BENCHMARK 1 Evidence-Based Practice Project: PICOT Paper Daysha Y. Polk NUR 550 Grand Canyon University June 1st, 2021 Evidence-Based Practice Project: PICOT Paper Generally, a high level of patient satisfaction for the clients in the emergency department (ED) is vital, especially at this time when the healthcare system is shifting towards patient-centered care. Prakash (2010) notes that patient satisfaction levels significantly impact on medical malpractice claims, patient retention, and clinical outcomes. That is, it affects quality healthcare’s timely, efficient, and patient-centered delivery, making it both a proxy but a very effective key indicator for measuring the hospitals and doctors’ success. Consequently, supporting the improvements of patient satisfaction levels can positively affect several healthcare organizations’ components, such as preventive possible malpractice lawsuits, securing a positive local reputation, and enhancing patient retention rates. Thus, there is an increased need to develop strategies to improve ED patient’s satisfaction with the provided care services. Increasingly, the use of real-time location systems (RTLS) by hospitals to track patients, instead of relying on the traditional, manually-entered status updates, is increasingly being viewed as a better strategy to decrease the number or rate of Left Without Being Treated (LWBT) patients, and thus, improve ED patient’s satisfaction levels and hospital’s revenue collection (Boulos & Berry, 2012). Thus, the paper will explore whether the utilization of RTLS in the hospital’s ED, compared to manually-entered status updates to tract patients, help decrease the rate of LWBT and to raise revenue collection within 6 months, for ED patients with decreasing satisfaction levels with the provided healthcare services. A wide array of factors is responsible for the decreased rate of satisfaction levels amongst ED patients. The current delays, long waits, leaving without being treated, decreased revenue collection from the ED unit, and reduced patient satisfaction scores have negatively portrayed the hospital's reputation to the public. As a result, the daily patient visits have continued to decrease as people attribute the facility to poor emergency care services delivery. All these complications result from the use of combined data resources and manual entry status updates when tracking patient records. This manual tracking cannot meet the demand for many patients and leads to overcrowding due to and reduced patient flow in the ED. Therefore, there is a need to install an automatic patient tracking system to increase the flow. Patient satisfaction level, especially for hospital’s emergency department (ED) is increasingly becoming a key health quality indicator. Patient satisfaction regards the degree to which patients are happy with their healthcare (Heath, 2016). Patient satisfaction levels is a care quality measure and gives healthcare providers infor ...

1. BENCHMARK 1
Evidence-Based Practice Project: PICOT Paper
Daysha Y. Polk
NUR 550
Grand Canyon University
June 1st, 2021
Evidence-Based Practice Project: PICOT Paper
Generally, a high level of patient satisfaction for the clients in
the emergency department (ED) is vital, especially at this time
when the healthcare system is shifting towards patient-centered
care. Prakash (2010) notes that patient satisfaction levels
significantly impact on medical malpractice claims, patient
retention, and clinical outcomes. That is, it affects quality
healthcare’s timely, efficient, and patient-centered delivery,
making it both a proxy but a very effective key indicator for
measuring the hospitals and doctors’ success. Consequently,
supporting the improvements of patient satisfaction levels can
positively affect several healthcare organizations’ components,
such as preventive possible malpractice lawsuits, securing a
positive local reputation, and enhancing patient retention rates.

