HA599 Unit 2 Capstone Project Proposal Example

Noon to Midnight, One Door, One Signature: A Capstone Project Proposal on Slow Ambulance Handoffs at a Composite Hospital's Emergency Department, Drawing the Boundary as Carefully as the Aim and Naming Who Has to Agree

[Student Name]

Purdue University Global

HA599: Master's Capstone in Health Care Administration

Unit 2 Project Proposal

[Instructor Name]

[Date]

The hospital, the county and every figure are composite and bracketed for the writer's own data.

Summary

This project will measure ambulance handoff delay at Tessford's emergency department between [12:00] and [00:00], appraise the evidence on staffed arrival points, and, if justified, propose a twelve-month pilot of a nurse-staffed arrival point for ambulance patients. Deliverables over ten units: a needs assessment, an evidence appraisal, feasibility and financial analyses, an implementation timeline, a risk register, an evaluation plan and an executive presentation.

Problem and Measure

Offload time is the minutes between an ambulance's arrival at the emergency department door, recorded by the county's electronic care report, and a nurse's signature accepting the patient. A first look at run records places [78] percent of waits over [30] minutes between [12:00] and [00:00].

Aim

Reduce the 90th percentile of offload time between [12:00] and [00:00] from [71] minutes to under [45] minutes within [90] days of opening an arrival point, without lengthening waits for walk-in patients.

Benefits, in the Organization's Terms

Crews returned to the county sooner, improving the relationship with the county EMS medical director, who has written twice this year. Fewer diversion hours, and with them fewer admissions lost to other hospitals. Less overtime for the triage and charge nurses who now cover handoffs. Benefits are stated as directions, not amounts, because no financial work has been done yet; Unit 6 will price them.

Boundary: What the Project Excludes

Inpatient boarding. It drives much of the delay, but it belongs to bed management and a separate improvement team. Excluding it keeps this project achievable; the risk register will watch for boarding spilling into the arrival point. Walk-in waiting times. They will be watched so the project does not shift delay onto them, but improving them is not the aim. County dispatch and staffing. The project will not change where the county sends ambulances or how it staffs them. Overnight hours. Volume between [00:00] and [12:00] is too thin to test a staffed solution. Every exclusion has a reason, so a reviewer can disagree with one without rejecting the project.

Why a Local Project Is Useful

National guidance treats offload delay as a shared responsibility of hospitals and EMS systems (Cooney et al., 2011), and research focused on the delay itself, rather than crowding in general, remains limited (Li et al., 2019). One study found that delayed high-acuity patients did not have worse mortality than matched patients, but did spend longer in the department (Stewart et al., 2019), which suggests the main costs are to EMS availability and department flow rather than direct harm, a point the needs assessment will test locally.

What a Staffed Arrival Point Would Look Like

The leading candidate, to be tested in later units, is a small area near the ambulance entrance with room for [four] stretchers, staffed from [12:00] to [00:00] by a registered nurse who accepts every ambulance patient on arrival, takes report, completes a rapid assessment and moves the patient to a bed or triage queue as space opens. Crews would leave as soon as the nurse signs. The idea is not new; versions have been tried in Canada and Australia with mixed results, which the evidence appraisal will weigh. Naming the candidate now lets stakeholders react early, while making clear that the needs assessment could still point elsewhere, for example toward faster triage rather than a new space.

Stakeholders and Consent

Chief nursing officer, sponsor: approves the project and later the pilot. Needs: evidence and a cost estimate. Emergency department director and nurse manager: own the process. Need: staffing that does not weaken triage. County EMS medical director: shares run data and must agree to any change in where crews go. Needs: shorter waits. House supervisor: owns diversion decisions and logs. Facilities and the fire marshal: approve any use of space near the ambulance entrance. Informatics: builds any time-stamp capture. Finance: prices costs and benefits. Emergency nurses: will staff the arrival point. Need: a voice in its design.

Data and Access

County electronic care reports under the existing quality agreement; the emergency department tracking board; diversion logs; overtime records from payroll. The privacy officer has confirmed that matched records will be used for operations improvement under the hospital's existing policies, with no identifiers leaving the hospital.

Timeline Across Ten Units

Units 3 to 4: measure and appraise. Units 5 to 6: test feasibility and cost. Units 7 to 9: plan implementation, risk and evaluation. Unit 10: present to executives.

Risks to the Project Itself

County data may arrive late; the house supervisor's logs may be incomplete; the sponsor may change. Each has a fallback, such as using one month of data if a full quarter is not available.

Approval Requested

Approval to proceed with Units 3 to 10, with access to the data listed above and a monthly check-in with the sponsor.

References

Cooney, D. R., Millin, M. G., Carter, A., Lawner, B. J., Nable, J. V., & Wallus, H. J. (2011). Ambulance diversion and emergency department offload delay: Resource document for the National Association of EMS Physicians position statement. Prehospital Emergency Care, 15(4), 555-561. https://doi.org/10.3109/10903127.2011.608871

Li, M., Vanberkel, P., & Carter, A. J. E. (2019). A review on ambulance offload delay literature. Health Care Management Science, 22(4), 658-675. https://doi.org/10.1007/s10729-018-9450-x

Stewart, D., Lang, E., Wang, D., & Innes, G. (2019). Are emergency medical services offload delay patients at increased risk of adverse outcomes? CJEM, 21(4), 505-512. https://doi.org/10.1017/cem.2018.478