FEEDBACK FOR OM009This is a good start; however, there are sti.docx

FEEDBACK FOR OM009
This is a good start; however, there are still multiple sections
that need to be improved. Once you are ready, please let me
know so I can unlock your next attempt. Please make sure that
you carefully read the rubric prior to making the changes. I
also highly recommend that you organize your slides based on
the rubric. In order to pass this paper, you would need a 3 on
every section as explained in the rubric.
Learning Objective 1.1: Define evidence-based decision
making.:
MEETS EXPECTATIONS
2
Presentation accurately and thoroughly defines evidence-based
decision making.
Definition is supported by relevant academic/professional
resources.
Additional Comments: Provide an example of a specific facility
that used evidence-based decision making. Also, ensure that
you use academic references to support your example.
Learning Objective 1.2: Explain the relevance of evidence-
based decision making in the healthcare industry.:
MEETS EXPECTATIONS
2
Presentation accurately and thoroughly explains the relevance
of evidence-based decision making in the healthcare industry.
Explanation is supported by relevant academic/professional
resources.
Additional Comments: Provide an example of a facility or
organization
Learning Objective 2.1: Apply evidence-based decision making

to define a problem.:
MEETS EXPECTATIONS
2
Presentation clearly defines the problem that applies evidence-
based decision making.
Additional Comments: Provide the most compelling evidence
and references
Learning Objective 2.2: Recommend options based on data.:
MEETS EXPECTATIONS
2
Presentation provides one logical option for no additional beds
and two logical options for additional beds.
Presenter notes include detailed empirical support from the
facts given in the case study and evidence from relevant
academic/professional resources.
Additional Comments:
Learning Objective 2.3: Describe how recommendations address
specific issues in healthcare ICUs.:
MEETS EXPECTATIONS
2
Presentation thoroughly describes how three options will
address the issues in the ICU.
Presenter notes include detailed empirical support from the
facts given in the case study and evidence from the relevant
academic/professional resources.
Learning Objective 2.4: Develop evidence-based
recommendations that maximize benefits to hospitals, patients,
and the community.:
NEEDS IMPROVEMENT
1

Evidence-based final recommendation is illogical and/or
vaguely explains how the final recommendation will maximize
benefits to the hospital, the patients, and the community is
incomplete.
Additional Comments: It is unclear to me which one is your
final recommendation
Learning Objective 2.5: Justify evidence-based
recommendations.:
NEEDS IMPROVEMENT
1
Presentation provides an illogical or unsubstantiated
justification for the final recommendation.
Justification is not supported by academic/professional
resources or the resources are not relevant.
Additional Comments: Again, have a slide that specifically
mentions that it is your final recommendation.
Learning Objective 2.6 Compare data over time to support
recommendations.:
NEEDS IMPROVEMENT
1
Graphic comparison between the current state of the ICU versus
the remote monitoring ICU implementation in 5 years is
inaccurate or unclear.
Additional Comments: Your graphs only show additional beds.
This requires current ICU vs. remote monitoring
Learning Objective 2.7: Explain the impact of recommendations
on staffing, productivity, competitiveness, and finances.:
NEEDS IMPROVEMENT
1
Presentation provides an illogical explanation of the impact of
the recommendation on staffing, productivity, competitiveness,
or finances, or Explanation is inaccurate.

Explanation excludes the appropriate qualitative or quantitative
data used in the analysis, or the qualitative and quantitative data
is included inaccurately or inappropriately in the analysis.
Additional Comments: Be clear on your final recommendation
and then provide the impact of the recommendation on staffing,
productivity, competitiveness, or finances.
Learning Objective 3.1: Summarize evidence used in developing
an opportunity statement and recommendation.:
NEEDS IMPROVEMENT
1
Summary is verbose or the summary is unclear or inaccurate.
Additional Comments: Your presentation is missing a summary
slide
Learning Objective 3.2: Summarize the analysis used to create
the recommendations.:
NEEDS IMPROVEMENT
1
Summary of the analysis used to create the recommendation is
incomplete or inaccurate.
Additional Comments: Create one summary slide with your
analysis and recommendation
Learning Objective 3.3: Evaluate the validity and reliability of
data.:
NOT PRESENT
0
Evaluation of the validity and reliability of data is missing.
Additional Comments: This section is missing.
Written Communication: PS 1.1: Use proper grammar, spelling,
and mechanics.:
MEETS EXPECTATIONS
2

