NR 720 Week 3 Observation Summary Example

Observation Summary: Twenty-Two Central Line Placements Watched From Insertion to First Infusion, With the Recorded and Observed Times Kept Apart

Student Name

College of Nursing, Chamberlain University

NR 720: Topics in Healthcare Systems Leadership I

Instructor Name

Month Day, Year

Observation Summary: Twenty-Two Central Line Placements Watched From Insertion to First Infusion, With the Recorded and Observed Times Kept Apart

What Was Watched, Where and When

The pathway watched was a single transfer of one item: a newly placed central line, from the moment the placing clinician finished the dressing to the moment the bedside nurse first ran an infusion through it. The observer, a nurse executive student who does not work in the unit, watched 22 consecutive placements in the 20-bed medical intensive care unit over three weeks in March 2027, on weekdays between 08:00 and 18:00, about 41 hours on the unit in total. The observer stood at the central workstation, from which both the patient rooms and the portable radiography alcove are visible, and moved to the doorway when a nurse checked results at the bedside computer. No placement was selected; every weekday daytime placement in the period was included.

What Counted as a Moment

Six moments were fixed in advance so every occurrence would be recorded the same way: line complete, film ordered, image taken, read posted, line cleared in a note, nurse told the line was cleared, and first infusion through the line. The nurse being told was defined as the first moment the bedside nurse said or showed that the nurse knew the line was cleared, by a call, a conversation or a check of the results tab followed by action. Each occurrence also recorded the order's priority and how many times the nurse checked the results tab while waiting. The moments follow the map built earlier, so each crossing between roles has a start and an end, and the people, tools and rules at each crossing can be compared across occurrences (Carayon et al., 2006).

Two Columns: Recorded and Observed

Five of the six moments have a timestamp in the record. The sixth, when the nurse learned of clearance, exists only in observation. For the five recorded moments, the observer noted both the record's time and the time seen on the unit; they matched within two minutes in every case except the clearance note, a reminder that a map or record is only as good as its check against practice (Antonacci et al., 2018), which was written on average six minutes after the clinician had told the nurse in person on the four occasions that happened, and before the nurse knew on the other eighteen.

The Occurrences, Summarized

Table 1

Intervals Across 22 Observed Central Line Placements, Medical Intensive Care Unit

Note. Note. Five of the 22 lines were cleared by the placing clinician on a personal look at the image, ahead of the formal report; their read-to-clearance interval is counted as 0.

Eighteen of the 22 films were ordered at the default routine priority and four at urgent priority. For the four urgent films, the image-to-read interval had a median of 14 minutes; for the 18 routine films it was 74 minutes. Nurses checked the results tab a median of five times per placement while waiting, between two and eleven times.

Three Occurrences Set Side by Side

Three occurrences show the range. In occurrence 4, a routine film was taken 26 minutes after the order and read 98 minutes later; the clearance note followed 22 minutes after the read, and the nurse, who had checked the results tab eight times, learned of it 17 minutes after that. The line was first used 171 minutes after placement. In occurrence 11, the advanced practice provider viewed the image as soon as it appeared, 15 minutes after the order, cleared the line in a note and told the nurse at the bedside; first use came 46 minutes after placement, and the radiologist's read, posted an hour later, agreed. In occurrence 17, the film was ordered at urgent priority, read 11 minutes after it was taken, and the clearance note followed 19 minutes later; first use came at 58 minutes. The equipment, the unit, the technologists and the radiologists were the same in all three. What differed was the priority on the order and whether anyone owned the job of telling the nurse.

What the Pattern Shows

Across 22 placements, the work on the film itself, positioning, exposure and reading, took minutes. In lean terms, nearly all of the interval was waiting rather than work (Graban, 2016), and most of the median two hours was spent in two places: in the radiologist's queue, which sorts by priority, and in the gap after the read, when the clinician assumed the nurse would see the result and the nurse waited to be told. The five placements in which the clinician read the image personally and cleared it before the radiologist had the shortest totals, a median of 52 minutes.

The Sample, Named Honestly

These are weekday daytime placements only. Nights and weekends, when a single radiologist covers every study in the building and fewer advanced practice providers are on the unit, may be faster or slower, and nothing here describes them. Twenty-two placements over three weeks is enough to see a repeated pattern but not to estimate the median precisely, and the observer's presence may have shortened some intervals, since staff knew placements were being timed. The record review in the next stage, covering three months of placements, will test whether the pattern holds when no one is watching, and will include nights and weekends so the daytime picture can be compared with the rest of the week.

Protecting the People Watched

The unit manager and the radiology manager approved the observation, and every nurse, clinician and technologist was told in advance what was being timed and why and that no individual would be identified. Notes recorded roles, not names, and no patient identifiers were written down; occurrences were numbered 1 to 22. The purpose was to time a process, not to assess anyone's work, and the summary reports only roles and intervals, never individual performance.

References

Antonacci, G., Reed, J. E., Lennox, L., & Barlow, J. (2018). The use of process mapping in healthcare quality improvement projects. Health Services Management Research, 31(2), 74-84. https://doi.org/10.1177/0951484818770411

Carayon, P., Schoofs Hundt, A., Karsh, B. T., Gurses, A. P., Alvarado, C. J., Smith, M., & Flatley Brennan, P. (2006). Work system design for patient safety: The SEIPS model. Quality and Safety in Health Care, 15(Suppl. 1), i50-i58. https://doi.org/10.1136/qshc.2005.015842

Graban, M. (2016). Lean hospitals: Improving quality, patient safety, and employee engagement (3rd ed.). CRC Press.