Acute Hospital Care

Providing the best care to each patient starts with providing the proper amount of staff members to each unit. Looking at the needs of different units not only allows administration to see areas for improvement, but also areas that are being handled correctly. Utilizing the indicators provided by The Joint Commission, 4 East, a pediatric medical/surgical floor, has a high rate of falls and nosocomial pressure ulcers that appears to be related to the increase overtime nurses have been working for that floor (Nightingale, 2010). Research has shown increases in adverse events have been related to nurses working over 40 hours a week (Bae, 2012).

The ability of nurses to provide a high level of care to each individual patient will cause a decrease in inpatient complications and a decrease in rates of inpatient mortality (Needleman, Buerhaus, Pankratz, Leibson, Stevens & Harris, 2011).

For over a decade researchers have been performing studies examining the effects patient-to-nurse ratios have on adverse outcomes, mortality rates, and failure-to-rescue rates of patients and on job dissatisfaction and burnout experiences of nurses. Aiken, Sloane, Sochalski, and Silber (2002) performed a study which showed that each additional patient per nurse increased patient mortality within 30 days of admission by 7% and increased failure-to-rescue by 7% as well. This same study also showed that each additional patient per nurse resulted in a 23% increase in nurse burnout and a 15% increase in job dissatisfaction. Additionally, Rafferty et al. (2007) performed a study in which the results showed that patients in hospitals with higher patient-to-nurse ratios had a 26% higher mortality rate and nurses were twice as likely to have job dissatisfaction and experience burnout. Blegen, Goode, Spetz, Vaughn, and Park (2011) performed a study where results showed that more staffing hours for nurses resulted in lower rates of congestive heart failure morality, infection, and prolonged hospital stays. The same study also showed that increased nursing care from registered nurses resulted in lower infection and failure to rescue rates and fewer cases of sepsis.

Neither staff member identified the downward trending of the patients available vital signs and did not evaluate consciousness of the patient. Failure to assess appropriately and recognize deterioration of the patient resulted in a prolonged period of time in which the patient was not adequately oxygenated. Research has shown that short staffing, with decreased nurse to patient ratio, has been found to be associated with increased mortality (Aiken, Clarke, Sloane, Sochalski, & Silber, 2002; Joint Commission on Accreditation of Healthcare Organizations, 2005; Needleman, Buerhaus, PKankratz, Leibson, Stevens, & Harris, 2011). This reinforces the need to match staffing with patient census, acuity, and need for nursing care.

A common goal all healthcare providers share, is the desire to provide excellent patient care. The delivery of care is constantly changing in healthcare, however, the patient will continue to remain the focus of care. The success of nursing care thrives off the ability to fulfill patient needs and to maintain patient safety and satisfaction. When patients are admitted to the hospital, their need for an increase in their level of care and attention, due to the decline in their health status, and inability to preform normal daily activities of daily living. The loss of independence places the patient in a vulnerable state of mind, causing the individual to rely on members of the healthcare team to assist with basic self-care needs while in a stable and well-organized environment. A structured environment can be accomplished through the practice of hourly rounding on all patients.

Additionally, urgent care centers have been able to offer patients an alternative to the significantly higher cost of emergency room visits. Following an emergency room visit, patients are charged according to the level of care they are receiving which is rated from minor to major injuries and illnesses. Insurance companies may reject coverage of patients who sought care for a low level injury or illness in an emergency room setting leaving the patient with a large bill for a moderate condition. In addition to the cost of the treatment, insurance companies charge patients an additional fee just for utilizing an emergency room. Furthermore, the cost of seeing an urgent care provider versus an emergency department provider is significantly cheaper.

Durning, (2010) tells how nurses are limited in giving quality care due to the number of patients they have on their shift. It also explains the huge difference in the task of caring for a post-partum mother and a patient recovering from a major trauma surgery. When nurses are too busy because they have too many patients to care for, they are more likely to overlook an important change in their patient. This will cause the patient to deteriorate unnecessarily and could potentially result in death (Durning 2010). “Nurses are the main surveillance system in hospitals” (Queensland Nurse, 2010, p.14). If they have too many patients to look after, something is more likely to be missed. There was a study done last year by Nursing Times, that showed the more nurses a hospital had per bed, resulted in fewer patient deaths, and actually lowered the patient’s length of stay (Queensland Nurse, 2010). The state of Victoria in Australia, like California actually has government mandated nurse-to-patient ratios. Since its implementation of the ratios 10 years ago, Victoria’s health system has been made considerably better. There is a safer environment for the patients, the workplace morale is better, and there are less complaints from the public about the quality of care they receive while hospitalized (Holmes, 2010).

