Improving “waiting Time” in the Emergency Department
According to the Centers for Disease Control and Prevention (CDC) (2012), the average time patients spend in the U.S. emergency department (ER) before they can see a doctor has increased to 25% between 2003-2009. The main cause of longer wait times (WT) in the ER is overcrowding. Overcrowding has been found to be closely related to both subjective and objective patient satisfaction (Miro’ et al, 2003). Longer wait times in the ED is such an important issue because its consequences are detrimental not only to the ER patients, but also to providers. As a health care provider, decreasing patients’ WT in the ED is essential, although challenging, to improve patient’s health outcomes and increase patients’ satisfaction. Although it is a very challenging issue to tackle, hospitals that have initiated some quality improvement (QI) strategies are experiencing some positive outcomes in that area of care. The outcomes are measured by decreased waiting times, improved patients’ clinical outcomes and increased patients’ satisfaction.
The purpose of this paper is to investigate on the issue of longer waiting times in the ED. The body will use live experiences of daily practices relevant resources to substantiate the following ideas by: stating the general background or the prevalence of long waiting time in the ED and to describe previous attempts (interventions) used by healthcare institutions to solve these chronic waiting time issues.
Causes of longer WT in the ED
Research holds that major precipitating factors of longer WT are overcrowding defined by Paul, Reddy & De Flitch (2010) as a serious threat to healthcare system that has reached the crisis proportions in the United State...
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... revealed that longer waiting times has negatively impacted the lives of not only patients, but also healthcare providers . Some QI strategies implemented such as simulation tools, fast -track and reorganization of the ED by several hospitals has shown some improvement in workflow thus decreasing overcrowding and the length of time spent in the ED. As healthcare leaders, the focus should reside on ongoing advocacy for new policies or guidelines to resolve the waiting time issues and addressing limitations of previous interventions. Addressing the ED issues, Leaders should abide by the IOM report considering overcrowding as a mostly external or a system-wide issue. Implementing preventive measures described earlier will help not only to decrease WT in the ED, but also to avoid future incidents similar to the one recently experienced in St Barnabas Hospital.
In the U.S and other nations of the world, the health expenditure and number of physicians increase as the economy expands. However, physician shortage is of a great concern globally, which the U.S and the Military Healthcare System (MHS) are no exceptions. According to Garber (2004) “a shortage exit when there is unsatisfied demand, which occurs when the quantity of a good or service is less than what people will be willing to buy at the current price”. For example a long wait time to get an elective surgery done, or a long wait for a patient to get an appointment to see the doctor are evidence of physician shortage. Another definition of shortage is “having a projected supply of physicians that meet less than 80% of the forecasted demand or need, calculated at the estimated means (Scheffler, Liu, Kinfu, & Dal Poz, 2007). The World Health Organization report (2006) estimated that, 57 countries had absolute shortage of 2.3 million physicians. This shortage according to prior studies implied the lack of a sufficient number of health care professionals to deliver skilled health interventions such as child-birth.
The Crowded Clinic: Critical Analysis The Crowded Clinic Case Study (Colorado State University - Global, n.d.) discusses the issues of practice management as they apply to access to care. Access to care may be as inconvenient as lengthy patient wait times to issues far more serious that may have a profound effect on the health and well-being of a single patient or an entire cohort. In order to properly address the issue and look for a remedy, it is necessary to understand the underlying conditions that create the problem before creating the means to manage the change required to correct the problem. The Crowded Clinic has multiple issues, including social and operational, which are creating the associated inaccessibility to services.
Because of the lack of organization with the health care providers in Canada, the wait times are too long and can cause serious complications to any condition the patient went in for in the first place. This situation of how the health care system can resolve wait times was brought to the government but they continue to ignore the proposals brought to them. It is possible to resolve the problems of wait times without extreme change and expenses in the health care system. The solution is to be found in the reorganization of the health care providers. Lack of assistance in the emergency room can make ones illness to become worse, therefore, causes the patient to be forced to wait in emergency rooms for an extended period of time and when they are finally seen by a health care provider, the outcome is very poor due to lack of registered staff, physicians and proper assessment(Goldman & Macpherson, 2005, p.40). The objective of this paper is to discuss and critically analyze the conditions of emergency waiting rooms. The specific issue this paper intends to explore is extensive and prolonged waiting times for patients accessing health care, patients who need urgent treatment and the vulnerability of elderly patients and children. With an in-depth critique of the barriers to health care and shortcomings of emergency rooms, strategies will be provided to enhance a health care system that makes it more accessible and efficient.
As part of the 2017-2018 budget, Ontario will invest 1.3 billion dollars over a three-year period, in an effort to decrease the extreme wait times. As stated on the Government of Ontario's website, $529.7 million of the $1.3 billion dollar investment will be used for priority services within the hopsital sectors in order to improve quality-based procedures, which in turn reduce wait-times. In the last fourteen years, the Govenment has invested more than $2 billion to reduce wait times, therefore, by having the Ontario Government allocate over $1.3 billion in 2017-2018, demonstrates a significant commitment to reducing wait-times in our health care system.
The film, The Waiting Room, paints a clear picture of the variety of obstacles that commonly occur in the emergency department. The majority of patients are uninsured, are using the hospital as their primary care physician, long wait times and communication challenges. This paper will outline challenges displayed in the documentary paired with different ideas working to create a more effective health care experience.
