ER Usage: A Case Study

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

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.

A study by the CDC showed that approximately 70 % of emergency department visits can be

Implications on Healthcare System: The general misuse of the Emergency Rooms as a replacement for patient’s primary care can be considered one reason why hospitals on Marcus Island represent the biggest hurdle with regards to healthcare cost containment. Patients are likely to use the ER for primary care because they know they will be seen on the same day at the ER, versus the potential wait time of 2-4 weeks to get an appointment to see their primary care provider. Inappropriate ER use is expensive for hospitals, and prohibits continuity of care for patients.

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.

Emergency departments are considered an important aspect of the health care system. For many years, wait times have been an area of concern for many Canadians and remain a significant issue. One of the major concerns within the Canadian health care system is the amount of time spent as waiting time in the healthcare services. Wait times are the length of time from when the patient is triaged and registered, to when the patient leaves from the emergency room (Affleck, Parks, Drummond, Rowe, & Ovens, 2013). Whether waiting for a doctor, waiting for prescription medication, or even waiting to get tested, the reasons for wait time in Canada are caused by many factors (Cole, Hopman, & Kawakami, 2011). This paper will seek to examine the factors contributing to longer wait times in the emergency department, examine the ways in which wait times impact society, and conclude by presenting possible solutions to reduce wait times.

Lakeland Regional Health was number one in America for the most Emergency Room visits March 2015-2016, even so they re-direct on average 260 uninsured and Medicaid patients a month to their Family Health Clinic for non-emergent care. The Affordable Care Act, though providing insurance benefits to many who could not afford insurance in the past, has not changed the quantity of patients utilizing the emergency room for primary care mostly due to the overwhelming need for more clinics that accept Medicaid, Share of Cost, and the uninsured.(2) Patients have often commented that it is cheaper to pay the penalty on their taxes each year over applying for the ACA insurance. The deductible and out-of-pocket for the insurance generally matches but the limits are often well above what the patient can afford to pay, and insurance does not pay until they have met that deductible amount. The question is not about providing care to the patients that arrive in the emergency room, but to offer a screening process to ensure that the emergency room is available for true emergencies, and that the safety of patients are considered and the delay of care is as short as possible.

Queuing is feature of our daily life, whether in an airport, a post office or Emergency Departments(ED), few of us wishes to wait too long for service. The clinical cost of waiting too long for urgent treatment in an ED is all too long for service. Following media headlines, pooled with powerful political agenda lead to, in the late 1990s and the early 2000s many ED in the UK were struggling with high demand and poor patient flow. During this period it

There are many key components in approaching access to health care: coverage, services, timeliness and workforce (Healthy People 2020, 2015). Patients who have a positive and consistent source of care will ultimately have better end results, minor discrepancies and fewer costs (Healthy People 2020, 2015). Timeliness is the health system’s capability to optimize services in a convenient manner, whether it embraces the time spent either waiting in a doctor’s office or an emergency department. At the same time for many patients it encompasses the time between analyzing the need for tests or treatment and obtaining those results. Working as an ER nurse there has been incredible long waiting times in emergency rooms secondary to the fact that people are using the ER for care and more notably as their primary care physician. Likewise prolonged Emergency department wait times can decrease patient satisfaction and notably people leave without been seen. Finally the different element of workforce is vital in contributing access to health services. Primary Care Physicians (PCPs) play an important role in providing access to health services and it has been noted that many medical students are leaning away from working in primary care (Healthy People 2020, 2015). Our ultimate goal is to direct them towards that needed profession.

How can a low income sick person pay for an expensive treatment especially when they are not currently employed? There are individuals that have the resources to cover any medical expenses that they may encounter in life, but certainly not everyone has such funds. When people are diagnosed with end-stage renal disease (ESRD), the health provider sadly notifies them that they will not be able to perform most of the things that they were used to doing. ESRD patients must adjust to complete change of life styles due to deteriorating health, treatment timing, and transportation from home to dialysis facilities. In most cases, people with ESRD will more than likely lose their jobs because their work and treatment

First of all, ED overcrowding has a significant negative effect on patient safety and quality of care. According to….., for patients judged by the triage nurse to be critical, more than 10% waited more than 1 hour to see a doctor. This is dangerous, because many illnesses are time dependent. Late diagnose might result in delays in the treatment and cause permanent consequences of disability or death. High occupancy in one Australian ED was estimated to cause 13 patient deaths per year. Another study examined the complication rate among patients with acute coronary syndrome and found a significant increase in serious complication in patients seeking emergency care during times of crowding. Patients and their accompanying family or friends may also have greater exposure to hospital-acquired infections during prolonged waiting time.

When pondering the instances that have the potential to result in a hospital stay, a sizable list becomes apparent in a matter of seconds: heart attack, stroke, cancer, emergency surgery, infection, a bad car accident, or even the birth of a child. Additionally, other instances can result in a hospital visit, such as a sport injury, shortness of breath, a broken bone, a deep cut, or intense pain. Likewise, doctor visits occur for countless reasons, including the need for shots or blood work, physical examinations, the flu, a bad cough, basic medical testing, and well-being check-ups. Ultimately, it is explicit that an innumerable amount of circumstances may result in a person seeking medical care. The salient implication of this is a

Since the implementation of the Affordable Care Act, emergency department (ED) volume has increased by greater than 15% in our facility in approximately one-year. This phenomenon

The Emergency Department for most healthcare organizations has been referred to by many as the gateway to the entire hospital. This is largely in part due to the observation that the Emergency Department is often the most frequently visited department of the acute care hospital that many patients will ever receive care from (Falcone, 2013). The Emergency Departments function by its design is to fulfill a healthcare organizations obligation of providing care during episodes of acute, severe injuries or illnesses. This function at times can be one that requires a unique workflow to be present within the department. Adding to the required tasks needed to fulfill this obligation, is also a large patient population who utilizes the emergency departments resources for non-acute and/or chronic medical conditions that are best classified as non-emergent in nature. Nonetheless, the Emergency Departments of healthcare organizations who are participant’s in Medicare and Medicaid, must balance the allocation and utilization of their resources to accommodate both these acute and non-acute patients within the guidelines that have been set forth by the Center for Medicare and Medicaid Services or CMS. In addition to this requirement, other regulations such as the Emergency Medical Treatment and Active Labor Act (EMTALA) stipulate that under certain pre-defined “medical conditions”, Emergency Departments are required to provide a standard of care which can include ensuring that an

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).