Edd Crowding

In this article, the authors investigated the vulnerabilities in emergency department to internal medicine patient transfers through self-administered surveys of all emergency medicine house staff. More specifically, the survey investigated adverse events due to faulty communications during handoffs. According to this survey, 29% of the emergency staff reported either an adverse or near-miss event due to errors during handoffs. Furthermore, the survey respondents identified inaccurate or incomplete information, cultural and professional conflict, crowding, and many other factors as the contributors to handoff errors. By identifying specific contributors to handoff errors, this article serves as guidance for handoff intervention.

In 2000, the Department of Health(DH), set a range of emergency care access targets in its NHS plan, and in 2001 the government published Reforming emergency care   (DH, 2001) which established waiting time targets for all UK emergency care patient contacts;. The new standard was introduced into the NHS in England in 2002; stating that 98% of patients presenting to ED’s would be seen, treated, admitted or discharged within four hours of arrival by 2004, no one was to wait more than four hours in an ED (from arrival to admission to a bed, transfer elsewhere or discharge). Whilst the author agrees that it has improved the overall for the patient’s experience within the ED. It must be borne in mind that before the decision ‘to come into’ hospital (TCI), that the patient receives the correct clinical decisions prior to TCI.

Visit your local Emergency Room on any given day and you are likely to witness a sort of controlled chaos: nurses, doctors, transporters, patient care technicians, and other ancillary staff members all darting about, attempting to meet the needs of increasingly sick patients in oft-overwhelmed and overpopulated hospitals. All around, various alarms sound. IV pumps signal fluid bags about to run dry. Vital sign monitors ping at differing volumes and intensities, in an electronic demand for staff to mind the out-of-normal-range

“Long wait times could potentially result in worse patient outcomes, greater patient suffering, patient dissatisfaction, more difficulty retaining and recruiting staff, a higher risk of infectious disease outbreaks and an increased risk of medical errors” (Ducharme, Alder, Pelletier, Murray, & Tepper, p. 456). This article explored how the addition of nurse practitioners and physician assistants in 6 Ontario emergency departments could help to reduce wait time, patient flow, and the number of patients who left without being seen (Ducharme, Alder, Pelletier, Murray, & Tepper, p. 455). This study was seen to be the first of its kind in analyzing effects in an emergency department on patient flow by adding nurse practitioners and physician assistants to the healthcare team (Ducharme, Alder, Pelletier, Murray, & Tepper, p. 459). The quantitative study design used for this study was the experimental design since it was based on implementation and evaluation of the effects (Keele, p. 41). The article does not address how the sample size was determined and actually

In response to this the government introduced the fast track systems which was aimed at reducing wait times within ED. But “Have fast-track systems in Emergency departments been effective in reducing wait

We started off by evaluating are current staff in the field measuring top and bottom performers to see what is working and what is not. We followed up by researching various models that would fit with are patient care delivery model; with the goal being standardization of a

While touring with Dr. Willig, we observed the general process of a physician who rounds for an internal medicine service on 9 South, one of UAB’s Internal Medicine floors.  The physicians rounding on this particular floor are considered “Adult Specialists” per Dr. Willig.  Patients are routed to 9 South through a variety of entry portals into the health system: the Emergency Department by way of EMS, ED walk-in patients, ambulatory surgery patients requiring post-op admission, or by direct admission from an outside hospital.   Dr. Willig explained that direct admissions are routed through Bed Control who is responsible for deciding where a particular patient will be placed within the hospital.  This decision is made using clinical judgment in reference to each patient’s particular illness/disease process as well as Teletrac, UAB’s software for tracking the clean status and availability of their patient rooms (Willig, 2017).

The number of readmissions and emergency visits have been seen to decrease when health information exchange is implemented (Yeaman & Rodolfo, 2015). This is really good news for hospitals therefore, they need to embrace the technology. Furthermore,  the Centers for Medicare and Medicaid Services (CMS) is really focusing on the quality of care being delivered by acute care facilities. The hospitals with soaring number of readmissions within 30 days of discharging patients will receive very stiff penalties from CMS under the new rules (Yeaman & Rodolfo, 2015).

Emergency department across the world are facing challenges with growing patient numbers and inability to stretch capacity to meet demand. ED crowding has become a global phenomenon, and has been identified as national crisis in some countries (1) with nearly half of all EDs report operating near or above maximum capacity (2). Emergency department (EDs) in urban settings are experiencing extreme challenges in terms of overcrowding, long wait times, and decreased patient satisfaction (3). Several studies have identified that ED crowding contributes to reduced quality of patient care (4–6), delays in initiation of treatment (7,8) and less adherence to recognized guidelines (9). At some instances it is even linked to mortality. (10).

Hayden, Berlingame, Thompson, and Sabol (2014) studied the impact of placing a Family Nurse Practitioner (FNP) in triage would have on the efficiency of Emergency Department (ED) patient flow. Specific metrics included in the study are left without being seen (LWBS) rate, average length of stay (LOS), average door-to-provider time and patient satisfaction scores. There were 22,937 ED patients included in the study. Of those, 11,463 patients were in the pre-project control group and 11,480 patients were in the post-implementation study group.

Length of stay in the Emergency Department (ED) is one important aspect of healthcare that can affect patient satisfaction as well as the number of patients that can be seen by a physician in a day. Length of stay (LOS) is measured as the time a person spends at the ED between arrival and departure (1). A longer LOS will not only affect patient satisfaction negatively by creating unnecessary frustrations, but can also cause ED overcrowding, leading to poor patient care (2).

Another proxy of the emergency healthcare system is the capacity of the emergency department. Initially emergency departments were created to respond to critical or life threatening conditions but are now responding to a spectrum of conditions ranging from life threatening to non-urgent conditions. This consequentially leads to higher patient volume, and operation beyond the intended capacity and an increase in LWBS. Fayyaz et al., also argues that emergency boarding of admitted patients and hospital occupancy as a cause of ED crowding rather than influx of non-urgent patients. Furthermore, lack of available beds for high acuity patients who are critically ill or intubated may remain in the ED for 24-48 hours awaiting a room. As this continues to get worse the emergency departments continue to receive an influx of critical patients that ultimately places a strain on limited resources such as nursing staff and

The number of admitted patients increases within hospitals on a daily basis. Doctors admit patients for various reasons such as if they want to monitor a patient’s symptoms, reaction to medicine or recovery process. In this way, patients can receive the care they need and get more specialized attention from nurses, doctors, and other medical practitioners. However, if the patients are in a hospital for too long a large payment is reflected in their health bill, and they take up space that more critical patients desperately need. In this paper, we shall discuss the causes of long hospital stays and some recommendations that can reduce the number of inpatient days to the national average of 4.8days.

Emergency department wait times are notoriously long, this not only decreases patient satisfaction, but also decreases throughput and therefore decreases the income of the hospital (by decreasing number of patients serviced), which has obvious consequences for a hospital’s financials. Designs must optimize patient throughput without compromising the quality of patient care.

The third step, NHS need to make the flow of patients and information become more easy and convenient that means patients could avoiding queuing, multiple referrals in the hospital. To achieve this goal, the understanding of demand for