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The current project will be implemented into the Emergency department (ED) in a large urban hospital that serves a densely populated metropolitan area. The hospital is located in a major city and operates a busy ED that experiences chronic overcrowding. The healthcare facility serves a diverse population with various healthcare needs, and it often faces surges in patient volume due to seasonal factors, community events, and accidents. The ED of the healthcare setting is facing staff shortage due to high turnover rates, difficulty in recruiting healthcare professionals, and budget constraints. The hospital recognizes the need to address these challenges and implement a comprehensive plan to overcome staff shortages in the ED.

Problem Description

Emergency department (ED) efficiency remains a vital aspect of delivering safe, quality care. ED utilization has risen considerably without a corresponding rise in available emergency services. Researchers have identified several factors which affect the modern ED, shortage of staff has been considered as one of the significant factors (Ahsan et al., 2018). Ramsey et al. (2018) identifies that increased nurse-to-patient ratios correlate with improved patient outcomes and that lower staffing is associated with increased left without-being-seen (LWBS) rates. Australia's healthcare system is underpinned by a large and diverse health workforce comprised of skilled professionals employed in a number of occupations and across a variety of settings. Issues relating to the number of health practitioners, supply and demand for health services and health professionals in different regions and settings, medical education and training, and the future of Australia's health workforce have been explored in a number of reports. However, staffing shortages in modern emergency departments can have a significant and multifaceted impact on the quality of care, patient safety, and overall functionality of the department (Ramsey et al., 2018). Some of the existing evidence on solving the staff shortage in ED are available, including the study by Ahsan et al. (2020), that flexible scheduling of staff and minimizing the variation of workload among healthcare workers during the whole shift can be effective.

Intervention

The current proposal aims to address the issue related to the healthcare staff shortage in ED and apply intervention to overcome these issues. The project will introduce a plan to implement both reactive and proactive scheduling strategies, use flexible staffing modes, hire more healthcare workers and employ temporary or agency staff to fill immediate gaps.

Reactive scheduling involves adjusting staffing levels based on the current patient volume and demand. When patient influxes are unpredictable, reactive scheduling allows us to adapt to the immediate needs of the ED. Meanwhile, proactive scheduling anticipated and plans for high-demand periods, often based on historical data, trends, and known events like flu season (Park & Ko, 2022). Both reactive and proactive can be beneficial; reactive scheduling can minimize underutilization of staff during periods of low demand and ensure that most critical cases receive immediate attention. However, proactive scheduling minimizes the need for last-minute adjustments and overtime during predictable busy periods (Park & Ko, 2022). It also supports a more balanced workload for staff and helps prevent burnout. Flexible staffing models can be a valuable tool to overcome staff shortage as it allows healthcare organizations to adapt to fluctuating patient volumes and ensure that staffing levels are aligned with the demand for care (Haddad et al., 2023). By implementing these flexible staffing models, Eds can more effectively respond to variable patient volume, reduce staff shortages, and ensure that patients receive timely and quality care. The project plan aims to recommend the hiring of more healthcare professionals like paramedics, and Emergency Medical Technicians (EMTs) and appoint more ancillary staff. Appointing paramedics can decrease the workload for ED RNs who could then manage patients with more serious injuries or illnesses (Pourmand et al., 2023). With additional training, EMTs can serve as valuable members of the emergency department care team, they can perform the duties which are traditionally performed by ED nurses. EMTs can offer assistance by performing cardiopulmonary resuscitation, providing oxygen and glucose and administration of certain treatments, such as nebulizers and medications for allergic reactions (Griffiths et al., 2021).

The implementation of this practice plan needs to work closely with the HR department and staffing agencies to identify qualified candidates for full-time, part-time and temporary positions. There is need to develop Standard Operating Procedures (SOPs) for both proactive and reactive scheduling, which detail how staffing adjustments will be made, who is responsible for making those adjustments, and how communication will occur. Lastly, maintain a detailed records of staffing changes, adjustments, and their outcomes. This documentation can be valuable for future planning and quality improvement initiatives (Haddad et al., 2023).

