Emergency Department Laboratory Improvement Evaluation at Saud City - Research Proposal Example

Research Proposal: Emergency Department Laboratory Improvement Evaluation at King Saud Medical in Riyadh, Saudi Arabia Submission: Total Number of Words: 2,024 Executive Summary The proposed research study aims to search for the best ways to improve the laboratory services given to all patients who are admitted in KSMC’s ER department. As such, research questions behind the proposed research study include: (1) What are the common strategies used in reducing downtime in laboratory services?; and (2) Will KSMC personnel be able to improve the operational workflow from ER to laboratory department and vice versa? To address the first research question, a systematic literature review will be conducted to identify and determine the effectiveness of each identified strategy in terms of reducing downtime in the work process between the ER and laboratory department. Eventually, the gathered literature review will serve as a tool in the provision of useful training for each healthcare staff who is currently employed at KSMC’s ER and laboratory departments. The second research question will be addressed by conducting an experimental research study. Before and after conducting the training program, the normal workflow and time requirements between KSMC’s ER and laboratory department will be carefully observed, monitored, and measured. Eventually, time differences between these two (2) experimental studies will be noted and be used in answering the question whether or not KSMC personnel be able to improve the operational workflow from ER to laboratory department and vice versa. Table of Contents Executive Summary ……………………………………………………………………….. 2 Table of Contents ………………………………………………………………………….. 3 1. Introduction ……………………………………………………………………….. 4 2. Project Objectives ………………………………………………………………… 5 3. Literature Review ………………………………………………………………… 6 4. Description of the Proposed Work ……………………………………………….. 7 4.1 Approach, Tasks, and Phases …………………………………………... 8 4.2 Research Methodology …………………………………………………. 9 5. Value to the Kingdom ……………………………………………………………. 10 6. Undertaking of the Research Team ………………………………………………. 10 References ………………………………………………………………………………... 12 - 13 1. Introduction As a tertiary care centre, King Saud Medical Complex (KSMC) in Riyadh is committed in delivering safe healthcare services to all patients (King Saud Medical City, 2014). Since the emergency room department (ER) is the busiest in all other departments in KSMC, the proposed research study will seek to determine the best ways to improve the overall laboratory services given to all patients admitted in ER. In general, inefficient laboratory services can lead to unnecessary delays in the patients’ diagnosis and treatment (Holland, Smith, & Blick, 2005; Leman et al., 2004). In the process of improving the efficiency of laboratory services, it is possible to reduce the length of stay of patients in ER department (Holland, Smith, & Blick, 2005; Yoon, Steiner, & Reinhardt, 2003), prevent delays in patient care and reduce the risks of overcrowding KSMC’s ER department (Heyer et al., 2012; Yoon, Steiner, & Reinhardt, 2003). In search for the best ways to improve the laboratory services given to all patients who are admitted in KSMC’s ER department, the research proposal will address the following research questions: (1) What are the common strategies used in reducing downtime in laboratory services?; and (2) Will KSMC personnel be able to improve the operational workflow from ER to laboratory department and vice versa? Basically, the scope of the research work is to conduct a systematic literature review which aims to identify all strategies that can be use to effectively reduce wasted time whenever the healthcare professionals such as GPs and registered nurses would request for laboratory exams, at the time when biochemists and/or radiologists would perform the actual laboratory tests, and during the time when the biochemists and/or the radiologists would release the final laboratory results back to the GPs. The gathered literature review will serve as an instrument in the provision of trainings for KSMC’s staff particularly those who are working in ER and laboratory department. As part of evaluating the ability of healthcare professionals to improve ER services, the turnaround time wherein healthcare professionals such as GPs and registered nurses would request for laboratory exams, the time duration wherein biochemists and/or radiologists would perform the actual laboratory tests, and the time duration needed when the biochemists and/or the radiologists would release the final laboratory results back to the GPs will be measured before and after the provision of training program and the implementation of useful strategies. When performing the systematic search for literature review, related key words will be first be identified followed by setting the most appropriate inclusion and exclusion criteria which will be used in narrowing down the search for useful peer-reviewed journals. In line with this, only the most recently published journals between 2008 to 2014 will be used in the actual research study. 