Recognizing and responding to medical emergencies promptly is critical to patient care and outcome. Many true emergencies are time-sensitive and delay in treatment can lead to further harm. Quality outcomes are, therefore, significantly impacted by response and treatment times. Acute myocardial infarction (AMI) is one such disease that requires immediate intervention to reduce muscle damage or cardiac death. Quality improvements are essential to the best practices. Many institutions have created working algorithms to meet evidence-based guidelines and have successfully met standardized benchmarks. However, some still struggle to define an effective. In the positive deviance approach, improvements are warranted by the fact that they exist already in the community or organization and therefore, have been informally tested through practice in a particular context(LeMahieu, Nordstrum, & Gale, 2017).

Patients with symptoms of chest pain, and or other associated symptoms, are at risk for a heart attack. Within the institution, a clinical complaint of such requires an immediate echocardiogram (ECG), to identify the need for immediate interventions. Current process flow stipulates the patient is registered into the system and then gets evaluated by the triage nurse, who then order an ECG, then gets it reviewed by the physician. Repetitively, there have been cases with late recognition and treatment based on the delay in doing the exam. Standard practice guideline states the allotted time for obtaining an ECG upon arrival is ten minutes, and currently, we are averaging twenty-two mins, with occasional outliers.

Given that the response time is strictly relevant to the outcome and therefore finding a work around all the layers set in place may shed light on the area that needs to be improved in order to achieve the best outcomes and the best patient care experience.

In the work environment people are typically obedient to the rules even though some may be outdated and no longer applicable. Bucking the system has a negative connotation and implies the deviation but often sprues positive results (Laureate Education, Inc.) Moreover, creativity and individuality are absent with routine thinking limits or stagnates organization future. Patient care works best when things are not monotonous, and the workforce is empowered to deviate from practice. Such reasoning, therefore, supports the notion of pf positive deviance.

As a deviation to the normal process, a patient that meets the criteria should bypass registration altogether. Nurses would need to be retrained in reshaping the workflow without interfering with existing resources. A generic scanning code can be utilized to move forward with the exam. The patient should then go directly to a quick look area bed, in which time the nurse can be working simultaneously working to obtain information before arrival, history. Once the ECG is complete and reviewed by the ED physician, the registration process may be completed. Positive deviance is braced as a way to improve the quality and outcome. The concept of thinking outside the box can significantly impact the way we move forward. Removing the nuances of systems regimen will allow us to provide better care. A particular benefit of the positive deviance approach is the ability to integrate organization practices to understand what works or best practices (Bradley et al., 2009).

References

Bradley, E. H., Curry, L. A., Ramanadhan, S., Rowe, L., Nembhard, I. M., & Krumholz, H. M. (2009). Research in action: Using positive deviance to improve quality of health care. Implementation Science, 4, 1–11. https://doi.org/10.1186/1748-5908-4-25

Laureate Education (Producer). (2013h). Risks and benefits of positive deviance. Retrieved from https://class.waldenu.edu

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