Pre-Admission Testing in Gastrointestinal Laboratory

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Introduction

The stable work of the healthcare sector critically depends on the effective work of care providers and teams. Performing the significant tasks, specialists contribute to improving patients’ states and their recovery. For this reason, the area of practice acquires the top priority as one of the major aspects linked to the ability to attain existing goals. It is also vital to introduce the necessary improvements to ensure specialists have an enhanced understanding of their tasks and can perform the primary procedures. Thus, the issue under discussion is Pre-Admission Testing (PAT) in a selected gastrointestinal (GI) laboratory, its reduced effectiveness because of understaffing, its impact on outcomes, and the way to improve the procedure. It usually includes pre-op calls, obtaining medical history, and education about the planned procedure. PAT is a key to successful treatment and the following recovery.

Applicability

The applicability of the issue to the selected area of practice and its relevance are explained by several factors. First of all, PAT improves the efficiency of workflow and provides an opportunity to provide care and necessary education on time (Tariq et al., 2016). It also decreases the put-through time of patients in the outpatient setting, leading to the growth in patients’ satisfaction levels (Tariq et al., 2016). At the same time, ineffective PAT might slow down the speed of care delivery as patients might have numerous questions or poor understanding of the procedure because of the lack of knowledge. In such a way, having trained staff dedicated to doing PAT is a relevant issue applicable to the practice area.

Investigation

The investigation of the problem linked to the practice implies working with staff responsible for the procedure in the GI lab during the whole employment. Thus, the nursing staff agrees that PAT is a critical part of the workflow, demanding constant improvement as, at the moment, the put-through process is slow and much time is wasted. The analysis and discussion with other stakeholders, such as doctors, support the same idea. It is vital to have trained employees effective in doing PAT as it directly impacts the outcomes and can help to avoid unnecessary delays or complaints. Patients also report that they feel more comfortable when they have no questions before the intervention and realize its nature (Robinson, 2018). For this reason, PAT should be considered a critical practice that should be improved.

The official statistics and reports also provide credible evidence of PAT’s importance and the necessity to have staff doing the procedure. Thus, timely and effective testing helps nursing staff to prepare the patient for the planned intervention and collect the necessary information. These include medical history, previous cases, and the current state of possible allergies (Robinson, 2018). This background knowledge help to improve outcomes by 25% because of the specialists’ correct understanding of the case (Robinson, 2018). Moreover, PAT leads to an aligned workflow and helps to organize and structure the work of units with no delays (Christalle et al., 2019). Finally, Christalle et al. (2019) admit the correlation between patients’ satisfaction levels and positive outcomes, meaning that PAT implying education, might help to attain this goal. The given facts prove the necessity of having staff to do PAT to avoid workflow problems.

Analysis

The analysis of the situation also shows that the lack of staff dedicated to PAT might serve as the source of numerous delays and problems with workflow. Thus, the functioning of the selected GI unit suffers because of not having help with PAT; it has delays and problematic workflow. The problem is not a unique one, as following the reports, other units nationwide might also acquire similar problems (Christalle et al., 2019). In general, about 50% of facilities might have issues with doing patients’ pre-admission assessments (Christalle et al., 2019). It contributes to the growing dissatisfaction of all parties involved in the process and reduces the effectiveness of care providers (Christalle et al., 2019). For this reason, it becomes critical to address the problem and resolve it.

Furthermore, assessment of the problem reveals several factors contributing to the increased topicality of the problem. First of all, understaffing critically influences PAT procedure as the laboratory does not have nurses to help GI unit staff. Second, pre-op calls are usually made at the end of the workday, which reduces their effectiveness. They are rushed, while specialists might be tired, which influences attention and the ability to perform PAT at the desired level. Additionally, the diversity of patients’ needs might also serve as a contributing factor as they might need a different amount of time to get ready or require additional interpretations and explanations. As a result, PAT becomes less effective, and the workflow of the GI unit is backed up. It justifies the need for an effective solution that might help to address the problem and resolve it.

Solution

In such a way, the method to address the problem should consider the areas contributing to the increased topicality of the issue and offer an understandable and real framework for implementing a positive change in practice. For this reason, the following solution can be offered as a potentially applicable measure. The GI lab’s workflow improvement can be achieved by creating a position to perform PAT and hiring a person responsible for the task. It will help to rotate the role daily as every nurse is educated to do this testing. It will help to reduce the workload and ensure the calls are not done at late hours, which is vital for results. At the same time, no delays or problems with the workflow will emerge.