2. Thus, there is an increased need to develop strategies to
improve ED patient’s satisfaction with the provided care
services. Increasingly, the use of real-time location systems
(RTLS) by hospitals to track patients, instead of relying on the
traditional, manually-entered status updates, is increasingly
being viewed as a better strategy to decrease the number or rate
of Left Without Being Treated (LWBT) patients, and thus,
improve ED patient’s satisfaction levels and hospital’s revenue
collection (Boulos & Berry, 2012). Thus, the paper will explore
whether the utilization of RTLS in the hospital’s ED, compared
to manually-entered status updates to tract patients, help
decrease the rate of LWBT and to raise revenue collection
within 6 months, for ED patients with decreasing satisfaction
levels with the provided healthcare services.
A wide array of factors is responsible for the decreased rate of
satisfaction levels amongst ED patients. The current delays,
long waits, leaving without being treated, decreased revenue
collection from the ED unit, and reduced patient satisfaction
scores have negatively portrayed the hospital's reputation to the
public. As a result, the daily patient visits have continued to
decrease as people attribute the facility to poor emergency care
services delivery. All these complications result from the use of
combined data resources and manual entry status updates when
tracking patient records. This manual tracking cannot meet the
demand for many patients and leads to overcrowding due to and
reduced patient flow in the ED. Therefore, there is a need to
install an automatic patient tracking system to increase the
flow.
Patient satisfaction level, especially for hospital’s emergency
department (ED) is increasingly becoming a key health quality
indicator. Patient satisfaction regards the degree to which
patients are happy with their healthcare (Heath, 2016). Patient
satisfaction levels is a care quality measure and gives healthcare
providers information on the various aspects of health and
medicine, such as their care’s effectiveness and their empathy
levels. According to Xesfingi & Vozikis (2016), patient

3. satisfaction is a healthcare quality’s measure given that it
provides insight into the provider’s success at realizing the
patient’s care expectations, and is also a key patients’
perspective behavioral intention’s determinant. While
satisfaction has always been an important factor when
delivering any form of a service, it has recently gained
prominence or primacy within the healthcare space, especially
at this time when the healthcare industry is fast shifting towards
patient-centered models. According to Vocera’s 2016 ‘Rise of
the Chief Experience Officer’ report, about 64% of the
interviewed healthcare professionals stated that their healthcare
organizations prioritize patient satisfaction in a similar extent to
which they value clinical workflow and patient safety
improvements. Increasingly, patients are demanding a larger
claim in their healthcare, with the expectation that their
healthcare providers will attain a certain service level.
Healthcare quality is increasingly becoming a universal issue,
making the healthcare industry to undergo rapid
transformations. According to Asamrew, Endris and Tadesse
(2020), the rapid transformations are primarily driven by the
need to realize its patient population’s ever-increasing needs
and demands, instead of the traditional professional practice
standards-based needs. In their study of a patient’s satisfaction
score with a specialize hospital in Ethiopia, the researchers
determined that patient-healthcare provider interaction and
general facility amenity-related factors explained about 96.4%
of the variability in the net overall satisfaction score. The
hospital’s inpatient pharmacy services, the availability of
laboratory, radiology and pain management services, and good
quality services provided by the hospital physicians positively
influenced patient satisfaction scores. Additionally, availability
of accommodation rooms, toilet cleanliness, and dietary
services had significant association with the patient satisfaction
levels. In yet another study, Son and Yom (2017) classifies the
factors impacting on ED patient’s satisfaction levels into three
interrelated forces, including predisposing characteristics,

4. enabling resources and need. First, the predisposing
characteristics include demographic factors (age, sex, marital
status and past illness), social structure (education and
employment), and belief (subjective health, perceived social
class and attitude towards health service - quality and status).
Secondly, then enabling resources include family (income and
type of health insurance) and community (type of hospital,
mode of arrival, time taken, delayed or missed treatment and
frequency of visiting the ED). Finally, the need factors include
reason for visit and service received. Joe Greskoviak, president
and chief operating officer at Press Ganey, categorizes the
factors into communication, provider empathy, and care
coordination (Heath, 2016). All these points are interrelated and
affect each other.
Delayed or missed treatments have become a notorious
phenomenon in most hospitals. In a recent research by Asheim
et al., (2019), it was discovered that the prolonged ED stay was
associated with a higher probability of being discharged from
the ED without admission to the hospital and that there was no
significant difference in hospitalization length for the admitted
patients. Thus, the researchers concluded that prolonged ED
stay was not associated with increased risk of death. However,
many studies have determined that delayed or missed treatments
are strongly associated with decreased patient satisfaction levels
and reduced revenue for hospitals. Furthermore, ED
overcrowding also reduced emergency care quality by prolonged
patient total length of stay, increased rate of patients left
without being seen, ambulance diversion, decreased patient
satisfaction, decreased revenue collection, and etcetera (Wang
et al., 2017). According to Wand (2019), the lengthy
documentation and assessment processes, timeliness of
consultations and delays in decisions about patient disposition
in ED can lead to reduced ED patient satisfaction levels and
frustrations by ED staff and hospital executives. As noted
above, the complications are primarily caused by the hospital’s
reliance on combined data resources and manual entry status