2. Project Objectives The following objectives will be considered in this project: (1) By end of July 2014, 100% of the healthcare professionals who are currently working in KSMC’s ER and laboratory department will attend a training program which aims to reduce downtime in the operational workflow from ER to laboratory department and vice versa; (2) On the 15th of August 2014, 100% of the healthcare professionals who are currently working in KSMC’s ER and laboratory department will be invited to participate in deciding for the best strategy to use in reducing downtime in the operational workflow from ER to laboratory department and vice versa; and (3) By end of August 2014, the ability of all healthcare professionals to improve the operational workflow from ER to laboratory department and vice versa will be evaluated. 3. Literature Review There are limitations to each of the existing research studies on ways to improve the efficiency between ER and laboratory department. For instance, the study of Blick (2013) focused on creating an automated core laboratory using the lean/six sigma as a management tool to help reduce patients’ length of stay in ER departments. Storrow et al. (2008) proposed a simulation model which can be use to effectively decrease the turnaround time on patient throughput in ER department, patients’ length of stay in ER department, and the necessary emergency medical services provided to each patient in ER department. Sheppard et al. (2008) focused on comparing and contrasting the turnaround time for laboratory result reporting when conducted by dedicated phlebotomist and non-laboratory personnel, the risks of blood contamination, and the patients’ length of stay in relation to the need to improve the quality care services in ER departments whereas Singer et al. (2008) examined the effects of using Stat laboratory on patients’ length of stay in ER departments. Specifically the study of both Jalili et al. (2012) and Fernandes et al. (2004) are unique in the sense that both authors decided to identify the root cause of delays in sending laboratory reports back to the ER departments. All of the studies mentioned above are directly related to the research topic. However, none of these studies are sufficient in terms of guiding healthcare professionals on how to reduce turnaround time when GPs and registered nurses would request for laboratory exams, at the time when biochemists and/or radiologists would perform the actual laboratory tests, and during the time when the biochemists and/or the radiologists would release the final laboratory results back to the GPs. Therefore, completing the proposed research study can benefit healthcare professionals who are currently working at the ER and laboratory department of KSMC. 4. Description of the Proposed Work The proposed research study is composed of two (2) parts. To learn more about the useful strategies which can be used in reducing downtime in both ER and laboratory department, the first part of the research proposal will focus on conducting a systematic literature review. Eventually, the second part of the research proposal aims to evaluate the ability of the healthcare personnel to reduce downtime in both ER and laboratory departments. (See Figure I – Summary of the Proposed Work below) Figure I – Summary of the Proposed Work 4.1 Approach, Tasks, and Phases In relation to the proposed research study, the following approaches, tasks, and phases will be considered in this study: Objectives Phases Tasks By end of July 2014, 100% of the healthcare professionals who are currently working in KSMC’s ER and laboratory department will attend a training program which aims to reduce downtime in the operational workflow from ER to laboratory department and vice versa Data collection phase 1. Identify useful keywords related to the research topic; 2. Define inclusion and exclusion criteria; 3. Make use of online databases like PubMed, Google scholar, and NCBI in search for related literature; 4. Conduct the actual systematic literature review; 5. Finalize the systematic literature review; and 6. Seek permission from KSMC’s administration to conduct necessary training program for the proposed research study; 7. Conduct the actual training program; 8. Assign each of the healthcare staff to reflect on the best strategy that can be implemented at KSMC’s ER and laboratory department to improve patients’ quality care services; and 9. Set schedule for decision-making process (i.e. August 15, 2014). On the 15th of August 2014, 100% of the healthcare professionals who are currently working in KSMC’s ER and laboratory department will be invited to participate in deciding for the best strategy to use in reducing downtime in the operational workflow from ER to laboratory department and vice versa Decision-making phase 1. Make use of effective leadership skills to establish trust and promote two-way communication between the healthcare staff and the researcher; 2. Listen to the rationale provided by each of the healthcare staff as to why they have chosen a specific strategy; 3. Reflect upon the personal opinions given by each of the healthcare staff; and 4. Design and implement a structure which can be used to improve the workflow between the ER and laboratory department. By end of August 2014, the ability of all healthcare professionals to improve the operational workflow from ER to laboratory department and vice versa will be evaluated. Experimental research phase 1. Observe and measure duration of time in the workflow between KSMC’s ER and laboratory department before the provision of training program; 2. Observe and measure duration of time in the workflow between KSMC’s ER and laboratory department after the provision of training program; and 3. Analyze time differences and result from the use of observational technique. 