The Implications Of Using ALOS

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

Every day in this country, millions of people enter the hospital for a variety of reasons with the expectation of receiving the best of care. In the vast majority of hospital admits, the patient is treated and discharged without incidence. However, this is not the case for the estimated 210,000-400,000 annual patient deaths

Patients arriving in the ED are triaged by a nurse then placed in an ED room according to their acuity. After being evaluated by a physician, the patient is either released to home or admitted. When the decision is made for the patient to be admitted, a request for an inpatient bed is placed to nursing administration who then assigns an available bed. If there is not an appropriate bed available, the patient must remain in the ED bed. This effectively reduces the capacity of the ED causing the department to either divert patients or patients will leave without being seen. Every patient who is diverted or leaves without being seen is lost opportunity cost to the hospital.

Upon arrival a patient should have been made aware about a delay therefore he/she would not get inpatient. The appointment itself should not be rushed. A health proffessional should have explained everything in a clear and precise manner giving patient the opportunity to voice any concern or ask any additional questions. In regards to the appointment itself, the

looking at mortality rates in patients seeking emergency care conclude that the rate of death is substantially higher during times of crowding (Richardson, 2006, p. 213).

Immediately life threatening A patient with chest pain, severe blood loss, MVA, sepsis. These types of patient are prompt to deteriorate, and their life could be at risk if not treated within 10 min of arrival in ED. (Basnet, Bhandari and Moore, 2012)

a patient who is admitted to the hospital that requires to stay 1 or more days for treatment.

With so many cases of unfilled position in the hospital patients is not obtaining great services. Patient not receiving proper cares leads to closures, because of prolonged postponements that have led to deaths. Patient complaints at the emergency room have increased in recent years. Numerous patients that were admitted to the hospital’s emergency room are at high risk of dying. Six percent of emergency rooms in the U.S. have closed. These closings took place in the inner-city and low-income areas, but with an emergency room visit increasing by nearly 51%, the overwhelming amount of closures.

The additional revenues that were collected due to increase in ICU capacity by 20 beds enhanced the total ED revenues by 10%.4 The efficiency of care delivery is decreased when patients are diverted to other hospitals, they have to wait for long period to receive care or if they are placed on the floors where they do not belong. This is seen often due to delay in discharging patients.3 These delays and inefficiencies are the primary cause of decreased satisfaction among patients, their families, hospital employees, and physicians. They also result in avoidable increases in patient length-of-stay, reduced quality of care, and lost or diminished hospital revenue.3

In regards to patient outcomes following Code Blue and MET calls (as a percentage), the change from the provided data indicates that the implementation of the ‘EARLY SAVE’ program has had a positive effect on the number of patients remaining on ward. The change in percentages of the variables ‘Could not be resuscitated (died)’ and ‘Transferred to ICU’ has been allocated to the fourth variable ‘Remained on ward’, resulting in an increase in its percentage. An percentage increase in ‘Remained on ward’, and a decrease in ‘Could not be resuscitated (died)’ and ‘Transferred to ICU’ means that more patients were able to be saved, which is a positive indication (Reinhart et al., 2012).

Healthcare in the United States is changing which has given rise to new hurdles that must be overcome. One of the issues that we are currently facing in many tertiary facilities is the need for set criteria involving intensive care unit admissions and discharges. Throughout the country the total number of intensive care unit (ICU) beds are on the rise, but the current supply still outnumbers the demand (Cognet & Coyer, 2014). The cost of staying in an ICU is continuing to increase with technology, and there are limitations that insurance companies and the government have set forth to the number of days a patient can reside there dependent upon his diagnosis and condition. Intensive care units will continue to undergo strain due to high census, and decisions to discharge patients will be effected (Wagner, Gabler, Ratcliffe, Brown, Strom, & Halpern, 2013). Typically, the decision to have a patient occupy an ICU bed is based upon whether or not they are sick enough to be there or if they are well enough to be discharged to a progressive care unit (PCU) or medical surgical unit (Meyer, 2003). A progressive care unit is a step down from an ICU, but has stricter criteria for admission than a medical surgical unit based upon the patients medical status. Not all facilities offer a PCU, but the need for this level of care is continuing to rise with the number of ICU admissions increasing. Standardized guidelines for patient placement in

The study revealed several issues in this department. Voluntary emergency patients have to wait extended periods of time before being transferred to the appropriate department. The majority of those who have to wait are those seeking mental health assistance. Keeping people in the emergency department longer than necessary cause operational costs skyrocket, and worse, keeps the needs of patients from properly being met.

The descriptive statistics were used to evaluate the occurrence of rehospitalization within 30 days (readmission return to emergency department) and discharge outcomes (length of the stay and discharge time). Table 2 on page 252 presents the number and percentage of patients readmitted within 30 days from both groups; this descriptive statistic is also presented in the Figure on page 252. The mean length of stay and standard deviation are included in the same table. In addition, the inferential statistics, such as the t test, the Chi square (2), and logistic regression (odds ratio) were used. The t test was used to analyze interval or ratio data, for example: the length of stay or time of discharge. The Chi square (2) test was used to analyze nominal/categorical data, for example: to assess the relationship between the readmission to the hospital (or ER) and the type of medical team the patient had (with or without the NP). The authors considered a p value below 0.05 as a significant. In addition, the odds ratio was calculated using the logistic regression to

As regionalized ICU care is more common in modern healthcare interhospital transfers of critically ill patients may influence costs both at the referring centre as well as at the referral centre. In case there is no surcharge funding for transferred patients referral centres may encounter underfunding as demonstrated by a study performed in such a referral centre among 569 consecutive patients admitted to a tertiary care ICU from April 1, 1997, to March 30, 2000 [ ]. Crude comparison of directly admitted and transfer patients revealed that transfer patients had significantly higher APACHE III scores (mean, 60.5 vs. 49.7, p < .001), ICU mortality (14% vs. 8%, p < .001), and hospital mortality (22% vs. 14%, p <

inflow of patients is higher than the available beds. You are treating an elderly man who is breathless and cyanosed. While you assess whether he has chronic obstructive pulmonary disease or heart failure, he becomes drowsy and starts gasping. You quickly intubate him with some difficulty, prolonging his period of hypoxia, and put him on ventilator support. You then get a phone call from a senior consultant in the hospital that an important social activist is about to arrive with chest pain and will need to be admitted. You are directed to