5. updates when tracking patients and their records – all of which
cannot meet the healthcare service demand for the many
patients, leading to reduced patient flow in the ED,
overcrowding, and delayed and missed treatments.
Technology can significantly help hospitals solve the mentioned
complications. Primarily, by installing a RTLS, an automatic
patient tracking system in the ED, hospitals can significantly
increase the patient flow in their EDs (Drazen & Rhoads, 2011).
According to Garie Fallo, the Western Reserve Hospital’s CNO,
a technology suite can help improve care efficiency in EDs and
boost patient satisfaction scores by 90% through streamlining
the clinical workflow (Heath, 2016). With an automatic patient
tracking system, patients would not need to stop at any stage for
manual tracking, stipulating that there would be neither delays,
prolonged wait times on stretchers, nor family waiting. Rather,
the process would appear more satisfied, with a very seamless
move to the ED room. Thus, right from their arrival, the
patients would have a higher satisfaction with the provided
services. The side-effect of the high satisfaction scores,
according to a review of various peer-reviewed publications on
the importance of patient satisfaction carried out by Prakash
(2010), includes improved patient loyalty and retention, reduced
vulnerability to price wars or bargains, consistent improvement
in revenue and profitability, increased staff morale with reduced
staff turnover, reduced risk or malpractice suits and
accreditation issues, and increase personal and professional
satisfaction. Consequently, by installing the proposed RTLS,
hospitals can improve the ED patient’s satisfaction levels.
Specifically, RTLS, compared to the manually-entered status
updates to tract patients, help decrease the rate of LWBT and to
raise revenue collection within 6 months, for ED patients with
decreasing satisfaction levels with the provided healthcare
services.

6. References
Asamrew, N., Endris, A. A., & Tadesse, M. (2020). Level of
Patient Satisfaction with Inpatient Services and Its
Determinants: A Study of a Specialized Hospital in Ethi opia. (J.
Haughton, Ed.) Journal of Environmental and Public Health,
2020(Article ID 2473469), 1-12.
Asheim, A., Nilsen, S. M., Carlsen, F., Næss-Pleym, L. E.,
Uleberg, O., Dale, J., et al. (2019, December). The Effect Of
Emergency Department Delays On 30-Day Mortality in Central
Norway. European Journal of Emergency Medicine, 26(6), 446-
452.
Boehm, L., & Petty, K. (2016). The Rise of the Healthcare
Chief Experience Officer. Vocera’s Experience Innovation
Network.
Boulos, M. N., & Berry, G. (2012, June 28). Real-Time
Locating Systems (RTLS) In Healthcare: A Condensed Primer.
International Journal of Health Geographics, 11(25).
Drazen, E., & Rhoads, J. (2011, April). Using Tracking Tools to
Improve Patient Flow in Hospitals. Retrieved May 30, 2021,
from California Health Care Foundation (Online):
https://www.chcf.org/wp-content/uploads/2017/12/PDF-
UsingPatientTrackingToolsInHospitals.pdf
Heath, S. (2016, May 24). Patient Satisfaction and HCAHPS:
What It Means for Providers. (Xtelligent Healthcare Media,
LLC) Retrieved May 30, 2021, from Patient Engagement HIT
(Online): https://patientengagementhit.com/features/patient-
satisfaction-and-hcahps-what-it-means-for-providers
Prakash, B. (2010). Patient Satisfaction. Journal of Cutaneous
and Aesthetic Surgery, 3(3), 151–155.
Son, H., & Yom, Y.-H. (2017). Factors Influencing Satisfaction
With Emergency Department Medical Service: Patients’And
Their Companions’Perspectives. Japan Journal of Nursing