Writing reflects competent use of standard edited American
English.
Errors in grammar, spelling, and/or mechanics do not negatively
impact readability.
Written Communication: PS 1.2: Organize writing to enhance
clarity.:
MEETS EXPECTATIONS
2
Writing is generally well-organized. Introductions, transitions,
and conclusions provide continuity and a logical progression of
ideas.
Written Communication: PS 1.3: Apply APA style to written
work.:
MEETS EXPECTATIONS
2
APA conventions for attribution of sources, structure,
formatting, etc., are generally applied correctly in most
instances. Sources are generally cited appropriately and
accurately.
Written Communication: PS 1.4: Use appropriate vocabulary
and tone for the audience and purpose.:
EXCEEDS EXPECTATIONS
3
Vocabulary and tone are consistently tailored to the audience
and effectively and directly support communication of key
concepts.
Technology: PS 3.1: Use images and layout of presentations to

effectively communicate content to a specific audience.:
MEETS EXPECTATIONS
2
Images and layout generally support audience understanding of
key concepts.
Critical Thinking and Problem Solving: PS 5.1: Analyze
assumptions and fallacies.:
NEEDS IMPROVEMENT
1
Response is weak in assessing the reasonableness of
assumptions in a given argument.
Response does not adequately identify and discuss the
implications of fallacies or logical weaknesses in a given
argument.
Additional Comments: Once you address the comments in the
previous section, this should also address this section.
Critical Thinking and Problem Solving: PS 5.2: Generate
reasonable and appropriate assumptions.:
MEETS EXPECTATIONS
2
Response presents and discusses key assumptions in an original
argument.
Critical Thinking and Problem Solving: PS 5.3: Assess multiple
perspectives and alternatives.:
MEETS EXPECTATIONS
2
Response identifies and considers multiple perspectives and
alternatives.

Critical Thinking and Problem Solving: PS 5.4: Use problem-
solving skills.:
NEEDS IMPROVEMENT
1
Response presents solutions, but they are ineffective in
addressing the specific problem.
Additional Comments: This will also be addressed once you
address the earlier sections.
OM009: Data-Driven Decision Making
Read the case study and prepare a presentation that will guide
the CEO and board of directors to follow the recommendation
presented to expand the hospital’s ICU unit. As you complete
the Assessment, be sure that the presentation:
· Includes the elements necessary to effectively communicate
the data used to develop the business case.
· Provides a clear evidence-based, data-driven recommendation
regarding the expansion of the hospital’s ICU.
· Provides an opportunity statement that presents the problem,
the recommendation presented to solve the problem, and the
multiple options considered.
· Takes into account the needs of the community, the patients,
and the hospital when researching and presenting your findings.
Your presentation should include the following:
Introduction
Explain the importance of evidence-based decision making in
healthcare. Your slides must include (4 slides):
· A definition of evidence-based decision making
· An explanation of the relevance of evidence-based decision
making in the healthcare industry
· A clearly defined the problem you intend to solve through the
use of evidence-based decision making
Recommendation and Rationale

Using the data provided, analyze the current and future state of
the ICU. Consider three scenarios for the future state, one
without additional beds and two with additional beds. Based on
your research and analysis, determine two viable scenarios for
bed count and present these scenarios. Use graphics, text, and
charts as required (11 slides).
The slides and presenter notes should include:
· An overview of three options for the ICU that you analyzed
. The presenter notes should provide a 3-paragraph analysis of
the three options, using academic resources to support your
options.
· A description of how each option will address the issues in the
ICU
. The presenter should provide 3 paragraphs that provide a
detailed explanation of how each option will address the issues
in the ICU.
· A final recommendation for one of the options and an
explanation of why it will maximize the benefits to the hospital,
patients, and community
· A detailed rationale justifying your recommendation
· A graphic comparison between the current state of the ICU
versus the remote monitoring ICU implementation in 5 years
. The presenter notes should include a detailed explanation of
the graphic.
· An explanation of the impact of your recommendation on
staffing, productivity, competitiveness, and finances, using
appropriate qualitative and quantitative data to support your
explanation
. The presenter notes should include an explanation regarding
how the data supports your explanation.
Evidence Evaluation
Knowing that United General’s leadership team focuses on
evidence-based decision making, address the following , in 4
slides:
· Summarize the evidence used in developing the opportunity
statement and recommendation.

