Hospital Admissions

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

Additionally, urgent care centers have been able to offer patients an alternative to the significantly higher cost of emergency room visits. Following an emergency room visit, patients are charged according to the level of care they are receiving which is rated from minor to major injuries and illnesses. Insurance companies may reject coverage of patients who sought care for a low level injury or illness in an emergency room setting leaving the patient with a large bill for a moderate condition. In addition to the cost of the treatment, insurance companies charge patients an additional fee just for utilizing an emergency room. Furthermore, the cost of seeing an urgent care provider versus an emergency department provider is significantly cheaper.

There are many key components in approaching access to health care: coverage, services, timeliness and workforce (Healthy People 2020, 2015). Patients who have a positive and consistent source of care will ultimately have better end results, minor discrepancies and fewer costs (Healthy People 2020, 2015). Timeliness is the health system’s capability to optimize services in a convenient manner, whether it embraces the time spent either waiting in a doctor’s office or an emergency department. At the same time for many patients it encompasses the time between analyzing the need for tests or treatment and obtaining those results. Working as an ER nurse there has been incredible long waiting times in emergency rooms secondary to the fact that people are using the ER for care and more notably as their primary care physician. Likewise prolonged Emergency department wait times can decrease patient satisfaction and notably people leave without been seen. Finally the different element of workforce is vital in contributing access to health services. Primary Care Physicians (PCPs) play an important role in providing access to health services and it has been noted that many medical students are leaning away from working in primary care (Healthy People 2020, 2015). Our ultimate goal is to direct them towards that needed profession.

“Hospitals are not only required to care for emergency patients, but they also are required to do so in a timely fashion” (Pozgar, 2010, p. 272). “Hospitals are expected to notify specialty on-call physicians when their particular skills are required in the emergency department. An on-call physician who fails to respond to a request to attend a patient can be liable for injuries suffered by the patient because of his or her failure to respond” (Pozgar, 2010, p. 271). Under the doctrine of Respondeat Superior, hospitals are also liable for the actions of physicians working or on-call in their emergency department.

Emergency departments are units that specialize in emergency medicine that account for the majority of inpatient admissions to hospitals. The Centers for Disease Control found that emergency department visits increased by a staggering 20 percent in the first decade of the new millennium. In 2011 alone, there were roughly 136.3 million Emergency department visits nationwide. Of that, about 11.9 % resulted in hospital admissions and another 2.1% resulted in transfers to other hospitals and facilities. Patients with private insurance only made up 34.9% of total visits, another 54.4% were covered by Medicare, Medicaid or the Children’s Health Insurance Program and another 32% fell under the category of no insurance which includes only self-pay, no charge, or charity as payment sources (National hospital ambulatory… , 2013). It is noted the total percentage of payment method used exceeds "all visits" because more than one source of payment may be reported per visit and was included in both statistics.

Preventable hospital readmissions remain among one of the many serious quality issues plaguing the healthcare industry today. Readmissions can carry fiscal implications, impact patient safety, and outcomes of care (Helm, Alaeddini, Bretthauer, & Skolarus, 2016). The cost of unplanned hospital readmissions is estimated to be upwards of $15 billion dollars annually of which $12 billion has been associated with preventable admissions (Helm et al., 2016). It is highly recognized that as many as 20% of Medicare beneficiaries are presently being readmitted within 30 days of discharge (Hunter, Nelson, & Birmingham,

The policy of interest that we have chosen to discuss is the two-midnight rule that is inclusive in the Independent Prospective Payers System of 2013. This rule states that only Medicare patients who are expected to require an admission for over two-midnights, or 48 hours, will have their stay covered (Wright, Junt, Feng, & Moore, 2014). The original intent of the observational status concept was to allow physicians a period of time to observe the patient to assess whether or not they required a more thorough medical workup and treatment (Doctorhoff et al., 2014). In 2013, this concept has spiraled into a situation where it is creating confusion to healthcare providers, as these patients are being admitted all over different hospital units, instead of a dedicated observation unit. It is also causing an increased cost to the patient for medical treatment because unless the admission is