7. Science, 14, 27–37.
Wand, T., Crawford, C., Bell, N., Murphy, M., White, K., &
Wood, E. (2019, July). Documenting The Pre-Implementation
Phase For A Multi-Site Translational Research Project To Test
A New Model Emergency Department-Based Mental Health
Nursing Care. International Emergency Nursing, 45, 10-16.
Wang, H., Kline, J. A., Jackson, B. A., Robinson, R. D.,
Sullivan, M., Holmes, M., et al. (2017, October). The Role Of
Patient Perception Of Crowding In The Determination Of Real -
Time Patient Satisfaction At Emergency Department.
International Journal for Quality in Health Care, 29(5), 722–
727.
Xesfingi, S., & Vozikis, A. (2016, March 15). Patient
Satisfaction With The Healthcare System: Assessing The Impact
Of Socio-Economic And Healthcare Provision Factors. BMC
Health Services Research, 16(94).
2
2
PICOT Final
Name_________________Daysha Polk____________________
Complete your PICOT using your approved proposed nursing
practice problem. If they were approved, you may use the
population and intervention developed in your Topic 1
assignment. Include any necessary revisions in this submission.

8. Refer to the "Example PICOT" below as needed for guidance on
how to complete the PICOT.
PICOT Question
P
Population
Patients experiencing decreasing satisfaction levels at ED
I
Intervention
Real-time location systems
C
Comparison
Manually entered status updates to track patients
O
Outcome
Decreased rate of Left Without Being Treated (LWBT) and
raising revenue collection
T
Timeframe
Six months
PICOT
Create a complete PICOT statement.
ED patients with decreasing levels of satisfaction (P), does the
utilization of a real-time location systems (RTLS) in the
hospital's ED (I), compared to manually entered status updates
to track patients (C), help to decrease the rate of LWBT and to
raise revenue collection (O) within 6 months (T)?
Problem Statement
Create a problem statement for your PICOT. You will use this
problem statement throughout your final written paper.
The current delays, long waits, leaving without being treated,
decreased revenue collection from the ED unit, and reduced
patient satisfaction scores have negatively portrayed the
hospital's reputation to the public. As a result, the daily patient
visits have continued to decrease as people attribute the fac ility
to poor emergency care services delivery. All these

9. complications result from the use of combined data resources
and manual entry status updates when tracking patient records.
This manual tracking cannot meet the demand for many patients
and leads to overcrowding due to and reduced patient flow in
the ED. Therefore, there is a need to install an automatic patient
tracking system to increase the flow.
References
Asheim , A., Nilsen, S. M., Carlsen, F., Næss-Pleym, L. E.,
Uleberg, O., Dale, J., Bache-Wiig Bjørnsen, L. P., &
Bjørngaard, J. H. (2019, December 26). The effect of emergency
department delays on 30-day mortality in Central Norway.
European journal of emergency medicine : official journal of
the European Society for Emergency Medicine.
https://pubmed.ncbi.nlm.nih.gov/31135613/.
Fudge, N., Sadler, E., Fisher, H. R., Maher, J., Wolfe, C. D. A.,
& McKevitt, C. (n.d.). Optimising Translational Research
Opportunities: A Systematic Review and Narrative Synthesis of
Basic and Clinician Scientists' Perspectives of Factors Which
Enable or Hinder Translational Research. PLOS ONE.
https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.
pone.0160475.
Morrison, L. E., & Joy, J. P. (2016, June 20). Secondary
traumatic stress in the emergency departme nt. Wiley Online
Library.
https://onlinelibrary.wiley.com/doi/abs/10.1111/jan.13030.
Wand, T., Crawford, C., Bell, N., Murphy, M., White, K., &
Wood, E. (2019, April 30). Documenting the pre-
implementation phase for a multi-site translational research
project to test a new model Emergency Department-based
mental health nursing care. International Emergency Nursing.
https://www.sciencedirect.com/science/article/abs/pii/S1755599
X19300400?via%3Dihub.
Wang, H., Kline, J. A., Jackson, B. E., Robinson, R. D.,
Sullivan, M., Holmes, M., Watson, K. A., Cowden, C. D.,
Phillips, J. L., Schrader, C. D., Leuck, J. A., & Zenarosa, N. R.

