| Course | C855 Nursing Informatics Capstone |
|---|---|
| Task | Task 1 |
| Paper type | System optimization proposal |
| Length | About 1,100 words, 4 pages |
| Format | APA 7 |
| School | Western Governors University (WGU) |
| Program | MSN Nursing Informatics |
| Updated | September 2026 |
Free sample paper for C855 Task 1
System Optimization Proposal: From Detecting Suicide Risk to Acting on It After Discharge, a Safety Plan Template and Follow-Up Call Worklist Built on the Existing Screener
Student Name
Leavitt School of Health, Western Governors University
C855: Nursing Informatics Capstone, Task 1
Course Instructor
Month Day, Year
System Optimization Proposal: From Detecting Suicide Risk to Acting on It After Discharge, a Safety Plan Template and Follow-Up Call Worklist Built on the Existing Screener
The System as It Stands
For nine months, nurses at a composite rural hospital with 110 beds have asked the Columbia suicide screening questions inside the electronic health record (EHR) instead of on a scanned paper form. The screener is completed for about 92% of eligible emergency department (ED) patients, calculates a risk level, flags high-risk patients on the tracking board and opens a precautions order set. Detection has improved. What happens after a patient with positive screening is discharged has not changed: the patient leaves with a printed list of crisis numbers, and nobody at the hospital contacts them again. This proposal, the capstone of the system's development life cycle, sets out how the system will be optimized, maintained, supported and evaluated so that detection leads to action.
Why Optimization Is Needed: The Evidence
The strongest evidence for this gap comes from the same multisite program that established universal ED screening. In the ED-SAFE study of 1,376 adults with recent suicidal ideation or attempts across eight EDs, universal screening alone did not reduce later suicide attempts compared with usual care (23% versus 22%). Adding a brief intervention, secondary risk screening by the ED physician, discharge resources and a series of follow-up telephone calls after the visit, reduced the risk of a suicide attempt over the following year from 23% to 18%, a 20% relative reduction, and led to 30% fewer total attempts (Miller et al., 2017). Screening finds the patient; the follow-up protects them. The hospital's current system stops halfway.
A second study points the same way for the specific tools proposed here. In a cohort comparison across emergency departments in the Veterans Health Administration, patients who received the safety planning intervention with structured follow-up calls were less likely to engage in suicidal behavior over six months than those receiving usual care (3.03% versus 5.29%), and had more than double the odds of attending at least one outpatient mental health visit (Stanley et al., 2018). The safety plan itself is a brief, written, prioritized list of coping strategies and sources of support that the patient develops with a clinician (Stanley & Brown, 2012).
The Proposed Optimization
Three changes build on components the hospital already owns, with no new software purchase.
Safety plan template. For every patient discharged from the ED after a moderate or high-risk screen, the EHR will present a structured safety plan: warning signs in the patient's words, coping strategies, people and places for distraction, people to ask for help, professional contacts and steps to make the environment safer. The completed plan prints for the patient and is stored as discrete data so the follow-up caller can see it.
Follow-up call worklist. Discharge of such a patient will automatically add them to a worklist for the behavioral health liaison, with calls due at 2 days, 7 days and 30 days. Each call is documented in a short structured note: reached or not, current risk as reported, safety plan reviewed, barriers to the outpatient appointment and escalation if needed. Unreached patients stay on the list with a second attempt the next business day.
Outpatient referral closure. The discharge referral to the county mental health center will be sent electronically with the safety plan attached, and the worklist will show whether the first appointment was kept, using the center's reply through the regional health information exchange.
Alignment With the Triple Aim
The Triple Aim asks health systems to pursue better care for individuals, better health for populations and lower per capita cost at the same time (Berwick et al., 2008). Better care: patients leave with a plan written with them rather than a generic list, and hear from someone within 48 hours. Better population health: the hospital can report for the first time how many at-risk county residents reached outpatient care, a measure the county health improvement plan has asked for. Lower cost: preventing even a small number of repeat attempts avoids ED visits, admissions and intensive care stays, and the intervention uses the liaison's existing hours, redirected from searching paper charts for discharged patients.
Monitoring and Evaluation Plan
The informatics nurse specialist will own evaluation, with measures reported monthly to the suicide prevention committee.
| Measure | Type | Source | Target at 6 months |
|---|---|---|---|
| Safety plan completed before discharge for moderate or high-risk patients | Process | Safety plan template | 90% |
| 2-day follow-up call attempted | Process | Worklist | 95% |
| Patients reached by at least one call within 7 days | Process | Worklist notes | 75% |
| First outpatient appointment kept within 30 days | Outcome | Health information exchange reply | Baseline, then 10 percentage point increase |
| ED return for self-harm within 90 days | Outcome | ED encounters with self-harm diagnosis | Monitor; too rare for a target |
| Liaison time per call | Balancing | Worklist time stamps | Under 15 minutes on average |
| Template abandonment at discharge | Balancing | EHR audit log | Under 10% |
Maintenance and Support
Maintenance covers the content and the technical build. The steering group will review the safety plan template and the call scripts yearly against current guidance, and the scoring version and question set of the screener are already versioned in the database, so any change is traceable. The EHR analyst will monitor the worklist interface and the health information exchange feed daily for failures, with an alert to the analyst when referral replies stop arriving. Support includes a tip sheet at every ED workstation, superusers on each shift, a four-minute training video for new nurses in orientation and a named contact for the liaison when a patient's record cannot be found.