One in particular states, “The hospital is professionally and ethically responsible for providing care, treatment, and services within its capability and law and regulations (Showalter,2013).” Patients may not always have the funds to be treated when their insurance coverage is not available. It would be up to the facility to decide how they are going to continue care in these situations. They have policies on the destruction of medical records. Another policy includes they must comply with the standards of emergency care. Also, that patients have access to interpreter services to include the most common languages used in the healthcare facility. These standards of care are updated all of the time by healthcare experts, nurses, staff, to ensure the most updated

The decline in hospital capacity was accompanied by a rise in staffing. Full-time equivalent personnel rose (Malagi & Kamath, 2016). Most of the additional personnel in hospitals are not focused on patient care but management or administration purposes. The American Hospital Association data shows that outpatient department visits have risen per 1,000 persons indicating that capacity for ambulatory services has risen overtime. Emergency departments have reduced with a larger percentage of closures being in rural areas. Compared to hospitals, physicians have continued to increase. Specialists have increased except for radiologists and general surgeons. There is, however, an uneven distribution of physicians between rural and urban areas. There is an estimated shortage of 3,000 physicians in nonmetropolitan areas. In addition to an increase in physicians, there are new forms of acute-care facilities. There are relatively new facilities that have been accredited. Ambulatory surgery centers have, for instance, risen (Best et al.,

With today’s technology and the specialized skills of doctors, nurses, and therapists, patients who need long term care of acute problems can obtain these services at institutions known as postacute care providers. One type of facility that falls under this title is the Long Term Acute Care Hospital (LTACH) (Munoz-Price, 2009, p. 438). This paper will discuss services provided by LTACHs, the role of the Chief Nursing Officer (CNO) in these facilities, and Medicare reimbursement effected by patient satisfaction surveys.

With so many cases of unfilled position in the hospital patients is not obtaining great services. Patient not receiving proper cares leads to closures, because of prolonged postponements that have led to deaths. Patient complaints at the emergency room have increased in recent years. Numerous patients that were admitted to the hospital’s emergency room are at high risk of dying. Six percent of emergency rooms in the U.S. have closed. These closings took place in the inner-city and low-income areas, but with an emergency room visit increasing by nearly 51%, the overwhelming amount of closures.

In recent years, the healthcare industry has seen a significant decline in the quality of patient care it provides. This has been the result of reduced staffing levels, overworked nurses, and an extremely high nurse to patient ratio. The importance of nurse staffing in hospital settings is an issue of great controversy. Too much staff results in costs that are too great for the facility to bear, but too little staffing results in patient care that is greatly hindered. Moreover, the shaky economy has led to widespread budget cuts; this, combined with the financial pressures associated with Medicare and private insurance companies have forced facilities to make due with fewer

Since the hospital is a community based acute care hospital, there are numerous subunits. Under the president of Hospital AB and Health Center, the total organization is divided into seven major units which are controlled by seven senior vice presidents. Each unit under the senior vice president is further subdivided into sub units according to the services being provided. The hospital has a distinct subunit configuration for the nursing departments. Each unit is under either a vice president or a director. The major subunits are perioperative services, nursing practice and education, behavior health services, heart center, out patient women services and perinatal clinic, inpatient women services and pharmacy. Each of these major subunits is further subdivided based on the services being provided. The senior vice president for all these units also oversees the programs for patient safety, patient satisfaction and joint commission accreditation. The departments of imaging services, rehabilitation services, cancer center, breast center and quality management comes under another senior vice president (unknown author, 2005).

• Emergency Outpatients – Patient given emergency care as a result of sudden severe illness or accident.

Acute care is defined as the level of health care when a patient receives treatment for a short and severe illness. Usually the illness is due to trauma, disease, or after a surgical procedure. In all or most cases acute Care is provided at a hospital by different medical staff. According World Health Organization "the term acute care encompasses a range of clinical health-care functions, including emergency medicine, trauma care, pre-hospital emergency care, acute care surgery, critical care, urgent care and short-term inpatient stabilization," in other words as I mentioned acute health care is used to treat sudden and urgent illnesses and injuries. The staff responds to life threatening injuries first, such as myocardial infarctions, strangulated hernias, car accidents, acute appendicitis, seizures, strokes and more.  Acute care staff will first make sure to treat acute needs before giving treatment to others. Acute care responds to patients based on their medical condition, regardless what caused their condition. Acute health care is very important because it a plays a huge role in preventing disability and death in patients, especially the first 24 hours of the illness.