The Rapid Evolution Of Health Care

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

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

From my experience volunteering in the emergency department at my county’s largest healthcare provider, Union Hospital, I recognize the medical issues,

“Long wait times could potentially result in worse patient outcomes, greater patient suffering, patient dissatisfaction, more difficulty retaining and recruiting staff, a higher risk of infectious disease outbreaks and an increased risk of medical errors” (Ducharme, Alder, Pelletier, Murray, & Tepper, p. 456). This article explored how the addition of nurse practitioners and physician assistants in 6 Ontario emergency departments could help to reduce wait time, patient flow, and the number of patients who left without being seen (Ducharme, Alder, Pelletier, Murray, & Tepper, p. 455). This study was seen to be the first of its kind in analyzing effects in an emergency department on patient flow by adding nurse practitioners and physician assistants to the healthcare team (Ducharme, Alder, Pelletier, Murray, & Tepper, p. 459). The quantitative study design used for this study was the experimental design since it was based on implementation and evaluation of the effects (Keele, p. 41). The article does not address how the sample size was determined and actually

Since the implementation of the Affordable Care Act, emergency department (ED) volume has increased exceeding 15% over budget in our facility in approximately one-year. This phenomenon is not isolated to our facility, it is a nationwide issue (American College of Emergency Physicians, 2014). In addition, ED lobby wait time has increased and the left without being seen (LWBS) numbers have climbed to over 6%. Furthermore, the ED was increasingly boarding admitted patients.

When will I see a Doctor? When will I get a bed? These are the questions that are constantly asked when in the Emergency Department (ED). The Canadian Association of Emergency Physicians (CAEP) & National emergency Nurses Affiliation (NENA)(2003) defines overcrowding as a situation where “services exceeds the ability to provide care within a reasonable time, causing doctors and nurses to be unable to provide quality care” (“ED overcrowding”, para. 2). Maintaining access and flow in the ED is essential to the improvement of overcrowding. I am in agreement with the people of Ontario, who state that it is frustrating to wait for hours just to see a doctor or to be transferred to an in-patient unit. Firstly, overcrowding

In case you are unaware of it: There is a serious doctor shortage in North America. Unfortunately, this dearth of physicians seems likely to worsen before circumstances begin to improve.

The year I was born brought a great change in medical history, and no it wasn’t simply because I was born. In 1986 the Emergency Medical Treatment and Active Labor Act was created. This is an act that the United States Congress passed as a part of the Consolidated Omnibus Budget Reconciliation Act (COBRA). It is stated that “It requires hospitals that accept payments from Medicare to provide emergency health care treatment to anyone needing it regardless of citizenship, legal status, or ability to pay. There are no reimbursement provisions. Participating hospitals may not transfer or discharge patients needing emergency treatment

While the community assessment confirms that traditional needs are met by the general acute hospital, the usages of ER services are not typical. Patients in the area are utilizing the emergency room for medicinal conditions that don 't warrant ER admissions. Using the ER for non emergent needs is contributing to inefficient and flawed patient care. (Shaw, Howard, Clark, Etz, Arya, 2013). Information from Providence 's Northeast ER demonstrates that 54% of patient visits, or 18,000 visits, were for restorative conditions that did not warrant ER administrations. This is sharp differentiation to the national normal of just 27% ("Emergency Department Visits", 2016). This exhibits a substantial requirement for an Urgent Care Clinic in addition to an ER.

While most of triage and routing occurs in the PCPs office or through an after-hours call system in a timely manner, the medical triaging system does not always work efficiently. Persons whom are uninsured, or insured yet lacking a PCP, resort to using the emergency room for nonurgent care (Baker & Baker, 1994). Without a PCP to act as a router, and without access to a 24-hour phone support, these individuals' options are limited. If their medical problem occurs at night, or if they are unable to make it to a walk-in clinic during the clinic’s hours because of work, childcare, or other responsibilities, the emergency room becomes the only option. This puts a huge strain on the emergency care system, since a large portion of its resources

However, most of America has also experienced the overcrowding of emergency rooms and have personally experienced the long wait times. Though no research finds a direct cause between EMTALA and overcrowding, long wait times are inevitably discussed any time the EMTALA policy is brought up. However, it certainly does not help that the U.S. has 45 million uninsured individuals who do not have access to primary care and are forced to turn to the emergency department for any kind of medical attention (Monga, Keller, & Venters, 2014). Additionally, of

Quality of care is one of the most important key for the success of health care system. It is unfortunate that the Pennsylvania hospitals are facing workforce shortages especially, the skilled/registered nurses and primary care physicians (PCP’s). Of these, nurses represent the first largest group of health care workers in hospitals, and thus, the shortage of nurses can potentially affect quality of care (U.S Department of Health and Human Service). The American Hospital Association estimated in June 2001 that 126,000 U.S. nursing positions were unfilled. It is estimated that by the year 2020, the gap could widen to at least 400,000 nurse vacancies. This is higher than the average nurse vacancy rate of 9.3 percent for the northeastern United States as reported by the American Organization of Nurse Executives (AONE) in its 2000 report. When the number of nurse staffing reduce, work pressure increases where nurse-to-patient ratio is high leading to more patient infections, injuries and patients will be sent home too early without adequate education about how to take care of their illness or injury, and thus, will cause readmission of patients. Second one is, the increasing demand for primary care physicians which is projected to grow more rapidly than physician supply. Based on current utilization process, the total demand for primary care physicians will

Emergency Department overcrowding is a national problem worsened by ED closures, insufficient hospital bed capacity, and insufficient primary care capacity. Primary care is essential to the effective and efficient functioning of health care delivery systems, yet there is an impending crisis in the field due in part to a dysfunctional payment system (SpingerLink). Practicing primary care physicians are demoralized, retiring early, and advising others not to go into the field (Springer Link). The percentage of recent U.S. medical school graduates and residents planning to enter primary care practice is reducing to levels that will lead to serious physician shortages (SpringerLink). The reasons for this decline are caused by several factors, but a central factor has been a succession of dysfunctional payment systems that discourage proper delivery of primary care. (SpringerLink) Another factor is the stigma of receiving care at Community Health Centers (CHCs) as being inadequate, even though some community health centers offer a

The emergency room has become the new primary care facility for the millions of uninsured in the United States. Thanks to an “unfunded mandate passed into law in 1986,” hospitals that participate in the Medicare program must “screen and treat anyone with an emergency medical condition” (Stephens & Ledlow, 2010). This unfortunately leads to emergency rooms full of people who may have something as simple as a sinus infection which then makes it really difficult for someone with a real emergency that did not require ambulatory transport to be seen in a timely manner. Another unfortunate result of this is that “over 1,100 emergency departments closed over the past decade” (Stephens & Ledlow, 2010).

Healthcare is rapidly evolving and applying new innovations into its field. It now includes more concepts that combine both information and technology, for example, the area of health information technology (HIT). Health information technology is also known as health informatics and includes the different areas of clinical specialties or diseases, user, agent, technology, and information level (Martin-Sanchez, Maojo, & Lopez-Campos, 2002). The field of bioinformatics fits into the category of health information technology because it is a disciplinary field that involves both science/ health and technology (Hoyt, 2010).