient safety. The average delay time is 30 to 95 minutes. Bed management nurses document the delays in a multifunctional software system that captures data for both clinical and financial purposes. (This system is separate from the newly implemented EHR.) Patients on the day shift tend to make it to units in a timely manner. After day shift, about 40% of patients experience delayed entry upon leaving the ED. Performance indicators have been showing unfavorable results. Declining staff productivity for both the ED and the bed management area is one of the unfavorable performance outcomes. The current staff productivity rate is 75%, but the target percentage is 95%. Productivity is measured by patient volume and the number of hours worked by staff. Despite the declining volume, staffing patterns for both areas have remained unchanged.
Discussion Questions
- How should the leadership team develop a plan to address the declining performance measures?
- What data requirements will be needed to make informed decisions?
- What data requirements do you think are needed to improve staff productivity?
- Why are performance indicators important and how should they be used to support decision making?
- How often should performance indicator data be reported and used for management purposes?
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