Name
Western Governors University
D226 BSNU Capstone
Prof. Name
Date
Surgical Site Infections (SSIs) refer to infections that develop at or near the site of a surgical incision following an operation. These infections can affect only the skin surface or penetrate deeper layers including tissues, organs, or implanted devices. SSIs represent a significant challenge within healthcare due to their contribution to patient morbidity, extended hospital stays, higher healthcare costs, and in severe cases, increased mortality rates. The Centers for Disease Control and Prevention (CDC, 2023) report that SSIs constitute nearly 20% of all healthcare-associated infections among hospitalized individuals. Effective prevention and management of SSIs are therefore crucial to enhancing patient safety, promoting quicker recoveries, and supporting healthcare models that emphasize both quality and cost-efficiency.
This paper constitutes the first task in the BSNU Capstone Course, focused on developing a comprehensive proposal for healthcare system change. The objective is to identify an organizational sponsor responsible for evaluating, endorsing, and authorizing the suggested change. Included in this document are sponsor feedback, supporting evidence, and a thorough justification demonstrating how the proposed change aligns with value-based care goals. The proposal also highlights critical stakeholders, presents a strategic implementation plan, and concludes with a reflective section on the author’s leadership role as a catalyst for clinical transformation.
The initiative is planned for implementation at the Mike O’Callaghan Military Medical Center (MOMMC), a military healthcare facility governed by the Defense Health Agency (DHA) and Department of Defense (DoD). Located at Nellis Air Force Base in Las Vegas, Nevada, MOMMC offers emergency and specialized medical services primarily to active-duty military personnel, their dependents, and other DoD beneficiaries.
Currently, the author works as a civilian contractor and registered nurse in the MOMMC Emergency Department (ED), which consists of twenty beds and two trauma bays staffed by a combination of military personnel, civilians, and contractors. As a Trauma Level III center, MOMMC handles trauma cases involving both military and civilian patients. While the staffing model is generally stable, deployment rotations pose challenges, with roughly 40% of the ED staff comprising civilian and contract workers to ensure operational continuity during these periods.
At present, patients arriving at the emergency department must first check in with two registration technicians who complete full patient registration before the patients undergo triage or medical assessment. Although thorough from an administrative perspective, this procedure creates delays for patients presenting with urgent medical conditions such as chest pain or cardiac distress.
The proposal suggests repositioning registration technicians to the back area to focus on clerical and administrative duties. Meanwhile, a medical technician and a registered nurse (RN) would be stationed at the front desk to conduct rapid symptom assessments and expedited registration. This adjustment prioritizes immediate clinical triage, enabling faster identification and treatment of patients showing symptoms of ST-Segment Elevation Myocardial Infarction (STEMI).
The main aim is to reduce the “door-to-EKG” time for patients with cardiac symptoms. According to guidelines by the American Heart Association (AHA) and American College of Cardiology (ACC), a 12-lead EKG should be performed within 10 minutes of ED arrival (Dechamps et al., 2016). Currently, MOMMC meets this benchmark for only 40–60% of cases. Placing clinically trained personnel at the initial point of contact enhances early symptom recognition and prompt intervention, improving survival rates and compliance with national cardiac care standards.
| Aspect | Current State | Proposed Change | Expected Outcome |
|---|---|---|---|
| Staffing at Front Desk | Two registration technicians | One medical technician and one registered nurse | Faster symptom recognition and EKG initiation |
| Door-to-EKG Time (STEMI) | 40–60% compliance with 10-minute goal | 100% compliance with 10-minute benchmark | Improved clinical outcomes and guideline adherence |
| Patient Flow | Registration delays | Streamlined triage and registration | Shorter wait times and higher patient satisfaction |
| Role of Registration Techs | Full registration | Administrative support at back desk | More efficient use of staff expertise |
This realignment leverages clinical expertise at the frontline, optimizing emergency cardiac care efficiency and patient safety.
Brian Hubbard, RN, BSN, MPA, was chosen as the organizational sponsor due to his extensive experience in intensive care, cardiac catheterization, and supervisory nursing at MOMMC. He supported the proposed staffing changes, recommending a 60–90-day pilot phase before full implementation. He noted that nurses and medical technicians might need to take on an additional 1–2 shifts monthly during this trial and cautioned about potential resistance. He emphasized the importance of clear communication, involving staff in the process, and underscoring the link between the change and improved patient outcomes.
| Barrier | Description | Mitigation Strategy |
|---|---|---|
| Staff Resistance | Increased workload and scheduling changes | Encourage open dialogue, involve staff early, highlight patient safety benefits |
| Administrative Resistance | Hesitancy from DoD/DHA to modify staffing models | Provide evidence-based outcomes and national guideline compliance |
| Skill Gaps | Limited experience with rapid registration | Offer comprehensive training and mentorship programs |
Effective leadership and staff engagement are critical to overcoming these challenges and securing sustainable adoption.