The choice of the given approach is justified by several factors. First of all, the analysis shows that the unit experiences understaffing, and the GI lab lacks specialists who can help it. Creating a new position and hiring a person can help to resolve the problem. A qualified nurse can do PAT, and it is possible to rotate the staff (Cellucci, 2019). It means that the solution might be effective in resolving the problem. Second, changing PAT’s time might help increase attention levels and ensure health workers will be more effective in collecting data and working with patients. Finally, the constant training and experience exchange might create the basis for better outcomes and enhanced GI lab’s functioning.

Resources

The solution might also require specific resources that can be found within the facility. First, it is critical to find financing to create a new position (Cellucci, 2019). Additionally, if the rotation is accepted, it is vital to create a schedule guaranteeing the peculiarities of the lab’s work are considered. For this reason, it is necessary to find the time and reorganize schedules to ensure the health workers engaged in the project are accessible and might be assigned PAT tasks. Furthermore, it is critical to guarantee that the GI lab’s director is ready to engage in the improvement process and confirm the proposed change’s necessity. Using these resources, it is possible to attain positive outcomes.

Cost-Benefit Analysis

Cost-benefit analysis might help to outline the potential effectiveness of the proposed solution and its applicability to the work of the selected unit. Thus, the solution implies creating a new position and hiring a person who can do PAT. The costs can be measured by the actual use of resources and time. Recruiting a new specialist might require around $3,000 as a monthly salary, which is the major spending. Thus, the cost of benefits is determined by assessing the effectiveness and possible improvements. For instance, an average medical error cost because of the lack of knowledge about a patient’s background estimates about $8,000 per admission (Buchbinder et al., 2019). It means that by spending $3,000 on the initiation of the program aimed at reducing clients’ complaints and minimizing mistakes rate, it is possible to save about $8,000, which can be viewed as a good investment. Moreover, as far as it is possible to rotate the functions, a new specialist might perform other roles, which will increase the units’ effectiveness.

Timeline

Implementing a specific solution, it is also critical to ensure the appropriate timeline is selected. The central requirement to establishing the timeline is to ensure the solution can start generating positive outcomes as soon as possible; however, it is also vital to guarantee that a sufficient amount of time is devoted to promoting the necessary change and making it a part of the workflow. Thus, for the proposed solution, the desired timeline is one month. It includes resolving organizational issues, such as acquiring the GI lab director’s approval, creating a new position, and hiring a specialist to perform the outlined tasks. It is planned that the organizational phase can be ended within 1 or 1,5 weeks. The remaining time is necessary to shift to a new approach and make it a part of the work process.

Stakeholders

The solution implies the participation of several major stakeholders to ensure it can demonstrate the desired results and precondition the positive change within the work of the GI lab. Thus, the most important stakeholders are the GI lab’s director, nurses engaged in the project, patients, and the facility’s management. Their collaboration and involvement are vital for attaining positive results and access to various types of resources. At the same time, they can signalize the necessity to introduce specific change by outlining factors influencing their perception of the problem and the aspects that might negatively impact one of these groups. The inclusion of these stakeholders is also a guarantee of the final project’s success and the solution’s ability to attain success.

GI lab director is one of the major stakeholders in the proposed solution. He/she possesses the authority to accept the proposed solution or reject it. For this reason, it is critical to guarantee he/she understands the nature of the offered intervention, its primary goal, and the required resources. Furthermore, the director’s engagement will help help to acquire the staff needed to create a new position and hire a specialist (Buchbinder et al., 2019). At the same time, a proposed rotation scheme and new responsibilities for nurses should be discussed to ensure the proposed alterations are accepted, and there are no barriers to implementing the solution and reorganizing the unit’s work.

GI lab staff should be viewed as another vital party influencing the outcomes. First of all, the current investigation and analysis of the issue mainly rest on their experiences and views of the problem. Anonymously, all nurses agree that the change is necessary to reorganize the unit’s work and ensure they might perform their primary functions and acquire positive results. It means that they might support the proposed decision and act as the primary change agents. Furthermore, new schedules and rotation schemes depend on the GI lab staff as they should be made considering their current needs and work patterns. Otherwise, there is a high risk of failure and the impossibility of attaining the desired outcome.

Patients are also stakeholders of the proposed solution as their results and satisfaction levels serve as a significant indicator of the necessity of change. It is expected that the introduction of a new approach to doing PAT will be more comfortable for patients as they will have more time to ask questions they have and be educated about the procedure, its peculiarities, and how to prepare. For this reason, their readiness to shift to a new schedule is vital for the solution’s effectiveness and ability to promote a positive outcome. The disregard for their needs and visions of PAT might precondition the failure of the intervention and the impossibility of aligning the evolution of the unit.

