Summary Of Primary Resources Of Emergency Department Essay

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

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

If patients were truly offloaded to NP’s by the triage system it would be cost effective based upon the service rate. But this did not happen. In fact, the percent of patients seen by NPs decreased from 40% to 28%, and the percent patients seen by MDs increased from 41% to 48% (excluding patients that requested a particular provider).

safe patient care across the United States (Needleman et al., 2011). Fewer RNs result in

In an effort to improve nurse to provider communication, an SBAR template (Situation, Background, Assessment, and Recommendation) is being implemented as a format for nurses to share relevant patient information during a triage visit. The project will be developed with input from the Clinical Nurse Supervisor, Information Management Specialist, Staff Nurses, and Providers. To start, a collaborative literature review will be conducted on the most recent research on nurse to provider SBAR documentation. With guidance from the Clinical Nurse Manager the best practice will be identified. The Information Management Specialist will assist in the development of the template and insertion into the electronic health record. In order to limit the scope

The presence of nurse practitioners (NP) in health care has been necessary for more than five decades. The American Association of Nurse Practitioners (AANP) indicates that there are over 205,000 NPs in the United States being utilized by Americans for their health care needs (AANP, 2015). NPs are a vital part of the modern health care system and are accepted by both health care consumers and other health care providers (Fairman, 2015). A study performed by Hart and Mirabella (2015), of emergency department patients determined that patients were satisfied with treatment by a NP in the past and were willing to receive treatment from the NP during their current visit. A study conducted in emergency departments in Canada indicated that NPs demonstrate attentiveness, comprehensive care, and role clarity (Thrasher 2008). These positive characteristics are critical components of patient satisfaction. Additionally, NPs have been utilized more especially with more American developing insurance coverage through health care reform. According to the Department of Health and Human Services (2013), those seeking services in primary care is expected to continually rise through 2020. This increased demand is largely due to the growth of an aging population and from the Affordable Care Act increase in insurance benefits. The Affordable Care Act, along with the shortage of primary care physicians, has expanded the role of the nurse

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.

Many emergency departments (ED) in the U.S. are facing overcrowdings, boarding issues, and scarcities of inpatient beds which have undesirable impacts the quality of care and patient safety (Astle et al., 2012). Recently, the Veterans Health Administration (VHA) mandated the use of electronic Bed Board System (BMS) to improve patients’ experience during admission, transfer, and discharge (United States, 2013). Furthermore, the number of Advanced Practice Nurses (APN) who work in the EDs continues to rise in past few decade (Jenning, Clifford, Fox, OConnell, & Gardner, 2015). The impacts of inefficient bed movement and boarding negatively affect APNs’ practice and quality of care. In this paper, one will propose a phenomenon of interest to comparatively analyze the benefits of BMS versus manual tools on bed placements, boarding times, and overcrowdings using the Neuman Systems Model.

Striving for excellent patient care is the cornerstone of nursing. However, delivery of innovative care requires nurses to take initiative in finding issues and concerns in current clinical practices to promote change that leads to optimal patient outcomes. One current issue in clinical practice is the varying patient-to-nurse ratios (PNRs) amongst different hospitals (Aiken et al., 2012). Having high PNRs may lead to nurse burnout, medical errors, and ineffective nursing care (Aiken et al., 2012; Karavasiliadou & Athanasakis, 2014). The solution would be to regulate PNRs, especially in areas such as the emergency room. To initiate this change, a task force would have to be established to use current data and research as evidence to propose the change, implement the change and evaluate its effectiveness.

