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Problems with overcrowding in the emergency department
Problems with overcrowding in the emergency department
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Emergency rooms are often crowded with low-risk patients, which result in long wait times, unsatisfied patients, misdiagnosis, and overworked emergency room physicians. As a result, at least two domains of quality of care, safety, and timeliness, are compromised by emergency room crowding (Bernstein et al., 2009). Additionally, one study found that periods of high emergency department crowding were associated with increased inpatient mortality and modest increases in length of stay and costs for admitted patients (Sun et al., 2013). Consequently, patients are not only paying a premium for their emergency room visits but may also be paying with their lives. Furthermore, the hospitals themselves are obligated to over utilize their staff and resources
Monitoring staff levels is an important factor. Also leveling the flow of patients in and out institutions could help to reduce wide fluctuations in occupancy rates and prevent surges in patient visits that lead to overcrowding, poor handoffs, and delays in care. Studies show that overcrowding in areas such as the emergency rooms lead to adverse outcomes, because physicians and nurses having less time to focus on individual patients. One study found that for each additional patient with heart failure, pneumonia, or myocardial infarction assigned to a nurse, the odds of readmission increased between 6 percent and 9 percent (Hostetter and Klein, 2013). All of which costs the hospital money.
The challenges that all acute care hospitals and facilities faces are the demand for highly specialized services has increased. The US population is constantly aging and the elderly tend to need more acute care services. Because many people lack health insurance, they tend to use emergency rooms in the hospitals as their source of care. The increase demand in acute care prompted hospitals to expand their facility
Think about it like this, if you were put in a place where care was low and based on the number of people are admitted wouldn’t you get stressed out. Now think about what stress does to the body. Terrible things right? Imagine stress on top of decaying of the mind and limbs from old age. This is a sure recipe for insuring that we stay in the hospital and on the operating table.
Hospitalized patients are often hooked up to monitoring devices such as heart monitors, which monitor the electric activity of the heart, or connected to a physiological monitor so their vital signs are constantly being measured. These monitors are intended to continuously assess the patients’ status, and alarm if the patients’ status drops below what is considered normal. The increased use of monitoring devices has created a new phenomenon known as alarm fatigue. According to the ECRI institute (2011), “alarm fatigue occurs when the sheer number of alarms overwhelms staff and they become desensitized to the alarms resulting in delayed alarm response and missed alarms-often resulting in patient harm or even death.” Alarm fatigue has become a major problem within the nursing community and has already had a negative impact on patient safety. Due to the adverse effects alarm fatigue is having on quality patient care, there has been a call to action to find solutions that may deter alarm fatigue. Evidence-based practices involving quality improvement initiatives have been put into effect. The problem has also gained national attention from such institutions as the Food and Drug Administration (FDA) and The Joint Commission (TJC).
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.
Patient Flow in Waiting Room Healthcare clinics are under a great deal of pressure to reduce costs and improve quality of service. In recent years, healthcare organizations have concentrated on preventive medicine practices and have tried to reduce the length of time that patients stay in a hospital. Outpatient services have gradually become an essential component of healthcare. Organizations that cannot make their outpatient component cost-effective are finding themselves financially burdened in this ever-changing industry (Caldwell, 2005). Patient waiting times and waiting-room congestion in outpatient settings are two challenges facing the healthcare industry.
As early as the 1990’s, outpatient care only made up for 10 to 15% of a hospital’s total profits, compared to inpatient care. Since the start of the twenty-first century, this figure has increased to approximately 60%. This shift in healthcare has been occurring in different medical organizations such as university medical centers, local hospitals, for-profit chains, and not-for-profit suppliers. The increase in outpatient services compared to inpatient has been showing no indication of slowing down. The main reason for the development in outpatient care is because of all the medical advancements in techniques and technology that allow for patients to be treated less invasively. Health care organizations are now being compensated in a way that puts emphasis on both the quality and the total care of the patient. Even though these organizations are achieving exceptional ambulatory performance in a manner that improves health and patient experience, cost is vital to future health system success.
Robson, W., & Newell, J. (2007, April). Severe sepsis: Do emergency departments offer patients optimal care? Emergency Nurse, Vol. 15(1), pp. 30-33.
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
In the event of a natural crisis such as a hurricane or an earthquake it’s possible that large hospitals would be overwhelmed. In 2005, Hurricane Katrina inundated New Orleans and many of the city’s hospitals experienced power outages. Those outages left the medical staff scrambling to care for patients who required life support. One of the hospitals was Memorial Medical Center they were so desperate they requested help from the National Guard. The National Guard was quick to send back-up generators to ensure the hospital could stay in operation.
Panic disorder is a psychiatric disorder in which debilitating anxiety and fear arise frequently and without reasonable cause. Panic attacks do not happen out of normal fear. Panic attacks happen without reason or warning. If you have panic disorder it could come from one of the following: family history, abnormalities of the brain, substance abuse, or major life stress(Panic Attacks and Panic Disorder. (n.d.). Retrieved March 28, 2016, from http://www.webmd.com/anxiety-panic/guide/mental-health-panic-disorder). This disorder is in the category of anxiety and depression. Panic disorder belongs to axis one, which is clinical disorders, this is the top level of the DSM multiaxial
Introduction In 1942 a report by William Beveridge formed the basis of the Labour governments welfare state, so that healthcare would be universally available and funded from taxation. Identifying what he considered the major problems being ‘five giants stalking the land’, want, ignorance, squalor disease and idleness (Naidoo, 2015). As a result, on July 5th 1948 saw the launch of the National Health Service (NHS) by the health secretary Aneurin Bevan at Park Hospital in Manchester. To provide health care for everyone from ‘cradle to grave’ based on three core principles: to meet the needs of everyone, free at the point of delivery, and based on clinical need, not the ability to pay (Naidoo 2015).
A. Working in the emergency room I encounter many patients who come in for psychiatric evaluation, wither it is due to suicidal thoughts or depression. Through the constant training that our hospital puts on, I have learned how to better deal with these types of patients who can be difficult at times.
Emergency cases: An increase in the number of emergency cases can increase the wait times for non-urgent cases because the sicker patients are cared for first.
My overall learning experience during my preceptor shifts was amazing. The first day I walked into the Emergency Department for my shift, I was having anxiety through the roof and very nervous. I felt like I did not know anything and it was a completely new environment then I am use to. At this point I feel very comfortable in the environment and felt like I have gained the knowledge to be a competent nurse in practice. I owe a lot of the success I have had in the ED to my preceptor Sam. He was seriously great and very patient with me when I was trying to learn something. He really pushed me every day to be confident and comfortable taking care of patients on my own. I have gained a vast knowledge of skills, procedures, policies, documentation,