The Emergency Department At Saint Vincent 's Medical Center

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

Improving the quality of discharge planning in acute care include addressing the lack of appropriate staff and patient education about appropriate planning for discharge (4). This includes implementing proper discharge teaching regarding signs and symptoms to seek medical attention, management and care of medical equipment, and access to community resources (4, 5). Other challenges are patients with complex comorbidities too difficult to discharge as well as lack of community supports and equipment for newly discharge patients and lack of rehabilitation and nursing home beds (4). Consequently, acute care units are pressured to vacate hospital beds in response to the growing elderly population. Hospital professionals tend to focus discharge teaching and preparation on medical areas such as diet, activity, treatments, and medications (5). Community referrals to appropriate services at the time of hospital discharge does not often happen contributing to poorer patient outcomes and re-hospitalizations

Omission of nursing care, such as failure to reposition patients, missing medications, and not responding to call lights, is usually unrecognized yet poses a threat to patient safety. Missed nursing care refers to any aspect of required patient care that is omitted or significantly delayed (Dabney & Kalisch, 2015). The more patients a nurse is providing care for correlates with more missed nursing care. This could result in failure to rescue, inadequate nutritional intake, and decreased mobility. Additionally, more missed care was reported by patients who also reported experiencing skin breakdown, medication errors, new infections, and other adverse events during hospitalization (Dabney & Kalisch, 2015). Patients are more likely to receive the wrong medication or medication too late with lower nurse staffing levels (MN

Every one of us has relied on a medical professional at least a few times in our lives. When we get seriously ill, or suffer a serious injury, we put our health in the hands of doctors, nurses, and pharmacists, fully expecting to be treated with a certain degree of professionalism and safety. Unfortunately, sometimes the expected care is not given, or not given to the extent which the ailment requires. In these situations, we can feel blindsided, confused, even taken advantage of.

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.

Meanwhile, elsewhere in Habersham County, Tom was feeling slightly nervous as he exited the staff lounge and entered the hustle and bustle of County Hospital’s ER to begin his first shift as an RN. The first few hours of his shift passed slowly as Tom mostly checked vital signs and listened to patients complain about various aches, pains, coughs, and sniffles. He realized that the attending physician, Dr. Greene, who was rather “old school” in general about how he interacted with nursing staff, wanted to start him out slowly. Tom knew, though, that the paramedics could bring in a trauma patient at any time.

Low literacy affects many individuals within today’s society. The amount of individuals that are unable to comprehend medication labels, medication regimens, and learning points from discharge teaching is shocking and result in further health related injuries (Koh et al., 2012). Nurses must take the important task of recognizing an individual literacy and comprehension ability before planning the individual’s care plan. The nurse must find out the ways an individual can receive information that

    The modern day emergency room is a department that is constantly busy. In the hustle of caring for patients, there are some details of the patient’s care that can be overlooked in a standard phone report to the accepting nurse. With this in mind, a change is needed so that there is an optimum patient outcome for each and every one of the people that walk through the doors of the emergency room and get admitted.

The National Patient Safety Goal 13 was to encourage patients to actively involve in their own care as a patient safety strategy. As per the Joint Commission (2007), the teach-back method is the preferred method to address that goal. According to Fenwick ( n.d.), “Teach-back can help providers communicate with people with low health literacy, but it can also help with communicating overall—even with people with proficient health literacy”. Both the National Quality Forum and The Joint Commission endorse the teach-back method for use in teaching and proper administration of discharge instructions for both the patients and caregivers (Fenwick, n.d.). The American Medical Association also provides the tool kit to educate health care professionals in the use of the teach-back method (Fenwick, n.d.).

Teaching patients about their illnesses and how to prevent illness are essential components of patient self-care. However, we now understand that people have individual ways of learning and many factors can influence one’s ability and willingness to learn. As the healthcare professionals continue to explore new ways to improve the quality of healthcare, they must undoubtedly tailor interventions and educations programs to meet patient’s unique needs. Deborah Clayton studied the effectiveness of reducing HF readmissions through patient education activities and the use of critical thinking skills (2012). She endorses that transition of care programs should focus on stimulating self-care, helping patients recognize warning signs, and preventing hospital readmissions. Moreover, she promotes the use of cognitive aids such as handouts to help patients visually identify changes in their condition as well as diaries and logs help patients track symptoms and progress (Clayton, 2012). Finally, she supports the use of teaching techniques that require patients to recall information and perform “teach-backs” because they help ensure that patients fully comprehend information that has been taught (Clayton,

Research shows numerous barriers restrict effective discharge teaching. Inadequate comprehension is the leading barrier preventing successful teaching thus increasing patient adverse effects, risks, and poor outcomes according to the article, “Effective Discharge Communication in the Emergency Department.” Reading level, advanced medical vocabulary, and low English literacy are the three primary categories hindering comprehension. This quantitative study concluded that the average reading level of sixth grade and the use of medical terminology make understanding instructions difficult and inhibit

Hospitalized patients experience many handoffs of care regardless of whether a community physician or hospitalist attends to them, and verbal and written communication among clinicians at patient discharge is infrequent and suboptimal ((17), (18)).Patients and families must assume an increasingly active role in coordinating and managing their care across settings and at home. Many may lack the knowledge, skills, confidence or resources to do so (19).

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 concern with not educating trainees before graduation is that incident and near misses tend to remain underreported because of the perpetuating negative culture surrounding error reporting. This in turn hinders learning from the event and stifles growth toward voluntary sharing of broken processes and system failures (Barnsteiner, 2011). The current focus on Quality Improvement is to provide high reliable care with little to zero risks by including the “combined and unceasing efforts of everyone—healthcare professionals, patients and their families, researchers, payers, planners and educators—to make changes that will lead to better patient outcomes (health), better system performance (care) and better professional development” (IHI, 2015).