Emergency Room Overcrowding

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.

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

Approximately half of a million Americans are homeless, living in shelters or on the streets at any one time (Galea & Vlahov, 2002). The homeless population utilizes the emergency room to gain access to, primary care, nutritional, pharmaceutical and basic needs with non-medical issues is a contributing factor to emergency room overcrowding. The non-medical can primary care component needs to be moved out of the acute care setting of the emergency room but still readily accessible to the homeless clients.

risk factors for disease and injury, socioeconomic status, access to health care use due to

Emergency room over utilization is one of the leading causes of today’s ever increasing healthcare costs. The majority of the patients seen in emergency rooms across the nation are Medicaid recipients, for non-emergent reasons. The federal government initiated Medicaid Managed Care programs to offer better healthcare delivery, adequately compensate providers and reduce healthcare costs. Has Medicaid Managed Care addressed the issues and solved the problem? The answer is ‘Yes’ and ‘No’.

The risk factors present in Mr. E determine the result of been admitted to the emergency room; all the sign was present in this case, even at the moment to arrive to the ER. Also was explain to Mr. E by his doctor. Among the risk factors present in this case are: demographic factors, lifestyle such smoking, alcohol intake, physical activity, and dietary; also in the factors personal or family history like hypertension, diabetes and psychosocial, and the las one the blood work or labs result.

This research is trying to answer the question of how to reduce overcrowding in emergency rooms? Would people would want to access published wait times provided on the internet, and would this guide a patient make decisions on where they receive their care. The hypothesis being one, crowding maybe reduced with having upfront information, and therefore also provide increased patient satisfaction due to waiting less. Patients would have more choices available to them such as

Tang N, Stein J, Hsia RY et al: Trends and characteristics and US emergency department visits, 1997 – 2007.  JAMA 2010; 304: 664-670

Until there are more hospitals and clinics built to meet increased demands in California, undocumented immigrants should not be included in the affordable care act due to long current wait times, decreased capacity, and projected increase of utilization of the health care system. The Affordable Care Act was crafted and signed into law by President Barack Obama to increase the quality and affordability of health insurance and also expanding insurance coverage to decrease the rate of individuals that are uninsured by 32 million (Congressional Budget Office, 2012). It also forces insurance companies to no longer deny anyone coverage due to pre-existing conditions or raise the premiums once they do get sick. Currently, those who remain uninsured in the United States are undocumented immigrants, citizens not enrolled in Medicaid even though they are eligible, or citizens whose insurance coverage costs more than 8% of their household income and is exempt from paying the annual penalty (Trumbull, 2010). In California there is an estimated 2.6 million undocumented immigrants (Wallace, 2012) and before we open our health care services to more individuals, we first must focus on the issues we have now to prevent any potential negative repercussions to the health care system.

The Severity of Illness Index is a widely used four level index (from level 1-4) that determine seven values of a patient’s illness. These values start with the stage of the principal diagnosis, followed by complications of the principal condition, and concurrent interacting conditions that affect the hospital course. These three relate to the burden of the illness of the patient entering a hospital. The next two values are dependency on hospital staff and extent of non-operating life support procedures. These are for internal monitoring purposes only and are minimally affected by hospital staff and practice standards in the organization. They are the least likely to influence predicting the Severity of Illness. The last two values are the

The first three dimensions relate to the burden of illness presented to the hospital by the patient. The fourth and fifth dimensions, dependency and non-operating room life support procedures, have been included for internal monitoring purposes only. They are defined so as to be minimally influenced by the hospital staffand by practice patterns in an institution. We have found that they are the least significant variables in predicting overall Severity of Illness. The last two variables reflect the response of the patient to the hospitalization. It is important to note that it is not what is done to the patient that drives the Severity of Illness Index, but what the patient actually looks like. The signs and symptoms of the patient's principal

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).