Stakeholder and Engagement

Addressing staff shortages in the ED is a complex undertaking that involves multiple stakeholders and engagement efforts. The stakeholders included in the current project plan are the ED leadership team, including the medical director, nursing director, and administrative leadership. HR plays a critical role in recruitment, onboarding, and managing the hiring of full-time and temporary staff. HR can also compliance with labor laws and handle contract negotiations. ED physicians, nurses, and support staff are directly impacted by staffing shortages. The project team will include the healthcare workers, including ED physicians and nurses, for assessing current challenges and providing feedback on the Plan. Engage them in the planning process and communicate the changes transparently (Petkovic et al., 2020).

In the preparation of a plan to overcome staff shortage in the ED, it is essential to consult with a variety of stakeholders and experts to ensure that the Plan is well-informed, comprehensive, and likely to succeed. Nurses, physicians, and support staff need to be consulted to gain the deep understanding of the day-to-day challenges they face due to staff shortages. Also, consult with the ED's medical director and administrator to gather insights about the current staffing challenges and their perspective on potential solutions (Pourmand et al., 2023). To enhance the effectiveness of the current Plan, consult with staffing agencies and employee associations. Staffing agencies and employee associations can provide options to discuss options for securing temporary healthcare workers and the contractual terms involved. Meanwhile, the employee association can consult with union representatives or association leaders to discuss the impact of the Plan on collective bargaining agreements and employee conditions. Lastly, there is a need to consult with patient advocacy groups to understand what challenges patients have to face in the ED because of staff shortages. The involvement of patient advocacy groups can highlight the patient perspective and let us understand how to promote the quality of care of patients (Petkovic et al., 2020).

Quality Improvement Methodology

In the current project plan, the Plan-Do-Check-Act (PDCA) cycle will be used. It is a repetitive four-stage model for continuous improvement in quality management. The use of the PDCA cycle can be highly beneficial in the quality improvement of a plan aimed at overcoming staff shortages in the ED (Hughes, 2018). The first stage of the PDCA cycle, which is the Plan, can identify specific problems or opportunities for improvement. The involvement of PCDA cycle can provide a systemic and structured approach to quality improvement (Knudsen et al., 2019). It ensured that the process of addressing staff shortage in the ED is organized and follows a logical sequence of steps. As PCDA is designed for continuous improvement, it can encourage healthcare organizations to continuously assess and refine their strategies to address staff shortages. PDCA encourages the investigation of the root cause of staff shortage. By analyzing data and comparing outcomes to hypotheses, healthcare organizations can gain insight into what is contributing to the problem (Hughes, 2018). The check phase of the PDCA cycle involves data collection and analysis, which allows to assess of the effectiveness of the Plan. The collected data can also be used to measure other needed improvements like patient waiting time, staff workload, and patient satisfaction. If the changes made during the PDCA cycle are successful, they can be standardized and incorporated into daily operations. As the current Plan aims to implement a new staffing model, if the PDCA cycle finds it useful, it can become the standard practice in the emergency department (Knudsen et al., 2019).

Outcomes/Analysis

To identify if we have achieved what we are hoping to achieve through the Plan, we can use several combinations of measurable outcomes, feedback, and analysis. As the major addressed issue in the Plan is the staff shortage in the ED and the problems related to it. To measure the achieved goals, revisit the objectives that were initially set for the Plan (Austin et al., 2020). The Plan will be considered successful if it achieves the reduced patient wait time for triage, assessment and treatment. Also, if it enables adequate staffing levels and workload management by leading to a more manageable and sustained workload for ED staff, reducing burnout and stress (Griffiths et al., 2021).

To measure the outcomes, identify some key performance indicators like patient wait time, staff workload, patient satisfaction scores, and staff turnover. Gather baseline data and analyze the data related to the selected performance indicator before and after implementing the Plan. Later, compare the post-implementation data to the baseline data for each indicator (Austin et al., 2020). To identify the effectiveness of the gather qualitative feedback from ED staff and patients. This feedback can provide insights into the overall impact of the Plan, such as staff morale, patient experience and quality of care. The feedback can also enable to assess the satisfaction level of ED staff including nurses, physicians, and support staff (Schoenfelder et al., 2020).

To measure these outcomes, a proper data collection plan will be followed. Information like patient records, time logs, scheduling systems, staff surveys, and patient feedback will be collected in different Excel sheets. Tools like spreadsheets or specialized data analysis software will be used to manage and analyze data efficiently. Use quality improvement tools and methodologies, such as run charts and control charts, to visualize and interpret data trends. Continue to monitor the KPIs and outcomes over an extended period to ensure the sustainability of improvements (Austin et al., 2020).

