Health Care Executive Summary

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 overcrowding occurs, patients are placed in the hallway waiting for room to be transferred to. Any time overcrowding occurs most ambulances divert away from the closest hospital to the patients and in this situation hospitals lose a lot of revenue. Data published in the US Department of Health and Human Services (HHS) in 2004 report national hospital ambulatory medical care survey on ED summary depicted that ED in United State are approaching a boiling point in terms of increasing patient demand and shrinking bed capacity, Levin et al (Fall,2006). According to the Institute of Healthcare Improvement, a recent survey conducted by the American College of Emergency physician of about 200 hospital administrators, majority pointed at overcrowding as their major constraint and about 60% said overcrowding in their facility forces the diversion of patients with urgent need

With a shortage of nurses, the care and safety of patients may become compromised. The nurses themselves may be having feelings of dissatisfaction, overwhelm and distress. Nurses who may become overwhelmed with the high number of patients may become frustrated and burnt out. And inadequate staff of nurses may lead to a negative impact on the patient’s outcome. The quality of care the patients may receive in facilities with low staffing may be poor.

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

I would say the majority of issues I have seen relate to nurses feeling their patient load was too much which may possibly result in unsafe patient care. This typically relates directly to staffing issues.

The administrator and the director of the nurses had poor communication with staff. They did not show up in the wings and their communication with staff relied just on the staff meetings and it wasn’t appeared in the case that how often they had meeting. They did not discuss the possibility of implementing the job rotation with the charge nurses, before announcing it in the meeting in order to evaluate available resources and decide whether job rotation would be beneficial to the Clinic or not. The principles of such job rotation must be stated in the staff plan, the personnel policy program or the personnel strategy of the workplace. Another issue was the evaluation of the charge nurses. It is not clear from the case that who was doing their evaluation and who was controlling their work? It seems from the case there was no supervisor to control their work and the manager gave all the authority to the charge nurses. So, how the charge nurses knew that they were doing well or know about their strengths and weaknesses. By giving all the authority to charge nurse without any constant control, they missed some vital information. Additionally, because nobody evaluated charge nurse activities they didn’t receive any feedback about their performance. The charge nurses also had a weak communication with their staff. Jennifer, the charge nurse of wing A didn’t have enough time to

The emergency department (ED) is one of the busiest place in most hospital and time is very crucial in some case. A survey done in 2002, shows that 90% of Level 1 trauma center and hospital are considered over capacity with more than 300 beds and 62 % of ED considered themselves the same (Milsten, A., Klein, J., Liu, Q., Vibhakar, N., Linder, L., 2014. p.13). Some might think it is beneficial in a business aspect; however, the negative effects have more weight than the positive. As the number of population increases, the ED started to notice a correlation with the increasing crowd, which has created a delay in treatment and even some patient had to leave without being seen (LWBS) by a physician or PA. Patients being unable to see a healthcare professional in the appropriate time and LWBS have been linked to the increase in mortality, physician door to doctor time, patient

. As a director of the ED, I need to resolve the problem as soon as possible. Mrs. Morrigan complained about long waiting hours. My first step will be to find the direct causes for the long waiting times; it may be due to the carelessness of the healthcare providers towards their duty, or it may be due to their failure to manage the time. The next step I will take is to find out the root causes behind these direct causes. The root causes might be understaffing and high workload, the patient to staff ratio may not be optimum, due to which physicians and nurses are not able to manage their time. The other root cause may be a dissatisfaction of the staff towards their job, which may be due to low salary, poor working condition and poor relations

The three governing entities for hospitals-- the medical staff, the administration and the board of trustees—seemingly have the same goals of providing safe, quality patient care and to do so at a reasonable cost. Tension between the three often exists, however, despite the common goals. I believe there are three main reasons for this tension: Mistrust, unclear expectations and lack of communication. These three concepts are intertwined, with each one affecting the other two, so it generates a cycle that is difficult to break.

In the United States, between 1996 and 2003 emergency room visits rose from 9.3 million visits to 113.9 million visits; an increase of 26 percent with an annual visit rate of 35.7 visits per 100 persons in 1992 and 39.6 per 100 persons in 2005 (Hunt, K., Colby, D., Grimes, B., Bacchette, P., Callaham, M., 2008). As the demand for ED services increase, wait times increase, over-crowding occurs, resources are strained and poorer patient outcomes are often the result.

Neither staff member identified the downward trending of the patients available vital signs and did not evaluate consciousness of the patient. Failure to assess appropriately and recognize deterioration of the patient resulted in a prolonged period of time in which the patient was not adequately oxygenated. Research has shown that short staffing, with decreased nurse to patient ratio, has been found to be associated with increased mortality (Aiken, Clarke, Sloane, Sochalski, & Silber, 2002; Joint Commission on Accreditation of Healthcare Organizations, 2005; Needleman, Buerhaus, PKankratz, Leibson, Stevens, & Harris, 2011). This reinforces the need to match staffing with patient census, acuity, and need for nursing care.

Executive Summary: Many visits to the Emergency Department are made for non-emergent needs. This causes congestion in the healthcare system and makes it harder for those who truly need emergent medical attention receive the care they need. Aging populations, under or non-insured patients, Medicaid expansions, and Psychiatric/Behavioral Health problems directly impact overcrowding in the Emergency Department. Providing alternative facilities and services, and utilizing Community Paramedicine programs will alleviate the strain overcrowding Emergency Departments face on a regular basis.

Taking a newcomer view to the emergency department, one thought stands out: the services given in the ED are often not the intended use of the facility. I found numerous articles which examine overcrowding, patient expectations at triage (mostly wait times), and the high cost of care, with the common conclusion that many of the patients seen in the emergency room should not be there at all. Medicaid defines "Emergency Medical Condition" as a medical condition (including emergency labor and delivery) that manifests itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in: placing the patient's health in serious jeopardy; serious impairment

Staffing deficits pose a direct threat of manifesting negative outcomes associated with the delivery of patient care. Anything or anyone that compromises patient care should be eradicated immediately. This author believes that staffing deficits remain a consistent issue due to lack of solutions that actively address the issue. This author believes that inadequate staffing is a major concern due to the degree of harm it can impose on patients. Adverse events associated with