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Design for Change in Practice

...... Once an intervention has been tentatively selected, Rosswurm and Larrabee (1999) recommend a synthesis of the available literature and data on the subject. There is an abundance of current literature on the topic, and the different studies and perspectives that have examined this issue come to remarkably similar conclusionsovercrowding specifically and inpatient boarding generally in emergency departments has been definitively linked to reductions in the quality of care, increases in mortality after certain periods, increases in the number of patients that leave without being seen, and a reduced efficiency in the ED as a whole (Bair et al 2010; McCarthy et al 2009; Zimmerman 2004). These studies have also shown that a reduction in boarding numbers and crowding can eliminate or reduce these problems
After all of these considerations, the fourth step in Rosswurm and Larrabees (1999) model for change is to design the actual changes to practice that should be implemented. In this case, this requires few additional resources other than learning materials for hospital staff to acquaint themselves with new procedures and practicesthere is no equipment necessary, and supplies used by the emergency department should actually decrease pretty much across the board as patients are more quickly