Shortening the Wait: A Strategy to Reduce Waiting Times in the Emergency Department
Introduction
Emergency Department (ED) nursing is fast paced and complex in nature. Their goal is to assess quickly and prioritize the patient needs so that those with emergent needs are seen before those with urgent or non-urgent needs. Causes of ED overcrowding and lengthening wait time include, influenza season, inadequate staffing, inpatient boarding due to inadequate hospital beds and patient population larger than hospital capacity (Hoot and Aronsky, 2008). The length of stay in the ED has a correlation with the quality of care a patient receives. Many EDs struggle with patient overcrowding and there appears to be no silver bullet to adequately
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Various contributing factors were identified including population growth, scarcity of primary health care providers, longer wait times for surgery and medical imaging, and the “one-stop” availability of ED services around the clock (Finamore and Turris, 2009).
This study addressed the challenge posed by less-urgent patient population showing up in the ED across Canada. This segment of the ED patients represents a significant proportion of the individuals seeking care in Canadian EDs thereby contributing to overcrowding. The authors hypothesized that less urgent patients might benefit from a targeted approach to care, given that they have conditions that do not require urgent or emergent care but must be seen in an acute care setting like a satellite clinic to adequately address their conditions.
Method of Study
This was a qualitative study that involved structured interviews of key stake holders, identification of data trends, strategizing on how best to meet the needs of the specific community focusing on the less urgent patients in the ED while also addressing the overcrowding problem. The researchers identified, interviewed and consulted key stakeholders from the following groups: emergency nurses, emergency physicians, admitting staff, medical
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
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
The additional revenues that were collected due to increase in ICU capacity by 20 beds enhanced the total ED revenues by 10%.4 The efficiency of care delivery is decreased when patients are diverted to other hospitals, they have to wait for long period to receive care or if they are placed on the floors where they do not belong. This is seen often due to delay in discharging patients.3 These delays and inefficiencies are the primary cause of decreased satisfaction among patients, their families, hospital employees, and physicians. They also result in avoidable increases in patient length-of-stay, reduced quality of care, and lost or diminished hospital revenue.3
Emergency Department crowding is a cause for great concern. It is costly and responsible for compromising quality of care and community trust (McHugh, VanDyke, McClelland, & Moss, 2011). According to McHugh et al. (2011), improving patient flow can mitigate ED crowding. This paper will describe a plan to implement an ED fast-track area (FTA) as one solution to improve patient flow and reduce ED crowding. The author will describe the approval process, review the problem, discuss the proposal, explain the rationale behind the proposal, examine the evidence, describe the implementation logistics, and determine the necessary resources required for implementation.
Knowledge is the driving force for change. As communities grow and expand, so do the issues and challenges facing healthcare. These issues influence the direction of nursing research which provides the scientific basis for our practice and provides answers to the demands for increasing efficiency in quality care, increased need for higher education and development in all areas of the nursing profession.
The Emergency Department (ED) is the highest cost environment to receive non-emergent care. The public views the ED as a safety net; more and more people are seeking treatment in the ED for non-urgent problems. This circumstance not only exacerbates overcrowding, it diverts attention from critically ill or injured patients and can diminish the quality of their treatment. Overcrowding in the ED is a problem that leads to delays in treatment and poor health outcomes (Hutchinson, 2015). ED overcrowding historically has been a problem seen most often in inner-city academic hospitals, but the issue is now a crisis in both urban and rural settings. Such use of expensive
Since the implementation of the Affordable Care Act, emergency department (ED) volume has expanded, exceeding 15% over budget in our hospital in approximately one-year. This phenomenon is not isolated to our organization, it is a nationwide issue (American College of Emergency Physicians, 2014). In addition, ED lobby wait time has increased and the left without being seen (LWBS) numbers have climbed to over 6%. Furthermore, the ED has been to a greater extend, boarding admitted patients.
Overwhelming workloads of hospitals nurses present a considerable problem for the American health system. With the growing nursing shortage resulting from an aging population and the pressure felt by health care organizations to reduce nursing staff in response to massive budget cuts, nurses are being forced to care for too many patients at one time causing severe work stress, fatigue, and burnout. Consequently, the quality of patient care suffers. Implementing a safe staffing strategy to assess the needs of registered nurses (RNs) in the acute care setting would ensure better patient outcomes and guarantee the diminution of the current healthcare crisis.
Emergency departments repeatedly face overcrowding due to increased public demand and decreased hospital resources (Rooney & Schilling, 2014). Finding a way to combat the over-crowding is challenging, because all patients feel that their issue for being at the emergency room is a true emergency and do not want to wait for services. Emergency healthcare professionals are faced daily with the burden of overcrowding and long wait times for their patients. Health promotion programs in the ED allow for better care of patients and in turn decrease the need to return as often and ultimately
Emergency departments are facing a shortage of trained nurses that are capable of functioning in the fast-paced environment such as an emergency department. The problem is the emergency room is not retaining nurses and faces a continuous influx of untrained, new nurses to fill the void. This unstable staffing situation leads to hazardous care environments for both patient and nurse. This is a perpetual the cycle that worsens with time and becomes a viscous cycle of departure. The nurses who stay become fatigued, overwhelmed and burned out, which causes more nurses to leave. The nurses who remain face short staffing, the burden of training new hires without help and no team to rely on for support.
Another aspect that is not taken into consideration is what percentage of these beds are committed to specialized portions of the medical field such as the maternity ward, pediatrics, and the operating room. The Harris health system emergency healthcare department like many hospitals has become overcrowded, so much so that the overcrowding of hospitals has become a national
Today, overcrowding affects the viability of emergency departments across this county (Derlet, 2002). Emergency department overcrowding refers to an excess of patients in the treatment areas exceeding ED capacity. According to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), over one half of all sentinel event cases of morbidity and mortality resulting from delays in treatment occur in hospital emergency departments. Emergency department overcrowding has been cited as a contributing factor in 31% of these sentinel event cases. (Trzeciak & Rivers, 2003). Consequently, overcrowding affects persons who suffer an unexpected severe illness or injury requiring time sensitive emergency treatment. Therefore, patients must
The American College of Emergency Physicians (ACEP) states crowding as, “the identified need for emergency services exceeds available resources for patient care in the ED, hospital or both” (acep.org). What is fueling these incidents is the rapid increase in ED visits combined with diminishing numbers of ED. In a study conducted by the Academic Emergency Medicine explains that, “ ED crowding is worsening in the US as demonstrated by longer waiting times to see clinicians and is likely exacerbated by the worsening problem of ED boarding, where admitted patients often stay for long periods in the ED waiting for inpatient bed placement” (Aronsky et al., 2011; p. 528). Crowding could possibly affect clinical outcomes, such as mortality, which may adversely lead to delays for time sensitive patients. These outcomes would then lead to a higher rate of patient dissatisfaction within the ED, thus leading to an increase amount of patients left without being seen (LWBS) rates.
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 centers 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). Assessment was done to find out the strength and weakness of the current process in use in the ED.
Doyle, Graves, Gruber, & Kleiner (2015) determined that the non urgent and the High Usage Patient were not the sole causes for overcrowding of emergency services. Research showed Emergency Medical Services played a well-defined role in causing patient overflow. Predefined hospital relationships, response needs of the emergency service, emergency service size, and subjective hospital selection were all contributory factors Doyle et al. (2015). Researchers found that hospital selections were based upon the response needs of Emergency Medical Services and not the needs of the arriving facility. In response zones where the call volumes were highest, hospitals that were located within that zone were often inundated with patients.