Thinking on the microsystem level.

      Problem: Identify the problem or issue. You should be thinking on the microsystem level. (see Hall & Roussel Ch. 10). Intervention: Describe the specific evidence-based intervention being proposed to address the problem or issue. Comparison: Discuss what is currently being done to address the problem or issue that is inadequate. Outcomes: Identify the expected outcomes that will result from the project implementation. This should both improve quality of care and cost. Example: Problem: Adult patients admitted to the acute care unit with a history of alcohol abuse who experience alcohol withdrawal symptoms during hospitalization. There is no standardized alcohol withdrawal assessment tool so early signs of alcohol withdrawal are often overlooked or attributed to something else. These patients often progress to developing DTs and are transferred to the ICU resulting in an increased length of stay, which increases the cost of hospitalization. Intervention: Implementation of a standardized, evidence-based alcohol withdrawal protocol. Comparison: Currently, there is no alcohol withdrawal assessment tool or protocol. Individual healthcare providers manage their patients who experience alcohol withdrawal as they see fit. Outcomes: Decreased length of stay and decreased transfers to the ICU. Longer stays are associated with increased costs. Transfers to the ICU cost more than care provided on the medical-surgical floor. Track-Specific Business Case Ideas: Nurse Executive: reducing unit overtime by improving staffing ratios Adult/Gerontology: infection rate reduction or fall prevention Neonatal/Pediatric: necrotizing enterocolitis prevention or hypoglycemia management Psych/Mental Health: improvement of medication/appointment adherence or management of a mental health client in the emergency room