· Describe why each piece of evidence is relevant to patients,
the community, and the hospital.
· Summarize the analysis used to create the recommendation.
· Evaluate the validity and reliability of the data.
United General Hospital ICU Expansion Case Study
Overview
United General Hospital is a 15-year-old, 220-bed hospital built
to serve a suburban community of 90,000 residents, 60 miles
outside Des Moines, Iowa. Of the beds, 10 are in the intensive
care unit (ICU). Over the last 15 years, the community has
grown to over 190,000 residents, who are supported by United
General and four urgent care facilities. With the urgent care
facilities able to address many of the population’s non-
emergency issues, there is an increase in the ratio between the
use of the hospital’s non-ICU facilities and its ICU facilities. In
a typical week, the ICU operates at 120% capacity and 40% of
patients experience a 6- to 8-hour delay transferring to the ICU.
The patients remain either in the emergency department,
creating an overcrowded emergency department, or in post-op,
causing overcrowding and delays in scheduled surgeries.
The hospital has just received $15 million in funding and is
considering expanding the ICU; however, the chief executive
officer (CEO) is not convinced that expanding the ICU
department is the right solution for the hospital. The analysis is
to include options that combine expanding the ICU department
with using remote ICU monitoring.
The ICU senior staff brought you, Raul Hemply, in as a
consultant to build a business case to support the decision to
expand the ICU and use remote ICU monitoring. You will work
with the ICU’s senior staff to build a business case and present
it to the CEO and board of directors for final consideration.

There will be great emphasis placed on data and analyses that
support your recommendation. Because of this, you need to use
data derived from informed or objective sources, or evidence-
based data, to build the recommendation. The CEO will want to
know the sources, validity, and reliability of the evidence
presented.
As you create your presentation, there are several options to
consider:
1. Subscribe to remote ICU monitoring services with a per
usage model so that you only pay for services as they are
rendered.
2. Expand the ICU with a combination of ICU beds and regular
beds managed by a combination of bedside and remote ICU
monitoring.
3. Expand the ICU with ICU rooms managed by bedside teams.
4. Expand the ICU and subscribe to remote ICU monitoring for
rooms that will serve patients with more serious conditions.
Conversation Excerpts
Conversation With George Mallory, the Senior Staff
Representative
George: Hello, Raul. It is good to meet you. We are looking
forward to working with you on this business case to expand the
ICU. We have already completed some research on the right
size of the ICU, and we will share that with you over the course
of your investigation.
Raul: Hi George, I appreciate you taking the time for this
interview. This will help me in my research of how much to
expand the ICU. I am also considering the use of remote ICU
monitoring service as a complement to expanding the ICU.
George: Remote ICU monitoring services is a topic that will
cause a lot of consternation here at United General. We have a

number of staff members that fear that a remote service will put
them out of a job, so I would touch lightly on that subject.
Raul: Has your group done any research on remote ICU
monitoring services in the area?
George: We started to but realized that it was so controversial
that it was not really an option. If you do look into a remote
service, please make sure to take the staff into account in the
analysis.
Raul: What caused the controversy with the idea of remote ICU
monitoring?
George: Physicians were reluctant to cede authority to a remote
operation, and nurses were concerned about a loss of autonomy.
During a staff meeting, a couple of nurses voiced concerns
because their colleagues complained of a poorly executed
implementation.
Raul: Thank you George. I will. Can you tell me who on your
staff has the research on the remote ICU monitoring services?
George: That would be Frank. Frank looked at the services from
the standpoint of patient and staff benefits and cost savings, as
well as how the services help the patient. We suggested that he
speak to staff in hospitals that have implemented these services
to get their reaction to the change but he never followed through
because the staff here was so set against it. It will be a hard sell
to the staff.
Raul: Thank you for the heads up. Was there any other research
completed about expanding the ICU that I may be able to use?
George: I cannot think of anything else. As a part of your study,
you may want to check with other hospitals that use these
services.
Raul: Thank you, George. I think I have enough to get started. I
will check back with you if I need any help.