10. (2017, October 5). role of patient perception of crowding in the
determination of real-time patient satisfaction at Emergency
Department. OUP Academic.
https://academic.oup.com/intqhc/article/29/5/722/4158405?login
=true.
© 2021. Grand Canyon University. All Rights Reserved.
© 2021. Grand Canyon University. All Rights Reserved.
Rubic_Print_FormatCourse CodeClass CodeAssignment
TitleTotal PointsNUR-590NUR-590-O500Evidence-Based
Practice Project Proposal Presentation120.0CriteriaPercentage1:
Unsatisfactory (0.00%)2: Less Than Satisfactory (80.00%)3:
Satisfactory (88.00%)4: Good (92.00%)5: Excellent
(100.00%)CommentsPoints EarnedContent100.0%Introduction
5.0%An introduction is not included.The introduction omits key
aspects of the PICOT and fundamental aspects of the evidence-
based practice project proposal that will be the main talking
points and PICOT statement for the presentation.The
introduction generally presents the PICOT statement and most
of the fundamental aspects of the evidence-based practice
project proposal that will be the main talking points and for the
presentation. The introduction is adequate. The PICOT
statement and the fundamental aspects of the evidence-based
practice project proposal that will be the main talking points
and PICOT statement for the presentation are discussed.The
introduction is succinct, captures the attention of the audience,
clearly identifies PICOT statement and the fundamental aspects
of the evidence-based practice project proposal that will be the
main talking points and for the presentation. Organizational and
Cultural Readiness10.0%The discussion on the organizational
culture and readiness is not included. The discussion on the
organizational culture and readiness is incomplete. The
organizational culture and readiness are generally discussed and

11. provide insight into some of the challenges faced by the
organization.The organizational culture and readiness are
adequately discussed and provide the necessary insight into the
organization challenges.The organizational culture and
readiness are thoroughly discussed and provide insight into the
organization challenges. Problem Statement and Literature
Review15.0%The problem statement is not clearly stated.
Research from the literature review is not included. The
problem statement outlines the issue. Support from the
research from the literature review is inconsistent. The problem
statement summarizes the issue and uses evidence-based support
from some of the literature review to rationalize and justify the
problem. The research from the literature review provides
general support overall.The problem describes the issue using
evidence-based support from the literature review to rationalize
and justify the problem. The research from the literature review
is current, relevant, and used to provide adequate rationale and
support throughout.The problem statement is consistent
throughout the presentation and concisely describes the issue
using strong evidence-based support from the literature review
to rationalize and justify the problem. The research from the
literature review is current, relevant, and used to provide
excellent rationale and support throughout.Cha nge Model or
Framework10.0%The selected model or framework and its
application to the proposed implementation are not
described.The selected model or framework is and its
application to the proposed implementation are only partially
described.The selected model or framework and its application
to the proposed implementation are generally described.The
selected model or framework and its application to the proposed
implementation are adequately described.The selected model or
framework and its application to the proposed implementation
are thoroughly described.Implementation Plan10.0%The
implementation plan is not described. The implementation plan
is only partially described. The implementation plan is
generally described and provides an overall outline for the

12. various aspects. The implementation plan is adequately
described and provides the details for the various aspects. The
implementation plan is thoroughly described and provides the
details for the various aspects. Evaluation Plan10.0%The
evaluation plan is not described. The evaluation plan is only
partially described. The evaluation plan is outlined and
provides general information for most aspects. The evaluation
plan is adequately described and provides key information for
the various aspects. The evaluation plan is thoroughly
described and provides the details for the various aspects.
Conclusion5.0%A conclusion is not presented.The conclusion
mentions some aspects of the presentation, but there are some
key aspects missing.The conclusion outlines the broad aspects
of the presentation.The conclusion summarizes the key points of
the presentation in a concise manner.The conclusion is short,
clear and summarizes the key points of the presentation in a
powerful and memorable way. Research
5.0%No outside sources were used to support the
assignment.Few outside sources were used to support the
assignment. Limited research is apparent.Research is adequate.
Sources are standard in relevance, quality of outside sources, or
timeliness. Research is timely and relevant, and addresses all of
the issues stated in the assignment criteria.Research is
supportive of the rationale presented. Sources are distinctive.
Addresses all of the issues stated in the assignment
criteria.Presentation
PowerPoint, speaker notes, Loom voice over or video.
10.0%The submission is incoherent, contains major
inconsistencies, is not presented effectively, or is missing a
substantial amount of the required elements.The submission is
ineffective, contains multiple inconsistencies, or is missing a
few of the required elements.The submission contains minor
inconsistencies that are not overly distracting. Presentation
contains a majority of the required elements.The submission is
presented effectively and contains all of the required

