Risk Factors Of The Emergency Room

Environmental Factors: The hospital is a very busy place. The background noise can distract the attention of the physicians while they ponder over the right prescription of a drug. The high demand of a medical profession can be stressful and lead to fatigue. These possible occupational hazards can contribute to medical errors.

The time is 1900 hours. You are working in a small, rural hospital. It has been snowing heavily all day, and the medical helicopters at the large regional medical center, 4 hours away by car (in good weather), have been grounded by the weather until morning. The roads are barely passable. WR., a 48 year old construction worker with a 36 pack year smoking history, is admitted to your floor with a diagnosis of rule out myocardial infarction (R/O MI). He has significant male pattern obesity (beer belly, large waist circumference) and a barrel chest, and he reports a dietary history of high fat food. His wife brought him to the ED after he complained of unrelieved indigestion. His

Mr. XXXX is a 44 years old Caucasian male, a general construction worker who works on a nearby highway for the bridge project, and checked in this urgent care center for complaining of chest pain and shortness of breath (SOB). The chest pain is constant dull and pressure like pain, and started 3 hours ago. The pain is located on the center of chest. He rates the pain 4 out of 10 on a pain scale 0 to 10 while resting. The pain gets worse and increases after eating. He experienced increased chest pain and SOB with simple walking from the parking lot to this office. The pain was not resolved with taking PO 365mg of Aspirin 2 hours ago and resting. He was diagnosed with hyperlipedemia 10 years ago. He is taking medication to manage his high cholesterol level. He denies past history of chest pain, hypertension, and coronary artery disease. He denies any history of heart surgery or cardio artery bypass surgery. He is anxious and fearful for his first chest and SOB. He smokes a half pack a day for past 20 years. He drinks one bottle of bear every evening with meals. He denies taking any herbal medication or illicit drugs. He has been a good appetite. He reported 20 lbs weight gain since his retirement from military. He has an irregular meal time and does not exercise as much as he used to do in the military.

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

S (situation): Hi, my name Kelsey and I am a nurse in the emergency department. I am calling about Shannon O’Reilly’s most recent laboratory results.

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.

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’.

Uncle Jake and Aunt Leah were playing golf last week. On the sixth hole, Jake told Leah that he was having unusual pain in his left arm and chest. All of a sudden he felt weak and complained that his shirt was much too tight. A dentist playing one hole behind them examined Jake and found he was short of breath, pale, and sweating. He called 911 on his cell phone and told Jake to lie down and wait for the ambulance. The paramedics rushed Jake to the hospital where he was evaluated by a cardiologist. The tests showed that he had four clogged arteries. He was scheduled for surgery the next day.

History of cardiomyopathy. The most recent echocardiogram was done in 2014 showing improved ejection fraction at 55%. He feels asymptomatic, at this time. He did have recent testing with Dr. Dourdoufis. I will request those notes and review them when they arrive. He will certainly let myself or Dr. Dourdoufis know or seek care if necessary if his symptoms change acutely.

Any patient brought into the Emergency Department, is first signed in at ED receptionist desk and triaged by a triage nurse, prioritized and brought to patient room by a charged nurse either by wheelchair or stretcher or walking by the patient depending on patient’s illness. A nurse is assigned to the patient. Emergency Doctor comes in and if the patient illness is life threatening it is stabilized and the Doctor orders test such as blood work and x-ray if necessary to be conducted. Based on the test result the patient is either discharged or admitted. Certain times the emergency department is filled with a lot of patient that there is no place to sit and patients keep coming in and creating

Mr. S is a 29-year-old male with past medical history of (PMH) hypertension (HTN) and obesity who presented to local emergency room (ER) with headache and chest and back pain. Mr. s had been seen at urgent care three days prior for a headache and near syncope and was told to hold his metoprolol due to bradycardia. Due to health insurance related problem, he has been off amlodipine and lisinopril for a month.

As previously determined, multiple risk factors contribute to a person developing cardiovascular disease. For further discussion, obesity will be the primary risk factor discussed due to the high obesity rate in the county I currently reside in. Guernsey County, Ohio, boasts an alarming high rate of residents who lack sufficient physical activity at 83.3%. This is an alarming finding but one that arguably contributes to the obesity rate of Guernsey County’s population at 30.2% which is just above the national percentage of 28.1% in America (city-data.com, 2014).

Emergency room overcrowding is a major issue throughout not just the United States but in many countries. There have been many strategies on how to combat this issue as patient satisfaction is often being a major variable on hospitals being reimbursed, which interventions are most helpful? One intervention that is gaining more and more popularity is advertising wait times. Through a PICO search with key words of “ED triage” and “patient satisfaction” or “wait times” provided some great original research over the past five years that has been peer reviewed in the Journal of Canadian Association of Emergency Physicians. While multiple research papers came up, the methodology and potential of taking this particular study further was of great interest.

Upon arrival to the emergency department at the hospital facility I work for, based on father Aoyagi’s symptoms, vitals were taken, labs were drawn, 12 lead EKG was done, MONA was initiated and the patient was made as comfortable as possible. A brief history was taken. The patient was a 72 years old Japanese native male, 5’4” in height, weighed 84kg, with a good muscular tone, slightly protruding abdomen, appeared much younger than his age, and very clean in appereance. The patient has a long history of smoking about half a pack to a whole pack per day for 40 years, hypertension, slightly controlled diabetes mellitus type II, hyperlipidemia, and possible family history of CHD. His diet was of a traditional Japanese, high in seafood, rice, vegetables, noodles, fruits, and tofu. Patient Aoyagi was a

Joseph is middle age Caucasian male who has suffered a heart attack. This may have been caused by him not taking care of his body properly. Joseph is already at high risk for heart disease due to a family history if vascular disease. He has also been stressing, an increase in weight, not exercising, and unhealthy eating. These things could all