Next step

After collecting the data, the first step will be to review and analyze the collected results, including both quantitative and qualitative data. Look for the trends, patterns, and significant changes in the data. Meanwhile, pay attention to how the outcomes align with the initial objective and expectations. Later, I will engage with key stakeholders, including ED staff and HR, to discuss the results and gather their perspectives (Austin et al., 2020). Also, conduct a cost-benefit analysis to evaluate the financial impact of the Plan and consider whether the Plan justifies the costs in terms of improved patient care, resource utilization and staff satisfaction. Based on the outcomes and feedback, plan for the next iteration of the quality improvement cycle. To identify the impact of the Plan, assess and analyze the workload of clinical staff. Including nurses and physicians can be helpful in determining whether the Plan has improved the staff-to-patient ratios and workload distribution (Austin et al., 2020). In future, the Plan will focus more on updating clinical documentation and reporting processes to capture changes in patient care and outcomes accurately. Later, the results identified will be integrated and clinically implicated in the clinical governance structure of the ED, ensuring that lessons learned from the Plan inform future clinical decision-making (Haq et al., 2018).

References

Ahsan, K. B., Alam, M. R., Morel, D. G., & Karim, M. A. (2019). Emergency department resource optimization for improved performance: a review. Journal of Industrial Engineering International , 15 , 253-266. https://doi.org/10.1007/s40092-019-00335-x

Austin, E. E., Blakely, B., Tufanaru, C., Selwood, A., Braithwaite, J., & Clay-Williams, R. (2020). Strategies to measure and improve emergency department performance: a scoping review. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 28 (1), 1-14. https://doi.org/10.1186/s13049-020-00749-2

Griffiths, P., Saville, C., Ball, J. E., Jones, J., Monks, T., & Safer Nursing Care Tool study team. (2021). Beyond ratios-flexible and resilient nurse staffing options to deliver cost-effective hospital care and address staff shortages: A simulation and economic modelling study. International Journal of Nursing Studies , 117 , 103901. https://doi.org/10.1016%2Fj.ijnurstu.2021.103901

Haddad, L. M., Annamaraju, P., & Toney-Butler, T. J. (2018). Nursing shortage. StatPearls [Internet]. Treasure Island (FL): https://www.ncbi.nlm.nih.gov/books/NBK493175/

Haq, N., Stewart-Corral, R., Hamrock, E., Perin, J., & Khaliq, W. (2018). Emergency department throughput: an intervention. Internal and Emergency Medicine , 13 , 923-931. https://doi.org/10.1007/s11739-018-1786-1

Hughes, R. G. (2018). Tools and strategies for quality improvement and patient safety. Patient Safety and Quality: An Evidence-Based Handbook for Nurses . https://www.ncbi.nlm.nih.gov/books/NBK2682/

Knudsen, S. V., Laursen, H. V. B., Johnsen, S. P., Bartels, P. D., Ehlers, L. H., & Mainz, J. (2019). Can quality improvement improve the quality of care? A systematic review of reported effects and methodological rigor in plan-do-study-act projects. BMC Health Services research , 19 , 1-10. https://doi.org/10.1186/s12913-019-4482-6

Park, C. H., & Ko, Y. D. (2022). A Practical Staff Scheduling Strategy Considering Various Types of Employment in the Construction Industry. Algorithms , 15 (9), 321. http://dx.doi.org/10.3390/a15090321

Petkovic, J., Riddle, A., Akl, E. A., Khabsa, J., Lytvyn, L., Atwere, P., ... & Tugwell, P. (2020). Protocol for the development of guidance for stakeholder engagement in health and healthcare guideline development and implementation. Systematic Reviews , 9 (1), 1-11. https://doi.org/10.1186/s13643-020-1272-5

Pourmand, A., Caggiula, A., Barnett, J., Ghassemi, M., & Shesser, R. (2023). Rethinking traditional emergency department care models in a post-Coronavirus Disease-2019 world. Journal of Emergency Nursing . https://doi.org/10.1016%2Fj.jen.2023.02.008

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. https://doi.org/10.5811%2Fwestjem.2018.1.36327

Schoenfelder, J., Bretthauer, K. M., Wright, P. D., & Coe, E. (2020). Nurse scheduling with quick-response methods: Improving hospital performance, nurse workload, and patient experience. European Journal of Operational Research , 283 (1), 390-403.

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