Finally, the facility’s top management is another stakeholder that should be considered. The top management considers incentives and decisions linked to hiring new specialists to find new financial resources. For this reason, it is critical to present the solution to the facility management to ensure it approves the proposed course of action and realizes the necessity of hiring a new nurse to rotate responsibilities and guarantee there is always a person to do PAT. In such a way, engaging all these stakeholders in the process and gathering their support is vital for implementing the solution.

Communication and Evaluation

It is planned to work with the given parties and communicate using the most effective and available methods. Mostly phone and emails are viewed as appliable communication channels helping to discuss the solution and its significant features (Buchbinder et al., 2019). It will also allow asking questions and discussing issues if they emerge. At the same time, monthly meetings are vital for monitoring the process. They will establish a platform for sharing thoughts and ideas about the current situation, what changes should be made, and whether the solution works. The feedback can also be collected during these meetings and via phone calls to patients who should share their visions. Processing this data, it is possible to determine whether the proposed change positively affects the unit’s work.

Implementation

In such a way, the implementation of the proposed solution implies several stages:

Acquiring the GI lab director’s approval.
Creation of a new position.
Hiring a specialist.
Creating a new schedule.
Switching to a new model.
Monitoring and adding necessary changes.

As it can be seen, the process has 6 phases necessary for the successful transition and promoting a positive change within a unit. Additionally, it will create the basis for further improvement and evaluation by collecting the feedback and using it for new positive change.

Role of a Scientist

Working on the given project implied several important roles that should be performed to attain success. The first one is the role of a scientist focused on analyzing the issue by using credible evidence. This type of research includes a comprehensive investigation from various perspectives and the use of specific sources to prove the relevance of the problem. For this reason, research evidence was collected related to such spheres as understaffing, high workload, PAT, and these factors’ influence on outcomes. It was critical to integrate this knowledge into the project as it is fundamental for justifying the necessity to address the outlined problem and the effectiveness of a specific measure offered to resolve it. For this reason, the role of a scientist can be linked to establishing correlations between the problem and results and gathering evidence for these aspects.

Role of a Detective

Working on a particular problem and finding a practical solution requires understanding the root causes of the issue’s emergence. It means that the project implied an in-depth investigation of the GI lab’s work. For this reason, similar to real detective work, it was critical to speak with all individuals affected by the problem and collect information from them. Their knowledge and data were fundamental for determining the current state of the selected unit, the challenges it faced, and possible ways to improve its functioning. The lack of this knowledge might have a pernicious impact on the whole study and promote the emergence of the wrong assumptions about the nature of the researched problem. For this reason, it was fundamental to perform a role of a detective and investigate all factors.

Role of a Manager

Finally, any positive change within a particular organization implies managerial roles. It is vital to align teams’ work, provide them with necessary resources, and ensure they can perform the main functions. For this reason, it was critical to analyze the proposed solution from a manager’s perspective to understand what possible interventions and resources might be needed to ensure a new approach is practical. The intervention implied creating a new position and hiring a specialist, which can also be viewed as one of the managerial functions. Additionally, a cost-benefit analysis performed to determine the nature of the proposed solution is one of the tools traditionally used by managers to select a possible change method. In such a way, the project provided an opportunity to act as a leader responsible for reorganizing the work of a unit.

Conclusion

Altogether, the following investigation revolved around the problem affecting the work of the GI lab and linked to the problematic PAT because of understaffing. The lack of specialists reduced the effectiveness of the unit’s work and promoted some delays and patients’ dissatisfaction. For this reason, the problem was evaluated and analyzed using both existing literature and nurses’ views on it. The proposed solution implies creating a new position and assigning a nurse to do PAT. The project provided an opportunity to perform different roles and work as an investigator determining the causes of a particular issue and offering ways to resolve it. At the same time, it promoted a better understanding of how to attain the positive change within a healthcare sector and the leader’s role importance.

References

Buchbinder, S., Shanks, N., & Kite, B. (2019). Introduction to health care management (4^th ed.). Jones & Bartlett Learning.

Cellucci, L. (2019). Essentials of healthcare management: Cases, concepts, and skills (2^nd ed.). Health Administration Press.

Christalle, E., Zill, J. M., Frerichs, W., Härter, M., Nestoriuc, Y., Dirmaier, J., & Scholl, I. (2019). Assessment of patient information needs: A systematic review of measures. PloS One, 14(1), e0209165.

Robinson, L. (2018). The impact of the nurse practitioner in pre-admission testing: A comparative review.DNP Projects.

Tariq, H., Ahmed, R., Kulkarni, S., Hanif, S., Toolsie, O., Abbas, H., & Chilimuri, S. (2016). Development, functioning, and effectiveness of a preoperative risk assessment clinic.Health Services Insights, 9(1), 1–7.

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