Urban Hospital: Article Analysis

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 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

There are many key components in approaching access to health care: coverage, services, timeliness and workforce (Healthy People 2020, 2015). Patients who have a positive and consistent source of care will ultimately have better end results, minor discrepancies and fewer costs (Healthy People 2020, 2015). Timeliness is the health system’s capability to optimize services in a convenient manner, whether it embraces the time spent either waiting in a doctor’s office or an emergency department. At the same time for many patients it encompasses the time between analyzing the need for tests or treatment and obtaining those results. Working as an ER nurse there has been incredible long waiting times in emergency rooms secondary to the fact that people are using the ER for care and more notably as their primary care physician. Likewise prolonged Emergency department wait times can decrease patient satisfaction and notably people leave without been seen. Finally the different element of workforce is vital in contributing access to health services. Primary Care Physicians (PCPs) play an important role in providing access to health services and it has been noted that many medical students are leaning away from working in primary care (Healthy People 2020, 2015). Our ultimate goal is to direct them towards that needed profession.

A point prevalence study conducted by … fount that the mean reported waiting time was 3.7 hours per patient. The times for the longest boarded patient ranged from 15 minutes to 33 hours, with a mean maximum waiting time of 8.3 hours. The prolonged ED waiting time resulted from ED overcrowding has negative adverse outcomes upon different stakeholders, including not only patients, but also staff members and hospitals.

“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

As EDs struggle to provide quality of care in a timely manner, due to ED crowding and boarding time (P), do the BMS and IQLCC offer a solution to improve the current status with their multiple real-time functions for tracking flow

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

I enjoyed reading your post. I am so surprised that the hospital allowed your son to wait six hours in the Emergency Department (ED) before seen by a pediatrician. That is outrageous. Long wait times remain to be an issue for many hospitals. There are tools to help hospital address this issue. The Agency for Healthcare Research and Quality developed a tool called TeamStepps (Rice, 2016). It stands for Team Strategies and Tools to Enhance Performance and Patient Safety (Plonien & Williams, 2015). It is a tool designed to encourage teamwork in health care settings. An out of state hospital called The Banner Payson Medical Center implemented the TeamStepps in their Emergency Department (ED) to address their long wait time issues. (Rice, 2016).

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.

Delays could also be due to further investigation or treatments that may be required prior to a specialist referral or specific health care services. (7) Wait times can be increased due to patient needs outside of the health care system. Only 11.1% of patients on the overall health care waiting lists are due to patient requests for delay of postponing of treatment. (6)

Time is obviously a critical factor when seeking medical attention. Emergency room nurses triage incoming patients based on the severity of their illness or injury. While an ER is required to attend to all patients, many find themselves waiting a very long time as other individuals

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

As can be seen in Table 1 below, the resources causing the long wait times are those that are over utilized, or those that show capacity utilizations greater than 100 percent. The only over utilized resource are the Physicians, who are being over utilized by 21 percent. The other major resources are still underutilized.