The rapidly increasing sector of aging population and an implementation of the Affordable Care Act, which extends coverage to an additional 32 million of Americans, would culminate in the dire shortage of medical providers (Moote, Kleinpell, & Todd, 2011, p. 452). Predicted shortage of health care workforce intensifies the interest in and need to understand better NP utilization, productivity, and unique value (Moote, Kleinpell, & Todd, 2011, p. 453). Within the last decade growing shortage of physicians and the restriction on resident duty hours implemented by the Accreditation Council for Graduate Medical Education (ACGME) in 2003 presented wide employment opportunities for Acute Care Nurse Practitioners (ACNP) (Moote, Kleinpell, & Todd, 2011, p. 452). As nurse practitioners (NPs) assume an increasing role in providing care to hospitalized patients, evaluation of the quality of care provided by ACNPs is an important determinant of their impact on the patients’ outcomes (Kapu & Kleinpell, 2012, p. 1, Sidani & Doran, 2010, p. 31). While organizational constraints and variations in the scope of practice persist, in order to firmly establish the position of the ACNPs in acute care settings, it is imperative to determine to what extent NPs contribute to the quality, safety, and effectiveness of healthcare (Stanik-Hutt, et al., 2013, p. 492).

The ER has a variety of patients come through the department, but everything depends on the severity of the condition to whom is seen first. Patients with chest pains will be seen first rather than a patient with a stuffy nose. When the patient first walks into the facility they are greeted by the nurse at the window. The nurse then will call them in and do an assessment which is the triage part of the ED. Triage is the first person you see when you enter and the one who set you up in a room. Triage assesses the severity of the patient and they decide along with the facility's policy who should be seen first. When the patient has been assigned a room a nurse then will enter and assess the patient's condition with a more focused assessment. The nurse then will hook the patient up to the blood pressure machine with the O2 monitor. Then the nurse will take a temperature to include the assessment of

When working in the emergency department, they need to have certain professional characteristics that will set them apart from general ward nurses. According to( ) rapid assessment, prioritizing, triaging and referral of critically ill patients on timely manner is one of the important attributes of emergency nurses that set them apart from general nurses. Emergency nurses have the ability to care for the full spectrum of physical, psychological and social health problems within their practice area ( ). They are able to develop a relationship with patients from all age range, socioeconomic and cultural backgrounds, in time-limit situations and often at a time when these patients are at their most vulnerable situation ( ).According to( ) emergency nurses demonstrated significantly higher levels of openness to experience, agreeableness, and extroversion personality domains compared to the normal population. Emergency room nurses must be organized and able to balance several patients at one time and in some cases, a single nurse will take care of 10 to 20 patients simultaneously which unlikely happens in general ward ( ).

Last year The Urgent Care Department faced a 2.4 million budget deficit. One of the main sources of premium time was RN overtime. In able to improve budget status, RN ratio was decreased by 1 FTE. RN Triage was supported instead by an LVN III for the evening and weekend shifts. Since LVN III scope of practice shares some similarities with RN scope of practice, some of the duties that were delegated to LVN III included: data collection for patients in the triage schedule, start IV’s, IV Hydration, draw blood, perform clinical procedures (EKG’s, Breathing Treatments, vital signs monitoring etc..) and assist with emergency room transfers. This idea was welcomed by our nursing team ( RN’s and LVN’s). The RN’s felt supported and the LVN’s

The literature review concentrates on the LWBS data and identifies reasons that LWBS rates may decrease. In this study, the author points out that many patients who receive a certain level of care during triage, such as pain treatment, x-rays, etc., may wait longer than those who do not receive those interventions. As discussed by the researcher, the potential for patients to leave without receiving proper care can increase based on age, race, triage acuity, arrival method, gender and payment. It is important to note that length of wait in the emergency department would also effect these outcomes.

Several existing problems precipitated the creation of the triage system implemented by Kathryn Angell in an effort to deliver improved medical care. The main problem was a lack of coordination in service delivery. This lack of coordination caused excessive wait times on the order of anywhere from 23 to 40 minutes to see a nurse, 40 to 50 minutes to see a doctor, and as long as 55 minutes to get a prescription filled. The practice of all nurses being involved initially in seeing all patients caused duplication of efforts, including repeating questions and examinations, and resulted in procedural bottlenecks. Additionally, there were inconsistent levels of service and extreme variation in treatment because of the different experience