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

I found chapter ten to be centralized around the federal law Emergency Medical Treatment and Labor Act (EMTALA) and one’s right to receive healthcare at the time of an emergency, regardless of the patient’s ability to pay or not. Ultimately, I believe the chapter, as well as chapter eleven, to focus on the issue of responsibility. Passed to eliminate “patient dumping,” hospitals have three obligations, a) patients requesting emergency care must receive a medical screening to determine if an emergency medical condition (EMC) exists; b) if the patient has an EMC, they must treat and stabilize; c) if the hospital does not have this capability then an “appropriate” transfer must be conducted. While the intent of the law is good, the outcome

According to the Centers for Disease Control and Prevention (CDC), a mere 9.3% of 130.4 million emergency room visits resulted in admission (CDC/ National Center for Health Statistics, 2017). Thus, the remaining 90.7% of emergency room visits behave as bottlenecks; unnecessarily obstructing the queue. In an effort to remedy such a disproportion I propose, as a third party payer, that emergency department providers be limited to a fee schedule in which reimbursement is provided on the basis of emergency treatment only. Additionally, I propose that restrictions be

Thus, emergency physicians cannot rely on earned trust or on prior knowledge of the patient's condition, values, or wishes regarding medical treatment. The patient's willingness to seek emergency care and to trust the physician is based on institutional and professional assurances rather than on an established personal relationship. Fourth, emergency physicians practice in an institutional setting, the hospital emergency department, and in close working relationships with other physicians, nurses, emergency medical technicians, and other health care professionals. Thus, emergency physicians must understand and respect institutional regulations and inter-professional norms of conduct. Fifth, in the United States, emergency physicians have been given a unique social role and responsibility to act as health care providers of last resort for many patients who have no other feasible access to care. Sixth, emergency physicians have a societal duty to render emergency aid outside their normal health care setting when such intervention may save life or limb. Finally, by virtue of their broad expertise and training, emergency physicians are expected to be a resource for the community in pre-hospital care, disaster management, toxicology, cardiopulmonary resuscitation, public health, injury control, and related areas. All of these special circumstances shape the

From figure 1 above, the table representation of the data from this study indicates that hospitals with high percentage/rate of 30-days readmission for heart failure patients such as Norths Hospital (21.5%) have a very low rate of mortality within 30-days of hospital admission (6.6%). Whereas, some hospitals such as the Metho Hospital has low Readmission rate for heart failure patients (20.7%) but high percentage for mortality rate (12%). On the other hand, there are some hospitals such as the Norwe hospital with a high rate of hospital readmission within 30 days (22.1) and relatively high mortality rate (11.9). But there seem to be some exceptions where there are close ranges between the two variables in hospitals such as Thor Hospital, where

Today people in America go to the Emergency Room for everything. Whether they skinned their knee, have muscle pain, or even a papercut. They don't even try to just put a band aid on it themselves, instead they go to the ER. There are people who take their kid to the ER for a cold when all they have to do is pick up some cough syrup. People don't need to go to the ER for these reason. They either need to go buy band aids, or go to their family care provider. A reason for this influx in visit to the ER is do to the EMTALA Emergency Medical Treatment and Active Labor Act. This bill made it were Emergency Departments can’t turn people away for not-payment. This is good to cover people who really need treatment that they can't offend, but also allows people who don't need to be in the ER to come because they can't get turned away. This has shifted American healthcare model to go to the ER for every bump, bruise, and stomach ache you feel, and not only do you have to wait 4-6 hours to be seen, but are taking an bed from someone who really needs it.

The emergency room has become the new primary care facility for the millions of uninsured in the United States. Thanks to an “unfunded mandate passed into law in 1986,” hospitals that participate in the Medicare program must “screen and treat anyone with an emergency medical condition” (Stephens & Ledlow, 2010). This unfortunately leads to emergency rooms full of people who may have something as simple as a sinus infection which then makes it really difficult for someone with a real emergency that did not require ambulatory transport to be seen in a timely manner. Another unfortunate result of this is that “over 1,100 emergency departments closed over the past decade” (Stephens & Ledlow, 2010).