Conversation With Frank Bellamy, a Senior ICU Staff Member
Raul: Hi, Frank. My name is Raul, and I would like to talk to
you about your research on remote ICU monitoring. I am
working on a business case to expand the ICU and to couple it
with the use of remote ICU monitoring services.
Frank: Sure, I would be happy to talk with you about the
research I have completed. Let me start with three general
benefits of these remote ICU monitoring services. Telemedicine
is able to link a single physician to multiple clients using
remote computer technology, leveraging the specialist’s
cognitive skills over multiple patients. However, it also
mandates significant process changes in how we provide ICU
services. In short, the remote ICU represents a "re-engineering"
of how we provide ICU care, expanding the reach, scope, and
availability of intensivists’ expertise. The re-engineering occurs
through a number of ways. First, the telemedicine connection is
continuously available in a proactive fashion that provides 24-7
coverage. Secondly, the system utilizes computerized clinical
intelligence algorithms with direct electronic links to
physiologic, laboratory, and pharmacy data, as well as patient
diagnoses to focus attention on potential adverse outcomes or
trends in individual patients and to notify caregivers before
trends manifest as adverse outcomes. Third, the traditional
physician, nurse, and patient relationship is substantially

augmented when there is an ICU physician immediately
available to address issues in patient care, particularly at night
when physicians are less likely to be present at the bedside.
Raul: During your research, did you speak with any staff
members from hospitals currently using remote ICU services?
Frank: Yes, I spoke with Mark Panther from Practitioner
Hospital in Indiana about their use of remote ICU monitoring. I
can tell you what he said, or you can give him a call for
firsthand information.
Raul: Thank you Frank. Please do not be offended. I think I will
give him a call directly. The information will be more valid
coming directly from the source.
Frank: I understand the need for a firsthand account. Here is his
contact information.
Conversation With Peter Bella, United General Hospital’s Chief
Financial Officer
Raul: Hi, Peter. My name is Raul, and I am working on a

business case to address the potential expansion of the ICU
department. I understand that you have completed some
research that may help me with the analysis for the business
case. I am investigating the addition of ICU beds and the use of
remote ICU monitoring services. What has your research shown
in these areas?
Peter: Hi Raul, I am glad to help in your research. As far as
remote monitoring costs are concerned, it costs $25,000 to
$30,000 per ICU bed, per year, to equip each room. In my
research, I have seen a 30% reduction in the ICU length of stay,
or LOS, numbers. Overall, the savings for the hospital is about
$4,000 per patient.
Raul: What have you uncovered in regards to staff and patient
benefits?
Peter: One benefit we expect is for physicians who are tired due
to long hours or stress. They are less prone to making avoidable
mistakes with the second set of eyes provided by the addition of
a remote ICU service’s clinical surveillance and support.
Raul: What about benefits that you might expect to see in in
regards to patient satisfaction?
Peter: We expect patient satisfaction to increase because of
their added confidence that both bedside staff and remote ICU
monitoring service will adequately cover them.
Raul: Thank you for the information, Peter. How do you see this
applying to an expansion of the ICU department?
Peter: If we expand the ICU department, one thing that you may
want to consider is to expand the department and start with
regular beds tied to remote monitoring. We pay $4,000 a day for
an ICU bed and $1,700 a day for a regular bed. If we add the
$500 per day cost of remote monitoring to the cost of
supporting a regular bed, we will be able to provide ICU
services to a larger number of patients without incurring the full
cost of an ICU bed. By starting patients in a non-ICU bed and
only transferring patients, if necessary, we can provide similar
benefits at a fraction of the cost.

