Emergency Department Boarding

A huge effect of boarding patients/overcrowding emergency departments is ambulance diversion. It occurs when a hospital ED cannot accommodate any more emergency patients so

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

The study revealed several issues in this department. Voluntary emergency patients have to wait extended periods of time before being transferred to the appropriate department. The majority of those who have to wait are those seeking mental health assistance. Keeping people in the emergency department longer than necessary cause operational costs skyrocket, and worse, keeps the needs of patients from properly being met.

The practice problem that this writer chose was psychiatric patients that are boarding in the emergency room that do not have a therapeutic environment. The website that this writer chose to use to research about the non-therapeutic environments for the psychiatric patients that are boarding in the emergency room is CINAHL complete. From this search of boarding psychiatric patient in the emergency room, eleven articles resulted. Boarding of psychiatric is all too common of an occurrence in the emergency room because of the decrease in inpatient psychiatric hospital beds. There has been a decreased in beds over the years in 1990 there was “3.7 beds per 1000 person” and in 2006, it decreased to “2.6 beds” (Nolan, Fee, Cooper, Rankin, & Blegen, 2015, p. 57). All of the article that were resulted from

Law enforcement interactions with the mentally ill community are increasing, due to a number of factors such as cuts on long-term psychiatric beds, improvements in treatments and the philosophy of integration (Adelman, 2003). Which leads to mentally ill people living in the community, which leads to increase crisis and police interaction because of insufficient funding. Existing community-based crisis response services are not well unified and are limited, especially in rural areas. General hospital-based emergency services can also be difficult to access because of bed reductions, and only offer treatment to those only that are seriously ill (e.g. be actively delusional or suicidal). As Eric Macnaughton states in his study BC Early

(Mann, 2014, p.2) These strategies include: broadening access to primary care services; focus on individuals who frequently utilize the emergency department (super-utilizers); and targeting the needs of individuals with behavioral health problems. (Mann, 2014, pp 2-4) Many resources and processes have been implemented in order to help decrease inappropriate emergency department visits. This paper is going to demonstrate some resources and processes that are in place to help individuals obtain health care at the appropriate health care setting.

The United States has never had an official federal-centered approach for mental health care facilities, entrusting its responsibility to the states throughout the history. The earliest initiatives in this field took place in the 18th century, when Virginia built its first asylum and Pennsylvania Hospital reserved its basement to house individuals with mental disorders (Sundararaman, 2009). During the 19th century, other services were built, but their overall lack of quality was alarming. Even then, researchers and professionals in the mental health field attempted to implement the principles of the so-called public health, focusing on prevention and early intervention, but the funds were in the hands of the local governments, which prevented significant advances in this direction.

In 1965, there was a histrionic change in the method that mental health care was delivered in the United States. The focus went from State Mental Hospitals to outpatient settings for the treatment of mental health issues. With the passing of Medicaid, States were encouraged to move patients out of the hospital setting (Pan, 2013). This process failed miserably due to under funding and understaffing for the amout of patients that were released from the State Mental Hospitals. This resulted in patients, as well as their families, who were in dire need of mental health services. This population turned to either incarceration (jails and/or prisons) or emergency departments as a primary source of care for their loved ones.

The state of Georgia did not expand Medicaid, and the emergency department continues to face problems with overcrowding. The quality of care is lowered for all patients needing emergency medical services. A lot of the emergency department demand is from patients that could be treated by a primary doctor. The ambulance diversion is when the hospital is over the capacity for the emergency department. However, this problem affects every member of the community, and forces the hospital to send ambulances to other hospitals because of overcrowding issues. The issue of patient boarding, the emergency department holds the patient, even intensive care patients until a bed become available. The overcrowding has caused increased stress on

Emergency department (ED) overcrowding has become an international health crisis and been identified as a major threaten to public health. As defined by Australasian College for Emergency Medicine, overcrowding is a situation in which ED patients’ demand for services exceeds the staffing capacity to provide care within a reasonable length of time, thereby impeding ED function. Some has called ED as the safety net of the health care system, given its unique role in public health. However, the increasing problem of crowding and the associated impacts has strained this safety net to the “breaking point”. ED overcrowding and prolonged waiting time are associate with adverse consequences towards quality of care and patient safety, as well as

As the ultimate safety net, Emergency Departments (EDs) are expected to care for any patient, at any time, under any circumstance. When EDs are overwhelmed in periods of surge, one solution is to redistribute the patients. A commonly used method of redistributing patients is ambulance diversion. Ambulance diversion is not a new phenomenon, and over time has become commonly employed by EDs to address the growing problem of ED overcrowding and saturation.1 As ED visits have increased through the years, ambulance diversion has evolved into standard practice in many health systems. Along with this, ambulance diversion has always been controversial whether it is actually beneficial or detrimental to the patient, EMS systems, and hospitals.

Middletown Hospital is a 200-bed, not-for-profit-general hospital that has an emergency department with 20 emergency beds. The emergency department handles on an average 100 patients per day. The hospital’s CEO has authorized the Six Sigma Team (SST) to address complaints received from patients seeking treatment between 6:00 p.m. and 10:00 p.m. The complaints are centered on waiting times and poor service. During this time the data indicates that approximately 70% of the department’s admissions occur (University of Phoenix, 2009, Course Syllabus).

Patient safety and quality of emergency room care are the greatest threats today (ACEP, 2014). Over crowding in Ed, shortage of staff, specialist, increasing medication error all compromise patient safety ,in effective and inefficient transition of care leads to errors, adverse events, inappropriate or increase length of stay and increased health care cost (state health. org). The principle goal of patient transfer is to provide quality care and well being. Emergency room over crowding is one of the major issue faced by every organization today. ED over crowing can compromise care quality, community trust, decrease patient outcome (AHRQ, 2010).

Mental infirmity is involved. If a person has a history of mental illness such as schizophrenia, depression or manic depression and has become terrifying in some way, or unsafe to himself or others, a hospital is the place to go. Also, if someone is using drugs and his behaviour drastically changes or he looks unwell due to health changes, he may need emergency care. Hospital emergency staff are trained to deal with crises, calm people and prevent suicides.

Emergency rooms across the nation are experiencing the epidemic of mental health patients boarding in their departments for days and weeks. The demand for beds far outweighs the supply and for pediatric patients it is even worse. The lack of community mental health resources and poor coordination of care are just a few of the reasons (Meieran, S., 2016). Suffering alongside the patients are the many caregivers who struggle with the moral and ethical issues surrounding the care of these young patients placed in this environment.