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

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).

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

Emergency departments are considered an important aspect of the health care system. For many years, wait times have been an area of concern for many Canadians and remain a significant issue. One of the major concerns within the Canadian health care system is the amount of time spent as waiting time in the healthcare services. Wait times are the length of time from when the patient is triaged and registered, to when the patient leaves from the emergency room (Affleck, Parks, Drummond, Rowe, & Ovens, 2013). Whether waiting for a doctor, waiting for prescription medication, or even waiting to get tested, the reasons for wait time in Canada are caused by many factors (Cole, Hopman, & Kawakami, 2011). This paper will seek to examine the factors contributing to longer wait times in the emergency department, examine the ways in which wait times impact society, and conclude by presenting possible solutions to reduce wait times.

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.

The state of Georgia did not expand Medicaid, and the emergency department continues to face problems with overcrowding. The quality of care is lowered for all patients needing emergency medical services. A lot of the emergency department demand is from patients that could be treated by a primary doctor. The ambulance diversion is when the hospital is over the capacity for the emergency department. However, this problem affects every member of the community, and forces the hospital to send ambulances to other hospitals because of overcrowding issues. The issue of patient boarding, the emergency department holds the patient, even intensive care patients until a bed become available. The overcrowding has caused increased stress on

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

The Centers for Disease Control and Prevention (CDC, 2017) notes the following statistics pertaining to Emergency Department (ED) visits in the United States during 2013: (a) number of visits-130.4, (b) number of injury-related visits-37.2 million, (c) number of visits per 100 persons-41.9, (d) number of ED visits resulting in hospital admission 12.2 million, (e) number of ED visits resulting in admission to critical care unit-1.5 million, (f) percent of visits with patient seen in fewer than 15 minutes-29.8%, (g) percent of visits resulting in hospital admission-9.3%, and (h) percent of visits resulting in transfer to a different (psychiatric or their) hospital-2.2%.

There are are multiple consequences of visiting the emergency department for non-urgent needs. Moskop (2010) identified overcrowding, expensive care, and suggested lower quality of care. The consequences seemed to be universally consistent with varying descriptions. For example, Boyle (2015) identifying long wait times as a consequence but this is an effect of

In this table, number 1 has the highest mean (3.07), for “Adequate support services allow me to spend time with my patients.”. This finding is consistent with the reality of hospitals allowing for laboratory, x-ray, pharmacy, and other services easily accessible to emergency patients. In addition, physicians are permanently stationed in the

Emergency hospital wait times are one of world’s biggest health care problems. It causes anger and frustration to the patient. It can make the patient feel uneasy because as they are waiting that may feel like something is horribly wrong when it fact it could be something small. Waiting does not make the patient feel any less scared. In fact, it makes them feel more scared because as they are waiting they do not know what could possibly be wrong with them. There is a proposed solution that can help alleviate some of the stress put on the patients and hospital staff as well. The solution process includes communicating, improving the perceptions of wait time, and maximizing wait times.

The increase in the emergency department visits is attributed to overall population growth, a decrease in the number of available emergency departments, increases in the number of older Americans, constrained capacity in other outpatient settings, and increasing number of uninsured. (Sultz and Young 2011)

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

Executive Summary: Many visits to the Emergency Department are made for non-emergent needs. This causes congestion in the healthcare system and makes it harder for those who truly need emergent medical attention receive the care they need. Aging populations, under or non-insured patients, Medicaid expansions, and Psychiatric/Behavioral Health problems directly impact overcrowding in the Emergency Department. Providing alternative facilities and services, and utilizing Community Paramedicine programs will alleviate the strain overcrowding Emergency Departments face on a regular basis.

The time sensitive nature of the emergency department makes staffing shortfalls potentially more dangerous than other health care environments. Patients that visited the emergency department of one New York hospital on Saturday, the day the hospital is short staffed, experienced greater levels of infections and death than those that visited during the week (Stock, et al, 2014).