This proposal supports value-based care by improving clinical efficiency, enhancing patient safety, and increasing satisfaction without additional financial burden. Key benefits include:
Reduced door-to-EKG times for cardiac patients.
Earlier detection and treatment of life-threatening conditions.
Strengthened interdisciplinary collaboration between nursing, medical, and administrative staff.
Improved patient throughput and satisfaction metrics.
Through optimized staff deployment and streamlined processes, MOMMC can deliver superior care quality while maintaining cost-effectiveness.
| Stakeholder | Role in Implementation |
|---|---|
| Staff Nurses and Medics | Perform rapid triage and EKGs |
| Registration Technicians | Handle administrative functions at back desk |
| Emergency Room Nurse Manager | Oversee workflow and staffing |
| Emergency Department Medical Director | Provide clinical oversight |
| Registration Director | Supervise registration processes |
| Chief Nurse | Align policy and allocate resources |
| Hospital Commander | Endorse and support organizational efforts |
| Staffing Chief | Approve and formalize staffing changes |
Monthly progress meetings will review data from the Genesis Electronic Health Record (EHR) system, focusing on door-to-EKG times, patient length of stay, and satisfaction scores.
The initiative mainly uses existing personnel without requiring new funding. Since military salaries are not hourly, redistributing workloads does not increase payroll costs. Resource allocation focuses on staff training, ongoing data collection, and engagement sessions, all within current operational budgets.
| Phase | Description |
|---|---|
| Planning | Engage stakeholders, finalize logistics, and set trial parameters |
| Milestones | Monitor weekly and monthly door-to-EKG data |
| Implementation | Conduct staff training and launch rapid registration pilot |
| Evaluation | Review performance after 90 days to assess effectiveness |
Data-driven continuous evaluation will ensure lasting improvements and inform future staffing policies.
| Outcome | Description |
|---|---|
| 100% Compliance | All eligible patients receive EKGs within 10 minutes |
| Improved Patient Outcomes | Faster intervention lowers cardiac complications |
| Increased Patient Satisfaction | Shorter wait times enhance patient experience |
| Financial Benefits | Increased throughput improves service utilization |
| Accreditation Maintenance | Sustained adherence to AHA and DoD standards |
These results promote ethical nursing principles such as nonmaleficence and fidelity by ensuring timely and safe patient care.
The Genesis EHR system will be utilized to monitor performance metrics, such as patient flow, EKG completion times, and triage efficiency in real time. Leadership will have access to data dashboards, promoting transparency and accountability across the organization.
Success will be gauged using both quantitative and qualitative indicators, including:
Ongoing improvements in clinical metrics.
Positive feedback from patient satisfaction surveys.
Enhanced staff morale and acceptance of new workflows.
Sustained communication and engagement throughout the organization.
With over twenty years as an emergency nurse, the author has witnessed systemic inefficiencies affecting patient care. By applying evidence-based practices, demonstrating leadership, and fostering interdisciplinary collaboration, the author embraces the role of a change agent dedicated to healthcare advancement. Through advocacy, education, and data-driven reasoning, the author cultivates a culture of continuous quality improvement within emergency services.
If successful, this rapid registration and triage approach could be expanded to other military treatment facilities (MTFs) nationwide. Scaling this model across the DoD healthcare system has the potential to reduce cardiac-related mortality, improve response times, and strengthen operational readiness for military and civilian populations alike.
Butt, T. S., Bashtawi, E., Bououn, B., Wagley, B., Albarrak, B., Sergani, H. E., Mujtaba, S. I., & Buraiki, J. (2020). Door-to-balloon time in the treatment of ST segment elevation myocardial infarction in a tertiary care center in Saudi Arabia. Annals of Saudi Medicine, 40(4), 281–289. https://doi.org/10.5144/0256-4947.2020.281
Centers for Disease Control and Prevention. (2023). Healthcare-associated infections: Surgical site infections (SSI). https://www.cdc.gov/hai/ssi/
Dechamps, M., Castanares-Zapatero, D., Berghe, P. V., Meert, P., & Manara, A. (2016). Comparison of clinical-based and ECG-based triage of acute chest pain in the emergency department. Internal and Emergency Medicine, 12(8), 1245–1251. https://doi.org/10.1007/s11739-016-1558-8
