Naarap Research Model

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

(Mann, 2014, p.2) These strategies include: broadening access to primary care services; focus on individuals who frequently utilize the emergency department (super-utilizers); and targeting the needs of individuals with behavioral health problems. (Mann, 2014, pp 2-4) Many resources and processes have been implemented in order to help decrease inappropriate emergency department visits. This paper is going to demonstrate some resources and processes that are in place to help individuals obtain health care at the appropriate health care setting.

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

There will be information at hand to assist in making medical decision during the time of visit. Lastly, the EHR mandates that people’s health information is to be kept secure ("Department of Health and Human Services," 2008).

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

The Native American Graves Protection and Repatriation Act (NAGPRA) was created to protect Native artifacts and give proper recognition and ownership to the native tribe or direct descendants of which it is rightfully affiliated with. Cultural items include sacred objects, inherited objects, funerary objects, and human remains. NAGPRA is a federal law passed in 1990 that is used by federal agencies and all museums but is applied to anyone who discovers the listed above artifacts. This Act includes provisions for unclaimed and culturally unidentifiable items on Federal and tribal lands. There are penalties for those who do not comply or who partake in illegal trafficking. NAGPRA authorizes Federal grants to tribes, organizations, and museums to help with the documentation and repatriation of items. There is a Review Committee to monitor the process and facilitate the resolutions for disputes.

Clinicians recognize risk factors assess, better diagnose and manage patients and reduce mortality rates. (Trenary, 2007)Describes how Banner Health Care System uses a system called eICU where patients are cared for by intensivists, experienced critical care nurses and health unit secretaries working from a remote location on the campus of Banner Desert Medical Centre. From this location care clinicians can see and hear six different units in five different hospitals .Their aim is to increase this added support to all ICU patients within their Banner Health Care System across the seven states in twenty different facilities. .Using the eICU system the ICU rooms are fitted with a camera, microphone and a speaker .The camera is activated when initiated by the bedside team when there is an alert received from the eICU system .There is no recording availability so the system is HIPAA compliant .This system adds an additional support to the nurse patient ration at bedside. A similar system is used in the Ob department to support the nurses and help to reduce complications during childbirth

I helped register new patients (English and Spanish speaking), verified clinic vaccine records in accordance with the TVFC, and analyzed clinical metrics measures using the clinics electronic medical records. I saw the influence that access to primary care can have on patients, by keeping them out of the ER and helping them keep up with medication and treatment programs.

Within the Electronic Health Record program, the nurse has access to evidence-based practice tools that can assist the nurse in making decisions regarding the patients plan of care (Linder, J., Bates, D., Middleton, B., & Stanfford, R., 2007). The most important feature of the Electronic Health Record is the ability to instantly provide real-time patient-centered data to all authorized providers (HIT, 2013). The Electronic Health Record is real-time, providing nurses with the most up to the moment patient information the significance of this feature can be explained in the following example. For example, if a patient is in surgery, the patient's health record is available to the circulating nurse in the Operating Room, the Post Anesthesia Care Unit nurse and can be shared with the unit staff nurse the patient will be transferred to after recovering in the Post Anesthesia Care Unit. This is of particular importance because having access to the patient's chart, allows the nurses at each phase on the patient's care the ability to prepare supplies, gather necessary equipment and arrange for supplementary staff. Evidence-based practice suggests appropriate planning is a key factor in promoting positive, cost efficient patient outcomes (Anderson, 2012). In the profession of nursing when time is of the essence, and time loss can mean loss of a life, this is a feature that is very

An Electronic Health Record is a computerized form of a patient’s medical chart. These records allow information to be readily available to authorized providers during a patient’s encounter with the healthcare system. These systems do not only contain medical histories, current medications and insurance information, they also track patients’ diagnoses, treatment plans, immunization dates, allergies, radiology images and lab tests/results (source). The fundamental aspect of EHRs is that they are able to share a patient’s information quickly across service lines and even between different healthcare organizations. Information is at the fingertips of lab techs, primary care physicians, pharmacies, clinics, etc. The

This service, once the patient is identified, searches for the existence of records within the exchange. This form of information retrieval would be very helpful to the care of a patient, most specifically in the case of emergency care (Morris, 2012). The Emergency Dept could begin a query at the time of triage to build a problem list, allergy list, medication list, current physicians and ongoing treatments. The costs associated with developing a record locator service, and the questionable sustainability in a market lacking interoperability between the available EHRs, have impeded the development of this form of exchange (Rudin,2014).It has been difficult for HIEs using this format to reach their tipping point to become self-sustaining. There are several determinants driving the success of Query-based HIOs – the need for a broader set of clinical data, more diverse and high-volumes of data, obtaining relevant users that need the database, and utilization rates (Morris,

How can EMR’s improve the nursing process now and in the future? Having had the op-portunity to perform my clinicals in three different Emergency Departments in the past two years and being exposed to both the positive and negative to both paper and paperless medical records Training new nurses is vital for an accurate EMR. Bober, M., & Boonstra, J.

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

Case management in the emergency department, constantly works to find the right data in a patient’s record to ensure that they have the correct insurance coverage and can be admitted or discharged at the appropriate time and place. Even when the smallest amount of essential information is not documented, this otherwise straight forward process turns into a scavenger hunt for who has seen the patient, interventions that were done and for what reasons, and at what time all of these things took place. ED case manager Veronica Kountz (personal communication, March 20, 2015) states that the inadequacy of documentation can lead to insurance companies not covering patient costs, which the hospital then has to absorb. Before a patient can be admitted or discharged, the right

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).