“Worst Case Scenario” – the Nightmare

The emergency department (ED) I worked for was a Level I Trauma Center, so patients were transferred by ambulances, most of whom were in very severe conditions, such as cardio-pulmonary arrest, unconsciousness and multiple trauma. There was no room for patients to choose a hospital. Roughly a third of patients coming to the emergency room (ER) died unfortunately. The other third admitted to the intentional care unit (ICU), and the remains stayed at other wards in the hospital or went back their home in a few days. In the ICU, the patients were laid on the beds that were lined toward walls and separated on the side from their next patients with only roll curtains hanging from the ceiling. Hence, they can

Measures 1) number of lateral transfer 2) median length of stay in the ED 3) bed occupancy rate.

The ICU should be equipped with a recliner in every patient room, therefore 12 more recliners need to be purchased. Signage inside the patient’s room can be made by printing and laminating the AACN Early Progressive Mobility Protocol from their website with minimal cost. Total estimated cost including 12 recliners and staff education time: $ 10,200. Re-teaching will be implemented at staff meetings on a quarter-yearly basis and the ICU nurses will have the opportunity to provide constructive feedback. HCAP statistics will provide data regarding length of stay in the ICU, Ventilator and Health-care Acquired Pneumonias and Wound care will contribute the data for Decubitus occurrence.

5. Phase V guarantees nurses are occupied with progressing investigates and assessment of the procedure and results, building up a nonstop process (Coombe,

An example of this might be a pediatric trauma patient. The patient is the victim of an accidental gunshot wound by a family member. The family lives on a farm outside of town and drove the victim to the closest hospital. The patient is being stabilized in this rural hospital and prepared for transport to the nearest Level 1 Trauma Center. This small hospital may not have the resources in place to adequately assist this family during a time of crisis. The ADN

Considered as top priority and central to the recovery plan of the unit, the operations of the unit have to be re-hauled, with higher emphasis on delivery of quality practices in preventing and controlling healthcare infection. The high risk areas of infection have to be curtailed with close monitoring, supervision of routine procedures of treatment. Exacting pressure has to be maintained to ensure there is no laxity among staff and all disposables are handled as per procedure and industry benchmarks achieved to the closet segment. Patient fall instances have to be contained by revisiting the existing physical layout of the unit, followed by examination and ad-hoc monitoring of the unit for obstacles in the path of patients. The budgetary allocations have to be handled with sagacity as nursing professional enhancement courses are primary in the current situation. The optimization of allocation of the limited budget would be prioritized with a maximum allocation provided to functions which would lead to immediate solutions for the unit to rebound as a top unit within the organization. The clinical goals would include (1) Holistic care of the highest quality standards (2) Patient-centric service delivery with optimized inter-professional cooperation. (3) Efficient and profitable management of resources (4) optimize healthcare integration scope.

In this paper I will be playing the part as a chief operating officer (COO) and I am responsible for a 15-bed Emergency Room (ER). In this scenario I am facing many complaints within the last year regarding inadequate care, poor Emergency Room management, long wait times, and patients being sent away because of lack of space, staff, or physicians to provide appropriate care. I am asked to (1) Thoroughly diagnose the root causes of the complaints about the clinic, (2) thoroughly devise a strategic plan for overcoming the problems associated with the current Emergency Room, (3) thoroughly justify how the “Good

We have established a comprehensive Emergency Operations Plan to handle our resources to provide safe environment for our patients in the event of adverse conditions such as power failures, water, fuel shortages, flooding, and communication breakdowns. Our facilities are prepared, staff knows responsibilities to extend patient care under disrupted utilities and other emergency situations.

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

The identified barrier in this transition of care from acute care to a skilled level when information is copied and the hard-copied chart is sent with the patient on their transport to the skilled facility. This process leaves room for many errors, when we rely on nursing personnel who are extremely busy to remember to send all the pertinent information for the accepting physician.

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

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

Understand the hospital or health system’s specific capabilities and infrastructure in the context of the communities served.

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

The nursing process is a five stage systematic framework, and based on the problem solving approach; it forms the foundation for nursing practice to facilitate focussed, individualised care planning for patients (Yildirim and Ozkahraman 2011). This assignment will serve to identify the five stages of the nursing process: Assessment, Nursing Diagnosis, Planning, Implementation and Evaluation. The skills: Communication, Observation, Critical Thinking and Reflection involved within the nursing process in partnership with the patient will also be highlighted.