The Retrospective Analysis Of Quality Improvement Throughput Measures At A High Volume Community Emergency Department Essay

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

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

When overcrowding occurs, patients are placed in the hallway waiting for room to be transferred to. Any time overcrowding occurs most ambulances divert away from the closest hospital to the patients and in this situation hospitals lose a lot of revenue. Data published in the US Department of Health and Human Services (HHS) in 2004 report national hospital ambulatory medical care survey on ED summary depicted that ED in United State are approaching a boiling point in terms of increasing patient demand and shrinking bed capacity, Levin et al (Fall,2006). According to the Institute of Healthcare Improvement, a recent survey conducted by the American College of Emergency physician of about 200 hospital administrators, majority pointed at overcrowding as their major constraint and about 60% said overcrowding in their facility forces the diversion of patients with urgent need

St. Vincent’s Medical Center, a 501 bed facility located in Jacksonville, Florida, provides general medical and surgical care to the North Florida Region. St. Vincent’s admits over 26,000 patients annually. The average occupancy rate is approximately 84% with the Emergency Department (ED) peeking at 100% for approximately 4-12 hours daily. The hospital is struggling with availability of bed space. This shortage of available beds creates a bottleneck in the ED on high census days. Bottlenecks are created in the ED when there is a shortage of inpatient beds to place admitted ED patients. Thus, patient flow, or throughput, is becoming more and more important.

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

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.

Visit your local Emergency Room on any given day and you are likely to witness a sort of controlled chaos: nurses, doctors, transporters, patient care technicians, and other ancillary staff members all darting about, attempting to meet the needs of increasingly sick patients in oft-overwhelmed and overpopulated hospitals. All around, various alarms sound. IV pumps signal fluid bags about to run dry. Vital sign monitors ping at differing volumes and intensities, in an electronic demand for staff to mind the out-of-normal-range

This research is trying to answer the question of how to reduce overcrowding in emergency rooms? Would people would want to access published wait times provided on the internet, and would this guide a patient make decisions on where they receive their care. The hypothesis being one, crowding maybe reduced with having upfront information, and therefore also provide increased patient satisfaction due to waiting less. Patients would have more choices available to them such as

“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

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

Emergency Departments (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. This paper describes the Emergency Room NARCS Intuitive (ERNI), an innovative program which focuses on reducing ED wait times and patient satisfaction in order to optimize quality of care.

Getting patients in and out help both patients and nurses. Getting patients happy and not having to sit there very long. To help with getting patients in and out fast could be with the electronic health records. Updates like these in the Emergency Rooms can work to make things smoother. Nurses will always be working their best to get things done in the best way possible. If that means no breaks and working longer hours for patient satisfaction higher, they will. Health records, hours, uniforms and hours are all changing in the Emergency Room. If that means the way health records change over from paper to electronic or having nurses uniforms change to pants and not dresses. Having said all this fantastic information about the changes in the Emergency Rooms things are getting better. So next time you go to the emergency room look to see how long you have to wait, look how they ask you question and put in the computer, how they can just pull up your chart fast, know all of your information and how the nurses uniforms look professional. Emergency Rooms have been around and being upgraded all the

This article addresses the nationwide problem of crowding in the emergency department. Crowding in the emergency department creates delays in care and has been proven to be most prevalent in urban and teaching hospitals across the country. The authors infer that since the institution of the Emergency Medical Treatment and Active Labor Act (EMTALA) in 1986, record numbers of individuals seeking care through the emergency department has skyrocketed. Patients either use the emergency department as the first line of care or the last line of care. According to the study, uninsured members of society are most likely to utilize the emergency department for care versus their “sicker” insured counterparts. A survey conducted in 2010 by the American

Most hospitals experience the affects of the unexpected, ambiguity and uncertainty, and as a result, face challenges with quality. Middletown Hospital is a 200-bed general not-for-profit hospital. The hospital has a 20-bed Emergency Department (ED). It averages 100 patients per day. The CEO of the hospital has been receiving numerous complaints about long waits for care and poor service and has charged the Six Sigma team to analyze the root cause of the bottleneck (University of Phoenix, 2011 Course Syllabus). This paper analyses the root cause