Conversation With Mark Panther, Senior ICU Staff Member at
Practitioner Hospital
Raul: Hi, Mark. My name is Raul, and I am researching remote
ICU monitoring services for possible use at United General
Hospital. I spoke with Frank Bellamy, and he told me that you
have some good information on remote ICU monitoring since
your hospital has implemented these services. What can you tell
me?
Mark: Hi, Raul. I am glad to help. For the most part, the idea of
the services frightened many of the staff because they felt that
they would lose their positions if we subscribed to a remote ICU
monitoring service. The nurses and physicians fought the idea
for a while, and we even found some sabotaging it when it was
first implemented here. However, once we got through the first
6 months, people started accepting it, and the service is now
running more smoothly.
Raul: What did you find to be the benefits of remote
monitoring?
Mark: One benefit is collaborations. An example was between a
new nurse and an experienced nurse in the remote center. The
new nurse, just off orientation, prepared to transport a patient to

radiology for a computerized tomography (CT) scan. The
patient had two chest tubes, and the new nurse felt uncertain
about how to safely disconnect the chest tubes from suction and
prepare the patient for transport. The nurse brought the
experienced remote monitoring nurse in by camera to assist. The
remote monitoring nurse coached the ICU nurse through the
steps to prepare the chest tubes and the patient for transport.
The bedside nurse felt relieved, confident, and supported in
caring safely for the patient.
Raul: What type of changes have you seen within the local
operations at your hospital?
Mark: Interestingly enough, we have seen improvements to our
pre-existing in-house intensivist care model with the addition of
the remote ICU monitoring. The reasons for this are that it
provides proactive and hourly remote "virtual rounds" on the
most critically ill patients, and our ICU physicians use its
computerized algorithms when triaging patients. These
algorithms are processes that are programmed into the system to
guide physicians and nurses during ICU intake. We also find
that it supports our staff decisions, thereby reducing the number
of errors in our critical care unit.
Raul: How did you address the cost of implementing the remote
monitoring system?
Mark: During our research, we uncovered that remote
monitoring was most effective for patients with a Simplified
Acute Physiologic Score over 50. We initially implemented
remote monitoring in a small number of rooms to take
advantage of this benefit and found that constant remote and
computerized monitoring reduced our mortality rate by 25% for
these patients.
Raul: Thank you for helping me research remote ICU
monitoring services. Is there anything else that would be helpful
in my research?
Mark: You may want to talk to our hospital administrator,
Becky Walters. She helped with the research and is currently
monitoring the benefits. She may have time to fit you into her

schedule. I will give her a call and let her know that you might
be calling.
Raul: Thank you, Mark. May I use you as a reference in my
report? Can I give people at United General your name if they
have any questions?
Mark: Sure, Raul. I am glad to help. I know the remote ICU
monitoring services have provided both staff and patient
benefits here, and I hope United General adopts them as well.
Conversation With Becky Walters, Administrator at Practitioner
Hospital
Raul: Hi, Becky. Mark Panther thought you might have some
insights that would help me build a business case to expand the
ICU department at United General with the use of a remote ICU
monitoring service.
Becky: Sure, Raul. We count on remote ICU monitoring
services to keep track of patients in areas that enhance our own
capabilities. Even though we have a well-staffed and well-
trained ICU department, the remote ICU monitoring services
alerted us to an early symptom of sepsis in one of our patients
before a nurse would have identified it, and we were able to
remove a central line before it resulted in an infection in the
blood system. In another case, an intensivist at the remote
command center detected instability in a patient, alerted the
bedside team to the issue, and identified a new treatment before
the bedside staff would have recognized the issue. So far, in the
first 2 years of implementation, we have seen a 10 to one ratio
of these types of interventions that have benefitted the patient.
Raul: How has the staff reacted to these interventions?
Becky: Initially, the staff resisted the remote ICU monitoring
services and the interventions but, after the first 6 months, the
staff started to see the benefits to the patients and welcomed the
collaboration with the remote center resources.
Raul: Are there any other benefits that Practitioner is seeing

