Avoidable Hospital Challenges

A visit to the emergency department (ED) is usually associated with negative thoughts by most people. It creates preconceived images of overcrowded waiting rooms and routine long waits for treatment (Jarousse, 2011). From 1996 to 2006, ED visits increased annually from 90.3 million to 119.2 million (32% increase). During this same time period, the number of EDs has declined by 186 facilities creating the age old lower supply and greater demand concept (Crane & Noon, 2011). There are many contributing factors that have led to an increase in ED visits. A few of these key drivers include lack of primary care access, rising of the uninsured population, dwindling mental health services, and the growing elderly

From the dark room, I am writing what’s my day in my diary. It’s such a horrible day when the doctor said “your second surgery did not go well as we expected. Unfortunately, you will be staying here for one more week”.

almost doubling the current proportion of 13%” (Ontario Ministry of Health and Long Term Care, 2014). With the significant ageing population, it is important that access to care, including the ED is improved or there will be a major burden on the healthcare system. It is imperative hospitals and alternative care settings collaborate to deliver the safest and most effective quality care (Ontario Ministry of Health and Long Term Care, 2014).

When focusing on the Centers for Medicare and Medicaid Systems strategies for improvement with unnecessary emergency room visits, a major key area is accessibility to health care at the appropriate health care setting. For many years, there has been the perception that the emergency department is the only place for someone who is uninsured or underinsured can go to receive the needed and appropriate health care, and in some situations that may be the case. (Rhodes et al, 2013, p.394) Due to the decreases in reimbursements for the publicly funded, more and more physicians are opting out to treating these patients, thus leading to an increase in emergency department utilization. According to a study conducted by Rhodes, Bisgaier, Lawson, Soglen, Krug, and Haitsma, this is becoming a greater concern for the

I am currently employed in the Veteran’s Affairs Loma Linda HCS in the Emergency Department. Our target population are adults, mainly male, with multiple on-going health conditions. In our ED, we see a huge volume of veterans who have chronic illnesses and conditions. I noticed that many re-peat ED visits that could have been easily avoided and prevented. Some are legitimate emergencies and urgencies, but unfortunately the great majority are the result of non-compliance, lack of adequate knowledge in managing illness and failure to partner with their care provider to promote better overall health.

In 2013 an average of one out of eight Medicare patients are readmitted within a 30-day period which lead to the estimated costs of around $18 billion a year for Medicare patients alone. Hospitals will either be penalized or receive bonuses for their performance with readmissions. This program will encourage hospitals to concentrate on ways to improve coordinating transitions of care while improving the safety and quality of care provided. In order to

According to Community Paramedic Taskforce Results 7/1/15-12/31/15 (2016), the average patient age was 71 years old, and 61% of these patients were female (n=247). This data is consistent with Rittner and Kirk’s study (1995) relating to age and gender distribution. In 2015 there were more people in this age group than in 1995, which increases reliance on EMS for services that do not always fall into the emergent category, yet do need intervention of some sort. To reduce burdening the EMS system with addressing non-emergent needs MIH/CP programs seek to connect the right patient, with the right care, at the right time. However, some of these patients are limited in mobility and cannot travel to a primary care provider to receive care.

According to the Administration on Aging, people age 65 and older currently represent 12.9% of the population of the United States as of 2009, with that number expected to double in the next 15 years (Administration on Aging, 2014). Along with the continued rise in the population of older adults comes an increased need for services specifically addressing the needs of this population. Despite the increasing needs for services for older adults, seniors are among the most overlooked and underserved populations in the United States.

Partnership for Patients (PfP) has made significant progress in decreasing the number of preventable hospital acquired conditions (HACs), hospital readmissions, hospital patient deaths, and health care expenditures. Nonetheless, much work remains to be done so that PfP is more effective in their mission to make and improve care safety and care transitions. The progress made is part of a program that has been in effect since April of 2011, soon after sections 3011 and 3026 of the Patient Protection and Affordable Care Act (PPACA) were signed into law. These sections allowed then Department of Health and Human Services (DHHS) Secretary, Kathleen Sebelius, and Center for Medicaid and Medicare Services (CMS) Administrator, Donald Burwick, to create and provide funding through Medicare for a dual program to reduce hospital readmissions and transition care services.