V ́ericourt, F., & Jennings, O. B. (n.d.). Nurse-to-patient ratios in hospital staffing: a queuing perspective. Retrieved from https://faculty.fuqua.duke.edu/~fdv1/bio/ratios3.pdf
The main shortcomings of health care in the U.S. include limited access and difficulty in coordination of care. In an 11-country survey conducted by the Commonwealth Fund, Americans were found to have a greater wait period than adults from other countries. In fact, 20% of adults reported a delay of six or more days to see a doctor or nurse (Schoen, Osborn, Squires, Doty, Pierson & Applebaum, 2010). Access to care is further complicated as only 29% of U.S. primary care practices make arrangements for patients to receive care on evenings, weekends, and holidays (Abrams, Nuzum, Mika & Lawlor, 2011). Physicians also face frustrations in the coordination of care. U.S. physicians are more likely to report that patients cannot afford treatment and are less likely to have electronic patient records that facilitate patient-centered care (Osborn, Schoen, Doty, ...
Given the fact that one-third of all healthcare expenditures is for ambulatory care, it is safe to say that patients spend most of their time in an ambulatory care setting (Carper, 2013). This setting has a significant impact in the overall assessment of the healthcare industry and how care is delivered. It is important to address data collected by surveys to implement strategies for quality improvement. Affecting care in Ambulatory settings will have the largest significance in the health outlook.
A hospital is a difficult place to run because there so many aspects to manage. There are many types of doctors and nurses, and so many departments in this type of facility. The patients come in a wide variety of different ailments, needs, colors, sizes, personalities, and beliefs. Not to mention, with all of the equipment, devices, and people coming and going a hospital can seem like a small town in itself. That is why it will take a group effort, open communication, and positive reinforcement to keep it running smoothly. I will address this case study by identifying each problem, advise an adequate solution for each problem, and give a reason for each solution.
In today's health care environment many factors contribute to quality care. As a medical practice manager it is important to provide the best medical service for patients in addition to excellent levels of service. Appointment scheduling is a very important aspect of a smooth running medical practice. Appointment cancellation, no shows, and long waiting time by patients have a negative impact on the efficient running of the practice not only in lost revenue but the practices professional reputation as well (Kruse 2010).
There has long been an issue with overcrowding issues in emergency departments and fast track units have been used in order to reduce wait times, dissatisfaction of patients, and morbidity. The purpose of this study was to look at the impact a fast track unit has on wait times, length of stay, patients who leave without being seen, and mortality rates. The research question for this study is, can a fast track unit help to improve wait times, length of stay, patients who leave without
Thousands of nurses throughout the nation are exhausted and overwhelmed due to their heavy workload. The administrators do not staff the units properly; therefore, they give each nurse more patients to care for to compensate for the lack of staff. There are several reasons to why
The Australian Healthcare System would be good case studies to understand pros and cons of private funded systems if enacted. Also how does waiting times measured by. Johar and Savage studied waiting list and admission data from public hospitals in NSW (New South Wales Public Hospitals) for 2004-2005. They define clinical needs of a patient using two indicators: assigned urgency and planned procedures. And they categorized urgency levels as 30, 90, and 365 days. The 30-day urgency status is for ‘‘a condition that has the potential to deteriorate quickly to the point that it may become an emergency.’’ The 90-day urgency status is for conditions that are ‘‘not likely to deteriorate quickly or become an emergency.’’ Lastly, the 365-day urgency is for conditions that ‘‘do not have the potential to become an emergency.’’ This system appears to be the most endorsed rule by both patients and medical practitioners internationally. For planned procedures, they select four common treatment: cataract extraction, knee replacement, removal of skin lesion and colonoscopy. Also, to control for supply-side factors that may impact on waiting times they undertake their analyses separately for three types of hospital. (1) Hospital is located on big city, (2) is on middle size of city, and (3) hospital is located on reginal city. As a result, nevertheless, by any measure, except for the 7-day urgency case, public
Nurse staffing is a complex issue. There are many factors which need to be considered when staffing a nursing unit. Evidence shows an association between Registered Nurses (RNs) having decreased workloads and better patient outcomes, including a decrease in patient mortality (Aiken et al., 2011; Needleman et al, 2011; How Lin, 2013; Patrician et al., 2011; Wiltse-Nicely, Sloane, Aiken, 2013). A small percentage of patients expire during their hospitalization as evidence suggests that a portion of these deaths can be attributed to RN staffing levels (Shekelle, 2013). As the reimbursement system for hospitals today emphasizes quality outcomes, this has an increase in the importance of the nurse’s role in patient care (Frith, Anderson, Tseng, & Fong, 2012). The quality of care is effected when there are higher RN-to-patient ratios. Mortality rates can be decreased by 50% or more when there is a lower RN-to-patient ratio. The morale of nursing staff and the hospital’s reputation are effected when there is a large nurse turnover and poor patient outcomes (Martin, 2015; Knudson, 2013). Having adequate nurse staffing levels saves lives (Martin, 2015). The purpose
Rationale: I feel that wait times in the ER have become a bit of an argument. Experiencing this problem from both sides of the issue I feel that this topic is one of great interest for me.