Recommendation Report

Introduction

In the healthcare setting, many interprofessional disciplines must work together to provide efficiency in time management, positive patient satisfaction, and desired outcomes. Implementing the ACT protocol will enhance the victim’s satisfaction of care and reduce ED staffing resources, saving hospital costs.

ENG FPX 1250 Assessment 5 Recommendation Report

ACT is a new policy that should be implemented to fast-track a victim of sexual or domestic violence assault. The ACT acronym stands for Assault, Call, and Treatment upon arrival. Implementing the ACT policy will eliminate the need to have the victim sit in the ED waiting room to be triaged, decreasing the victim’s frustration with the long wait time and not delaying their services. There are multiple core interdisciplinary leadership competencies, and having strategic and tactical planning, networking, team collaboration, and setting a direction will make this a successful transformation in the policy and procedures practices. Having a strategy of tactical planning and getting the buy-in from all team members is the best solution to the problem at hand.

By implementing the ACT policy, I hope to increase patient and ED staff comfort with the new protocol and increase patient satisfaction scores. The goal is to develop and implement this new protocol together so we may gain knowledge and understanding of what our victims have endured while improving their care and patient satisfaction scores. Using the feedback from the patient satisfaction surveys and the feedback given to leadership from the ED staff will empower us as a team to improve our workflow and encourage victims to not only come forward but understand that we are there to help them receive the appropriate care they need. In addition, implementing this new protocol together will also decrease overcrowding in the ED and improve physician and nurse duties by having the victim’s care under the Forensic Nurse’s services, therefore, freeing up the Physician and nurses to care for other patients waiting to be treated (Chrusciel, 2019). Finally, by effectively implementing the ACT protocol, our ED staff and our sexual and domestic violence assault victim will benefit from the fast-track workflow.

Changing a workflow in the ED is not an easy task. Many nurses said it could not be accomplished due to the demands and the stressful environment they face daily, and adding another policy may not be achievable. However, understanding the daily operations all ED staff face, this protocol could relieve some of those issues. Therefore, I propose introducing this protocol to quickly triage victims of sexual and domestic violence assault needing services, which will help to improve staffing duties and will also increase efficiencies.

Criteria

Numerous criteria were considered when weighing the risks and benefits of implementing the ACT policy. For example, the opportunities included the risk of victims leaving against medical advice, educating and in-servicing the ED staff, patient satisfaction surveys, and projected cost savings to the hospital. Reviewing these criteria will help solidify an achievable recommendation based on a risk-benefit analysis. The criteria were reviewed and are in order of level of importance:

• Leaving AMA (Against Medical Advice): Often, at times, Emergency Departments quickly become overcrowded, and many patients will leave AMA due to the long hours they wait to be seen or treated. This holds true for the victims of sexual or domestic assault as well. Often, the victim will not want to wait in a crowded waiting room with other people staring at them due to their physical injuries or their emotional state, as many times, these victims are bruised and battered. As a result, victims sometimes leave without being seen if they have to wait numerous hours to be treated, which will delay the services they desperately need. 

• Education and in-services: For this protocol to be successful, there must be education and training for the ED staff. One “lead” from each ED position will help with the training to have a successful implementation. Therefore, we will have one Physician, a Nursing Supervisor, Charge Nurse for the day and evening shifts, and one Unit Secretary Supervisor. This lead team will help facilitate, implement, and report findings of the new plan rollout to fast-track sexual and domestic assault victims under the ACT protocol. This plan, when appropriately implemented, will be successful due to each team member’s specific duties. Team leads will report back at the monthly meeting and collaborate with other leads on the findings of the new plan. 

• Patient and Staff Satisfaction form: A patient satisfaction survey will be given to the victim and mailed to the Forensic Nurse Coordinator. The Forensic Nurse Coordinator will collect all surveys and report findings at each monthly Leadership meeting. In addition, an ED staff survey drop box will be located in the breakroom for staff members to complete for feedback with any recommendations or comments on the new policy rollout.