Risks
Three risks are foreseeable. If the liaison's call volume exceeds capacity, calls will be prioritized by risk level and a nurse from the ED float pool will be trained as backup. If the safety plan template feels like a documentation burden at discharge, it can be started earlier in the visit by whoever is with the patient and finished at discharge. If referral replies from the county center are incomplete, the liaison will confirm attendance at the 30-day call and the data will be reported as confirmed by call rather than by exchange.
Conclusion
The screening system the hospital built does what it was designed to do. This optimization completes the life cycle by connecting detection to the follow-up that evidence shows is what reduces later suicidal behavior. It uses tools already in place, can be measured from the first month and can be extended to inpatient discharges once it is stable in the ED.
References
Berwick, D. M., Nolan, T. W., & Whittington, J. (2008). The Triple Aim: Care, health, and cost. Health Affairs, 27(3), 759-769. https://doi.org/10.1377/hlthaff.27.3.759
Miller, I. W., Camargo, C. A., Arias, S. A., Sullivan, A. F., Allen, M. H., Goldstein, A. B., Manton, A. P., Espinola, J. A., Jones, R., Hasegawa, K., & Boudreaux, E. D. (2017). Suicide prevention in an emergency department population: The ED-SAFE study. JAMA Psychiatry, 74(6), 563-570. https://doi.org/10.1001/jamapsychiatry.2017.0678
Stanley, B., & Brown, G. K. (2012). Safety planning intervention: A brief intervention to mitigate suicide risk. Cognitive and Behavioral Practice, 19(2), 256-264. https://doi.org/10.1016/j.cbpra.2011.01.001
Stanley, B., Brown, G. K., Brenner, L. A., Galfalvy, H. C., Currier, G. W., Knox, K. L., Chaudhury, S. R., Bush, A. L., & Green, K. L. (2018). Comparison of the safety planning intervention with follow-up vs usual care of suicidal patients treated in the emergency department. JAMA Psychiatry, 75(9), 894-900. https://doi.org/10.1001/jamapsychiatry.2018.1776
What the C855 Task 1 instructions ask
The C855 capstone asks you to propose an optimization of an existing health information system. Expect to present the system as it runs today and how well it performs, explain why optimization is needed with evidence, describe the proposed changes, align them with a framework such as the Triple Aim, and plan monitoring, evaluation, maintenance and support. Risks and mitigation may also be required. The system can be one you know from work or a realistic composite. The evaluator reads for changes that follow from a documented gap, use evidence and would be feasible for the organization to implement and sustain.
How this C855 Task 1 example is built
The proposal begins with the system as it stands, including what it does well. The evidence section explains the gap between detecting risk and following up, using a large multisite trial. Three changes are described in enough detail to build, each reusing existing tools. The Triple Aim section explains how the changes affect individual care, population health and cost. Monitoring names measures, owners and reporting intervals. Maintenance covers content review and technical support. Risks are paired with responses, such as prioritizing calls when volume exceeds capacity, and the conclusion ties the optimization to the full life cycle. Every change is described with the existing component it reuses, which keeps cost low and makes the proposal easier for leaders to approve.
Where the C855 Task 1 rubric puts the marks
C855 Task 1 aspects each receive competent, approaching competence or not evident. A current system aspect checks that the system and its performance are described. A need aspect asks for evidence that optimization is warranted. A proposal aspect looks for specific, feasible changes. A framework aspect asks for alignment with the Triple Aim or a similar model. Monitoring, maintenance and support aspects look for concrete plans with owners. Evaluators favor proposals that reuse existing resources where possible and that state how success will be measured. APA citations and professional writing are part of the rubric. Proposals that report baseline figures for each monitoring measure make later evaluation far more convincing.
C855 Task 1 help: what sends it back
Capstone proposals come back most often when the gap is asserted rather than shown. Use system data or published evidence to establish why change is needed. Second, proposed changes are sometimes new systems rather than optimizations. Build on what exists where you can. Third, Triple Aim alignment is often a sentence per aim. Explain the mechanism for each. Fourth, monitoring plans lack owners and intervals. Name who reports what and when. Finally, maintenance is easy to forget. Describe how content will be kept current and how users will get help, since a capstone optimization is only as good as its upkeep. Show the baseline for every measure so improvement can be judged.
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C855 Task 1 questions, answered
What counts as an optimization in C855?
A change that improves an existing system's performance or reach, usually by reconfiguring or extending current tools. The sample adds a safety plan template and follow-up worklist to an existing screener.
How recent should C855 sources be?
Most versions expect current evidence, often within five years, alongside any landmark studies that still anchor the practice. The sample pairs recent sources with the ED-SAFE trial.
What makes a C855 proposal credible?
Evidence of a real gap, changes built on existing resources, clear owners and measures, and an honest account of risks. Evaluators favor proposals an organization could actually adopt.
Does C855 include practice experience documentation?
The sample covers only the written proposal. Any practice hours, logs or preceptor documentation required by your program must come from your own capstone experience.
Where can I find a free C855 Task 1 sample paper?
The optimization proposal runs in full above, annotated section by section. Describe your own system with the C855 task and your first custom proposal costs nothing.