Emergency Department Models of Care

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

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

14 million Canadians visit Emergency Departments (ED) every year, and also reported to having the highest use of EDs (Ontario Hospital Association, 2006). ED overcrowding in Canada has become an epidemic. ED overcrowding has been defined as “a situation in which the demand for emergency services exceeds the ability of an (emergency) department to provide quality care within acceptable time frames” (Ontario Ministry of Health and Long Term Care, 2014). This has been an ongoing problem across Canada. Ontario has developed an initiative to reduce ED wait times by implementing a variety of strategies and collaborating with other institutions. This paper describes the Emergency Room National Ambulatory Intuitive (ERNI), an

S (situation): Hi, my name Kelsey and I am a nurse in the emergency department. I am calling about Shannon O’Reilly’s most recent laboratory results.

This study will include nurses that are currently working in emergency department with at least six months of experience with varying ages and levels of education. The emergency nurses would be required to complete a formal training on understanding the Emergency Severity Index (ESI) algorithm and the complexities in accurately assigning a triage level. The level of competence of the nurses will be increased if they participate in the online educational opportunities. In addition to the formal course, an online acuity level triage designation course will also be implemented. The ED leadership team will be instrumental in encouraging staff to participate so they are adequately prepared to function as a triage

Any patient brought into the Emergency Department, is first signed in at ED receptionist desk and triaged by a triage nurse, prioritized and brought to patient room by a charged nurse either by wheelchair or stretcher or walking by the patient depending on patient’s illness. A nurse is assigned to the patient. Emergency Doctor comes in and if the patient illness is life threatening it is stabilized and the Doctor orders test such as blood work and x-ray if necessary to be conducted. Based on the test result the patient is either discharged or admitted. Certain times the emergency department is filled with a lot of patient that there is no place to sit and patients keep coming in and creating

The author will discuss within the essay, the introduction of the Emergency Care Standard and the effects on patient flow within the NHS. Also, the many changes which have implications for the author professional practice and how if possible they maybe overcome.

The role of the emergency department is to diagnose and treat acute and urgent illnesses and injuries. Patients are seen in order of medical urgency. The emergency department bases the patients urgency for treatment based on levels. Level 1 is critical and life-threatening. This is usually related to ABC’s (Airway, Breathing, and Circulation). These patients are top priority and require a lifesaving intervention. Level 2 is also considered high priority and can also be life-threatening. Psychiatric patients are considered level 2, and patients arriving to the ED with chest pain. Level 3 patients require resources such as sutures, x-rays, CAT scans, MRI, etc. Level 3 patients are provided treatment services only after Level 1 and 2 have been addressed. The emergency department at CEMC also has a trauma room and a SANE room. The trauma room is equipped with life-saving medications (such as antidotes for drug overdose) and medical equipment. The SANE (Sexual Assault Nurse Examiner) room consists of equipment used to assess a patient who has been sexually assaulted. The equipment takes pictures of the patient for the SANE nurse to later provide to law enforcement. A SANE nurse is a specialty nurse and CEMC has one on call 24/7.

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

Some quality service and process in EmCare, such as Door –to-Discharge service or Rapid Admission process, or using the software which can keep records to progress emergency as well as hospital medicines can provide the top patient experience.

Kendra Chappell is a clinical shift manager (CSM) in the emergency department at Forsyth Medical Center (FMC). According to their website, Forsyth Medical Center is a 921-bed, not-for-profit, regional medical center in Winston-Salem, North Carolina, that offers a full range of medical, surgical, rehabilitative and behavioral health services (About us, n.d.). FMC has earned magnet designation from the American Nurses Credentialing Center (About us, n.d.). Kendra has twenty years of nursing experience including working as a Practical Nurse before obtaining her Register Nurse degree 15 years ago. She was a staff nurse in the emergency department for ten years before being promoted to CSM. She has earned a bachelor of science in nursing at Appalachian State University and is a Certified Emergency Nurse. She is certified in basic life support, advanced cardiac life support, pediatric advanced life support, trauma nursing core course, and emergency nursing pediatric course, certifications that are required of all emergency nurses at FMC. Kendra oversees the 81 bed FMC emergency department from 7 a.m. to 7 p.m. every Friday, Saturday, and Sunday. She supervises 25 to 30 nurses and 10 to 15 nursing assistants throughout the course of each shift.

In order to pass this unit, the evidence that the learner presents for assessment needs to demonstrate that

As an emergency nurse, I work in a very fast paced environment with many different groups of health care workers dealing with patients from all age groups and with different health complaints. As we all were witnessed at some points in our career, health care system goes under changes constantly which can be challenging sometimes. Example of that can be the change related to technology system. “Technology has brought about changes in the delivery of healthcare, especially in the speed with which information is communicated and stored and in the amount and kind of information that is available for decision making in nursing and administration.” (King, 2006, p. 100). In order to be successful during changes, strong management, good communication, and great team work is important.

I definitely agree with you on that in the emergency room (ER), patient-centered care can be a challenge. In the ER it is very busy and not that much is getting communicated with the patients’. If ER care is poorly patient‐centered during normal operations, it is likely even worse during times of crowding. The hospital I work at the ER is so crowded patients’ and their family members have to wait in the halls and lay on the gurneys, and wait for bed availability on the floors. This definitely happened when we had the flu epidemic going on. The ER was so packed and it was very busy and it was hard to communicate with the patients, because the ER nurses were running around from one patient to another. There are some patients that understand that

Safe, effective, patient-centered care delivered in a timely and efficient manner is the goal of quality healthcare. Unfortunately, the delivery of such quality faces serious concerns. The Institute of Medicine (2001) describes the quality gap in healthcare as having three types of problems, “overuse, underuse, and misuse” (p. 23). In recent years, emphasis on improving the quality of care has increased (IOM, 2001). Quality improvement methods, such as plan-do-study-act (PDSA), have successfully enabled health care providers to address the quality gap. The purpose of this paper is to identify a quality healthcare problem, discuss the quality improvement plan, and describe the strategy for implementing effective change using the PDSA method.