• Cost savings: By transferring the services to the FN service, this, too, would have the opportunity to get more patients treated, which could result in increased revenue of well over $296,352 annually. On average, NJ is ranked second for having the highest cost of an ED visit, around $3,087, before insurance payment (Learish, 2020).

ENG FPX 1250 Assessment 5 Recommendation Report

Any patient leaving /against medical advice before being seen is a significant concern, especially for our victims. This could be a concern for public safety if the victim does not receive the Forensic Nurse’s services, as the crime will go unreported, evidence will not be collected, and the alleged perpetrator will not be prosecuted. Having the ACT policy in place will negate this issue and significantly positively impact both the victim and the ED staff. One way is by not having the victim wait hours to be seen in the general population ED waiting room, and secondly, fast-tracking the victim over to the Forensic Nurse’s services will free up the In-take Registered Nurse, which will free up her time as a resource 

Finally, the last two topics play a crucial role and also have significant importance. Many victims do not come to the ED seeking treatment for numerous reasons. Some fear not being believed or blamed for their sexual assault, and many decide it is not worth the risk to reach out for help from these services for fear of receiving a negative response (Jones-Lockwood et al., 2019). Educating and in-servicing the ED staff will help negate these fears and help the victim receive the appropriate care they need. We expect our patient satisfaction scores to improve by implementing the ACT protocol. Understanding how the victim portrays our services, from coming to the ED to receiving exceptional care, and being treated swiftly with compassion and care through discharge, will help us better understand if adjustments need to be made to the ACT policy.

Recommendation

The success and positive outcomes from the above criteria are crafted for the ACT model for victims of sexual or domestic violence assault. Implementing this new policy will yield a better outcome for these victims. Integrating the necessary tools and having a fail-proof system in place will have a positive effect on the ED staff and the victim. The ACT protocol will allow the ED staff to fast-track the victim, providing an efficient way to help the victim than they have done in the past. Additionally, having the ACT protocol in place will benefit the victim and the ED staff, and the on-call Forensic Nurse to be notified immediately and begin to help the victim of an assault, which will create less stress for the staff and victims.

An analysis of the risk-benefit from the ideology outlined above concludes that implementing the ACT model within our hospital system will lead us to a proven successful implementation and positive outcomes. As with all new protocols, adjustments and additional in-servicing requirements will be required. However, the ED staff, Forensic Nurse, and team leads will work together to ensure all personnel has adequate training to ensure a smooth transitional workflow which will improve outcomes. 

For the ACT model to be successful, we must remain laser-focused in three key areas: to decrease wait times, decrease delayed services, and increase patient satisfaction scores. The benefits gained will be less stress for the staff and the victim. Understanding the changes and patience needed to successfully implement the plan and utilizing an interdisciplinary team approach will help us achieve our anticipated goals. Working as a team enables better use of medical staff and resources while streamlining the forensic evidence-collecting process, resulting in higher patient satisfaction. In addition, having the leadership’s support and plan of action to help educate and in-service the staff will have us all working together to achieve these goals and instill a stronger sense of team and trust.

ENG FPX 1250 Assessment 5 Recommendation Report

Citation

Chrusciel, J., Fontaine, X., Devillard, A., Cordonnier, A., Kanagaratnam, L., Laplanche, D., & Sanchez, S. (2019). Impact of the implementation of a fast-track on emergency department length of stay and quality of care indicators in the champagne-ardenne region: A before-after study. BMJ Open, 9(6), e026200. https://doi.org/10.1136/bmjopen-2018-026200

Jones-Lockwood, A., Lonsway, K., & Archambault, J. (2019, June). Improving responses to sexual assault disclosures [PDF]. https://evawintl.org/wp-content/uploads/2019-6_TB_Improving-Responses-to-SA-Disclosures.pdf

Learish, J. (2020, December 4). The most expensive states for er visits, ranked. https://www.cbsnews.com/pictures/emergency-room-visit-cost-most-expensive-states/48/

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