from the remote ICU monitoring services?
Becky: We had a great example of collaboration earlier this
year. A nurse called the remote ICU monitoring service at 1
a.m. to describe a patient’s leg wound, which appeared to be
worsening. The remote physician connected via cameras in the
patient’s room, visualized the patient’s leg, and realized the
urgency of facilitating an immediate intervention. While the
remote nurse assembled and reviewed the patient’s lab results,
the bedside nurse prepared the patient for the operating room
(OR), and the remote intensivist collaborated with the surgical
team to activate the OR team for the emergent procedure.
Raul: That is a great example of collaboration that I can use in
the study. Are there any productivity benefits you have noticed?
Becky: We have been able to increase the number of patients
under care. Prior to subscribing to the service, an intensivist
was able to oversee about 10 patient beds. With the addition of
the service, we have been able to take advantage of one
intensivist and four nurses in the remote command center to
oversee the care of 50 to 75 beds. We have seen a drop in the
average length of stay of an ICU patient by 24%, or an average
of 5 days. This reduces our costs by about $5,000 per patient
because we can move them to a regular hospital bed sooner.
You found through various discussions that one of the
challenges to implementing a remote monitoring system is the
resistance to the system by ICU physicians and nurses. To dig
deeper into this resistance, you request an interview with the
head ICU nurse.

Conversation With Francine Mueller, Head ICU Nurse at United
General Hospital
Raul: Hi, Francine. I would like to discuss your thoughts on
using a remote ICU monitoring service to augment an expansion
of the ICU department.
Francine: Sure, Raul. We are in support of the expansion
because we are experiencing a significant increase in patient
wait times for admission into the ICU. It would be to the
patients’ benefit to address this problem as soon as possible.
Raul: What are your thoughts on implementing a remote ICU
monitoring service to help defray cost by reducing the number
of ICU beds that the hospital would need to add?
Francine: There are positives that we believe would result from
using such a system, such as enhanced collaboration with
remote physicians and nurses and constant monitoring.
However, that same collaboration raises our concern over a loss
of autonomy and heightened scrutiny. Without a remote system,
we consult with local physicians about care and, sometimes,
have in-depth discussions about the advice for care. We would
not look forward to adding another source of contradictory
advice. That advice would be coming from a source with which
we are unfamiliar.
Raul: Francine, it sounds like you have reasonable concerns
about a remote ICU monitoring service. How would you
consider addressing these concerns?
Francine: I would want to have the nursing leads very
comfortable with the people providing the remote ICU
monitoring services. It would be critical for us to we understand
their background and for them to understand and respect our
knowledge. Moreover, because I would worry about a potential
service or equipment malfunction, I would want all staff
members fully trained on the system prior to implementation.
Raul: That sounds like a good suggestion and something that I
need to include in any implementation plans. What would you

say if I told you that Mark Panthers from Practitioner Hospital
stated that, once the hospital staff accepted the remote
monitoring system, they measured a significant increase in
positive patient care? Would you believe that 96% of the
patients and 80% of staff stated that patient care quality
increased because of their remote ICU monitoring system?
Francine: Thank you, Raul, for listening to our concerns, and I
am looking forward to reading your business case. I am going to
be especially interested in the implementation plans.
Appendix A
United General Hospital and ICU Key Facts
Year
Hospital
Occupancy Rate
Hospital
Total Margin
ICU Beds
ICU Capacity Rate
ICU Average Length of Stay (ALOS)
Patient Wait Times for ICU Bed (Hours)
2004
60%
5%
5
75%
90
.15
2005
61%
4
5
85%
90
.5

2006
70%
3
5
95%
81
1
2007
73%
2
8
100%
80
3
2008
74%
2
8
115%
73
3
2009
76%
1.7
8
116%
67
4
2010
76%
1.6
9
117%
60
5
2011

77%
1.6
9
118%
53
6
2012
79%
2
10
129%
47
6
2013
85%
1.2
10
120%
45
7
2014
95%
1
10
120%
13.5
7

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