Once you arrive at the emergency room, you experience more waiting depending on your current condition. Some of these waits depend on: length of stay, time waiting for assessment, condition, waiting for inpatient bed, and lack of resources. Finally, when you’re ready to leave the emergency department waits can occur, like waiting for an inpatient bed or a ride home (CIHI, 2012). All of these reasons impact the growing wait times, with older adults becoming more frequent in emergency departments and the increasing population of older adults these wait times are going to continue to grow causing more harm than good, if older adults are unable to receive the appropriate care in a timely matter (Cooke, Oliver, & Burns, 2012).

This allows community-based support systems. Services that are available are transportation, senior centers, counseling, adult day care, health screening and education on health and nutrition. These services are designed to help improve overall health of the older adult (Wacker & Roberto, 2014). The last quality improvement initiative I researched was the improvement in medication management for the geriatric population. The goal is to improve medication management of the older adult by educating doctors, nurses, and pharmacists (Bragg, Warshaw, Meganathan, & Brewer,

Disparities in the Elder Population There are many vulnerable populations amongst healthcare and healthcare practices in today’s society. As healthcare providers, we struggle to improve and eliminate disparities due to different types of barriers. Whether it’s a language barrier or an age barrier, these barriers prohibit the continuity of care and patient safety for anyone seeking medical attention. One population in particular that struggles with disparities is the older adult population. I believe that the older adult population (65 years and older) have a higher increase of morbidity and mortality than persons younger than sixty-five because of resource availability, and inadequate health literacy.

The changing cores consider the following. Every 10 years, one-fourth of all current knowledge and accepted practices in the healthcare and other industries will be obsolete (Allen, 2015). Effective October 1, 2013, new rules for inpatient hospital reimbursement under the Medicare program make final two sets of proposed rules that the Centers for Medicare & Medicaid Services (CMS) published in the Spring 2013–the definition of an inpatient hospital stay based on time and a hospital rebilling option (CMS, 2013). Working at Howard County General Hospital, for individual to become an inpatient at a skilled nursing facility after a three day minimum acute hospital stay, and who meet Medicare’s qualified diagnosis and comprehensive treatment

For years, healthcare costs have continued to increase in the United States and policymakers are constantly trying to find ways to reduce spending. According to reports, in 2011, about $900 billion out of the $2.6 trillion annual health care spending was wasteful spending. In the following year, there was a reported $690 billion wasted annually on healthcare. This wasteful spending is attributed to ineffective health care delivery, cost of adverse events, and poor care coordination that has led to avoidable readmissions (Lallemand, 2012). In the United States, readmissions are the highest amongst patients with chronic diseases accounting for about 90% of avoidable readmissions in 30 days after discharge, and costing the industry an estimated $17 billion. These readmissions are a result of inadequate discharge planning, lack of follow-up, and lack of education on disease management (Jayakody et al., 2016). Policymakers on the federal and state level have developed and implemented several programs, some varying state to state, to help reduce wasteful spending while improving quality of care.

The emergency room has become the new primary care facility for the millions of uninsured in the United States. Thanks to an “unfunded mandate passed into law in 1986,” hospitals that participate in the Medicare program must “screen and treat anyone with an emergency medical condition” (Stephens & Ledlow, 2010). This unfortunately leads to emergency rooms full of people who may have something as simple as a sinus infection which then makes it really difficult for someone with a real emergency that did not require ambulatory transport to be seen in a timely manner. Another unfortunate result of this is that “over 1,100 emergency departments closed over the past decade” (Stephens & Ledlow, 2010).