13. elements.The submission is presented effectively, and all of the
required elements creatively contribute to the presentation of
the concepts.Aesthetic Quality5.0%Design is cluttered.
Materials detract from the content or the purpose of
presentation is low quality.Design detracts from purpose. Text
and visuals are too simplistic, cluttered, and busy. Little or no
creativity or inventiveness is present.Design is fairly clean,
with a few exceptions. Materials add to, not detract from the
presentation. Materials used were quality products and easy to
see or hear.Design is appropriate and integrates a variety of
objects, charts, and graphs to amplify the message.Design is
clean. Skillful handling of text and visuals creates a distinctive
and effective presentation. Overall, effective and functional
audio, text, or visuals are evident.Synthesis5.0%Synthesis does
not successfully integrate ideas to form a cohesive whole. The
combination of elements is not logical and/or
verifiable.Synthesis integrates ideas inadequately. The
combination of elements is not logical. Synthesis integrates
ideas but does not adequately form a cohesive whole.
Combination of elements at times is confusing. Synthesis
integrates ideas to form a cohesive whole. Combination of
elements is logical and justified. Synthesis is unique. Synthesis
shows careful planning and attention to how disparate elements
fit together. The combination of elements is verified.Mechanics
of Writing
Includes spelling, punctuation, grammar, and language use.
5.0%Surface errors are pervasive enough that they impede
communication of meaning. Inappropriate word choice or
sentence construction is employed.Frequent and repetitive
mechanical errors distract the reader. Inconsistencies in
language choice (register) or word choice are present. Sentence
structure is correct but not varied.Some mechanical errors or
typos are present, but they are not overly distracting to the
reader. Correct and varied sentence structure and audience-
appropriate language are employed.Prose is largely free of

14. mechanical errors, although a few may be present. The writer
uses a variety of effective sentence structures and figures of
speech.The writer is clearly in command of standard, written,
academic English.Documentation of Sources
Citations, footnotes, references, bibliography, etc., as
appropriate to assignment and style.
5.0%Sources are not documented.Documentation of sources is
inconsistent or incorrect, as appropriate to assignment and style,
with numerous formatting errors.Sources are documented, as
appropriate to assignment and style, although some formatting
errors may be present.Sources are documented, as appropriate to
assignment and style, and format is mostly correct. Sources are
completely and correctly documented, as appropriate to
assignment and style, and format is free of error.Total
Weightage100%
The dissemination of an evidence-based practice project
proposal is an important part of the final project. Dissemination
of your project to a local association or clinical site/practice
informs important stakeholders of evidence-based interventions
that can improve clinical practice and ultimately patient
outcomes.
For this assignment, develop a professional presentation that
could be disseminated to a professional group of your peers.
Develop a 12-15 slide PowerPoint detailing your evidence-
based practice project proposal. Create speaker notes of 100-
250 words for each slide. For the presentation of your
PowerPoint, use Loom to create a voice-over or a video. Refer
to the topic Resources for additional guidance on recording your
presentation with Loom. Include an additional slide for the
Loom link at the beginning and an additional slide for
References at the end. Be sure to consider your personal
demeanor and tone during the recorded presentation.
Include the following in your presentation:
1. Introduction (include PICOT statement)

15. 2. Organizational Culture and Readiness
3. Problem Statement and Literature Review
4. Change Model, or Framework
5. Implementation Plan
6. Evaluation Plan
7. Conclusion
You are required to cite a minimum of six peer-reviewed
sources to complete this assignment. Sources must be published
within the last 5 years and appropriate for the assignment
criteria and nursing content.
While APA style is not required for the body of this assignment,
solid academic writing is expected, and documentation of
sources should be presented using APA formatting guidelines,
which can be found in the APA Style Guide, located in the
Student Success Center.
This assignment uses a rubric. Please review the rubric prior to
beginning the assignment to become familiar with the
expectations for successful completion.
You are required to submit this assignment to turnitin. Please
follow rubric.