4.2 Research Methodology The first research question presented in this study will be addressed by conducting a systematic literature review. Basically, the main reason for conducting a systematic literature review is to identify and examine how effective each of the identified strategy is when it comes to reducing downtime in the workflow of ER and laboratory department. Using online databases like PubMed, Google scholar, and NCBI, it is much easier to gather peer-reviewed journals that are directly related to the proposed research study. The second research question will be addressed by conducting an experimental research. Similar to the research method used by Storrow et al. (2008), the normal workflow and time requirements between KSMC’s ER and laboratory department will be carefully observed, monitored, and measured. As such, the time element will be measured based on minutes and hours (Storrow et al., 2008). Information taken from this procedure will be used as a benchmark for evaluating signs of improvement in the efficiency of both KSMC’s ER and laboratory departments. In almost any clinical cases, the provision of effective training programs is necessary in terms of improving the work performance of each staff. Therefore, after providing staffs with free training program, the workflow between KSMC’s ER and laboratory department will then again be carefully observed, monitored, and measured as part of the overall evaluation process. As part of the research ethics, the research team will talk directly to the administration of KSMC not only to discuss the main purpose of this study but also seek approval before conducting the actual research study. In relation to informed consent, all healthcare staff working at KSMC’s ER and laboratory department will be informed of the main purpose of the study and how the research findings can be use to help them improve the quality care given to each patient admitted at KSMC ER department. As such, each of the healthcare staff will be given the right and option to choose not to participate in the actual research study without any questions asked. 5. Value to the Kingdom The proposed research study is valuable to the Kingdom. Aside from reducing the patients’ unnecessary expenses caused by lengthy stay in the ER department, improving the efficiency between the laboratory requirements of each patient in the ER department and the ability of biochemists and/or the radiologists to deliver laboratory results can help GPs provide immediate diagnosis and treatment to each patient. As a result, people who requires immediately care can easily recover from their illnesses. Eventually, immediate recovery will allow these patients to reduce the number of their absences at work. 6. Undertaking of the Research Team In relation to certain rules and research ethics, the research team undertakes that: The text and graphics herein as well as any accompanying publications or other documents, unless otherwise indicated, are the original work of the signatories or individuals working under their supervision; No part of the research proposal has been funded by any other sources; No existing funds are available for the proposed research study; No fund will be sought from any other sources if an award is made as a result of this proposal; We agree to accept responsibility for the scientific conduct of this project; and No investigator from project team participates in more than 3 projects. References Blick, K. (2013). Providing clinical laboratory results on time, every time to help reduce emergency department length of stay: how our laboratory achieved a six signma level of performance. American Journal of Clinical Pathology, 140(2), 193-202. Fernandes, C., Worster, A., Hill, S., McCallum, C., & Eva, K. (2004). Root cause analysis of laboratory turnaround times for patients in the emergency department. CJEM, 6(2), 116-122. Heyer, N., Ernst, D., Liebow, E., Gayken, J., Bichols, J., Epner, P., et al. (2012). Effectiveness of practices to reduce blood sample hemolysis in EDs: A laboratory medicine best practices systematic review and meta-analysis. Clinical Biochemistry, 45(13-14), 1012-1032. Holland, L., Smith, L., & Blick, K. (2005). ). Reducing Laboratory Turnaround Time Outliers Can Reduce Emergency Department Patient Length of Stay. American Journal of Clinical Pathology, 124(5), 672-674. Jalili, M., Shalileh, K., Mojtahed, A., Mojtahed, M., & Moradi-Lakeh, M. (2012). Identifying causes of laboratory turnaround time delay in the emergency department. Arch Iran Med , 15(12), 759-763. King Saud Medical City. (2014). Official Website. Retrieved June 20, 2014, from http://www.ksmc.med.sa/user_en/login_ar Sheppard, C., Franks, N., Nolte, F., & Fantz, C. (2008). Improving quality of patients care in an emergency department: laboratory perspective. American Journal of Clinical Pathology, 130(4), 573-577. Singer, A., Viccellio, P., Thode, H., Bock, J., & Henry, M. (2008). Introduction of a stat laboratory reduces emergency department length of stay. Academic Emergency Medicine, 15(4), 324-328. Storrow, A., Zhou, C., Gaddis, G., Han, J., Miller, K., Klubert, D., et al. (2008). Decreasing Lab Turnaround Time Improves Emergency Department Throughput And Decreases Emergency Medical Services Diversion: A Simulation Model. Academic Emergency Medicine, 15(11), 1130-1135. Yoon, P., Steiner, I., & Reinhardt, G. (2003). Analysis of factors influencing length of stay in the emergency department. CJEM, 5(3), 155-161. Read More