The Emergency Room Narcs Intuitive ( Erni )

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

The implications and effects on patients waiting long hours to be seen in the ED are immense. In a recent study done over five years in Ontario hospitals showed the risk of adverse events and even deaths increased with the length of stay in the ED (Science Daily, 2011). When EDs become overcrowded the quality of care changes and declines; which is extremely dangerous. Authors of the study calculated that if ED length of stay was cut by only an hour that 150 fewer Ontarians would die each year (Science Daily, 2011). Wait times can also negatively affect patients financially, untreated medical conditions can lead to reduced productivity and inability to work leading to increased financial strains (Fraser Institute, 2014). As well as delayed access to care can result in more complex interventions needed. Therefore an initiative is needed to provide patients with timely, efficient care when accessing

Canada’s health care system assures universality, portability, and accessibility; disappointingly, not all Canadians have access to specialists and facilities. Many patients face long wait times or do not have access to anesthetic and surgical care because the inadequate supply of anaesthesiologists for demand of Canada’s aging population. For instance, a woman experiencing severe pain in her right lower abdomen may endure excessive wait time to receive pain relief and life-saving care. However, surgical or other medical procedures can only be performed if patients have access to an anaesthesiologist. Despite government promises, and the billions of dollars funnelled into the Canadian healthcare system, the average wait time for surgeries in Ontario is approximately 14.3 weeks (Barua, Rovere & Skinner, 2011).

In Ontario, on average patients wait for 158 to a high of 311 days for surgeries (Health Council of Canada, 2007). To further exacerbate the situation, since 2001 the wait-times for surgery has increased by approximately 50%. Furthermore, on average cancer patients who are suffering with chronic pain wait one to two years for an appointment to see an anesthesiologist for specialized pain treatments (BCAA, 2006). Explain the connection between wait times for surgery and the shortage of anesthesiologists more clearly. The government is not taking enough action to eliminate the issue of long wait times for surgeries; the Supreme Court of Canada says: “access to a waiting list is not access to health care” (CBC, 2006).

A healthcare system is any type organization of institutions, people and resources that are there to provide a healthcare to the population. In any country healthcare system is very important because the quality of life, productivity of the country and life expectancy is determined by the country's healthcare system. Each country has a different healthcare system that is suitable for population. Most of the country has a Universal healthcare system while some of them have a single payer healthcare system. Different governments run different types of healthcare system. Every healthcare system has own strength and weakness. Among the country that

The Global News article brings to light how bad the wait times in emergency rooms really are with people 55 and older waiting more than 2 days to see a doctor. This article informs the public of the situation providing enough statistics and resources in a reader friendly tone, while giving examples of how a province, like Saskatchewan, is

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.

First of all, ED overcrowding has a significant negative effect on patient safety and quality of care. According to….., for patients judged by the triage nurse to be critical, more than 10% waited more than 1 hour to see a doctor. This is dangerous, because many illnesses are time dependent. Late diagnose might result in delays in the treatment and cause permanent consequences of disability or death. High occupancy in one Australian ED was estimated to cause 13 patient deaths per year. Another study examined the complication rate among patients with acute coronary syndrome and found a significant increase in serious complication in patients seeking emergency care during times of crowding. Patients and their accompanying family or friends may also have greater exposure to hospital-acquired infections during prolonged waiting time.

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.

The presence of Emergency Department (ED) crowding, and long boarding times, hinders its ability to provide the quality and efficient care (Weiss, Rogers, Maas, Ernst, & Nick, 2014). According to Mullins and Pines (2014), an average patient in the United States spends more than 4 hours in the ED before being admitted to an inpatient unit. ED crowding and increased boarding time have negatively impacted bed availability, increased staff workload, decreased productivity, and lessened patient satisfaction. Many healthcare organizations, including the Veterans Health Administration (VHA), have established an electronic bed board system (BMS) and InterQual Level of Care Criteria (IQLCC), which aim to enhance patient flow within organizations (United States, 2013).

In response to this the government introduced the fast track systems which was aimed at reducing wait times within ED. But “Have fast-track systems in Emergency departments been effective in reducing wait

According to the health care in Canada survey 14, increased emergency waiting times are the major concern of the population weighing 31% of the health demands.

In a hospital, the Emergency Department is the most crucial area (Girija & Bhat, 2013). With many challenges, the Emergency Department must operate efficiently in an effort to deliver quality care in a timely manner while meeting the patient demand based on volume size (Richard & Jarvis, 2016). If there is an unbalanced match with the patient demand with the Emergency Department capacity and staffing to deliver care within a timely manner, it can reflect on the patient flow and can create crowding and long throughput times (Richard & Jarvis, 2016). As a result, it can lead to poor quality of care and patient outcomes (Richard & Jarvis, 2016). On the other hand, the shortest throughput time while operating efficiently with the needed staffing can lead to good patient satisfaction and better outcomes (Richard & Jarvis, 2016).

Unfortunately, this is an ongoing problem that has yet to be completely fixed. Take into consideration that not every hospital has the resources to build and add beds it is not only adding beds, it is also adding jobs, and then staff must be hired to work the additional beds. So, everything ties into money, so people seeking medical attention in emergency rooms need to be seeking attention only for emergencies, not for care that can be addressed by their primary care, or an urgent care facility. These wait times might not be fixed right away, but they are being worked on, and hopefully a solution will be found that will reduce the wait times in emergency departments all over. I feel the continuing research and patient surveys, more and more solutions can be found and implemented like the RA (Rapid Assessment) and Fast Track areas being used in many hospitals to cut back on wait times and improve quality care, and patient satisfaction. With the rise of patients seeking medical treatment in the Emergency Department in many hospitals, the volumes are going to continue to increase. However, with areas like Fast Track, and systems like the Rapid Assessment, patients with lower acuities will get treated quicker and this will continue to cut down on wait times and free up beds for true emergencies. Having seen all the factors and how they play a part in the increased wait times, I feel that

Overcrowding can be seen as a global issue which directly affects the quality of services in the emergency department. Therefore, providers need to streamline their organisational systems and processes to fully support the process required to deliver high quality care. It is clear that EDs are under even greater pressure to improve their operations; however, there are only a few indications of providers awareness of the tremendous need for focus on improving ED operations (Saghafian, Austin and Traub 2014). Indeed, such improvements are needed for increasing profit (Weiss et al. 2004; Reeder, Burleson and Garrison 2003), improving patient satisfaction (Epstein and Tian 2006; Weiss, Ernst and Nick 2006), and more importantly, improving patient