Emergency Room Boarding

The study revealed several issues in this department. Voluntary emergency patients have to wait extended periods of time before being transferred to the appropriate department. The majority of those who have to wait are those seeking mental health assistance. Keeping people in the emergency department longer than necessary cause operational costs skyrocket, and worse, keeps the needs of patients from properly being met.

The implications and effects on patients waiting long hours to be seen in the ED are immense. In a recent study done over five years in Ontario hospitals showed the risk of adverse events and even deaths increased with the length of stay in the ED (Science Daily, 2011). When EDs become overcrowded the quality of care changes and declines; which is extremely dangerous. Authors of the study calculated that if ED length of stay was cut by only an hour that 150 fewer Ontarians would die each year (Science Daily, 2011). Wait times can also negatively affect patients financially, untreated medical conditions can lead to reduced productivity and inability to work leading to increased financial strains (Fraser Institute, 2014). As well as delayed access to care can result in more complex interventions needed. Therefore an initiative is needed to provide patients with timely, efficient care when accessing

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 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 Emergency rooms all over the United States that are being utilized as primary care provider., by patients covered by private insurance, Medicaid, Medicare as well as the uninsured.(Baker, August 13, 2008) Some patients call their primary care provider and are told, they cannot be worked in for several days or weeks. The option given is to go to the Emergency room for treatment. Other reasons are people who do not have a primary care provider or insurance. Primary care providers do not want to take new patients without insurance, so their only choice is to go the emergency room for treatment. Another factor driving Emergency Room volume trends are physicians who send

2.) More time than not the facility is short staffed. This forced the staff to triage carefully and prioritize patient bases on the severity of their needs.

Having patients in hospital awaiting placements creates many issues in the healthcare system and on staff, family and the patient. The beds that are occupied by these individuals are taking up viable room where acutely ill patients need to be. This inhibits the efficient flow of the hospital from emergency room to discharge.

Doyle, Graves, Gruber, & Kleiner (2015) determined that the non urgent and the High Usage Patient were not the sole causes for overcrowding of emergency services. Research showed Emergency Medical Services played a well-defined role in causing patient overflow. Predefined hospital relationships, response needs of the emergency service, emergency service size, and subjective hospital selection were all contributory factors Doyle et al. (2015). Researchers found that hospital selections were based upon the response needs of Emergency Medical Services and not the needs of the arriving facility. In response zones where the call volumes were highest, hospitals that were located within that zone were often inundated with patients.

After working in an emergency department for eight years you get to know the “frequent flyer”. These are the patients that come in multiple times a month for either the same thing or a variety of chief complaints. The true reason for their visit is usual non-medical and so they are discharged after there symptoms have been addressed. For this reason they are placed in medical surgical beds in order to conserve resources.

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

ED overcrowding has been described as putting the critical and the non critical patients at risk of safety. When an ambulance is being diverted to a different hospital

Emergency Medical Services predefined relationships, with hospitals, contributed to emergency room overcrowding. Researchers found that hospital selections were based upon the coverage needs of Emergency Services and not the needs of the facility. Service type, single response or multiple response, and service size were indicators of hospital selection. Data suggested that patients were that patients were transported to hospitals according to their zip codes. Patients located within high income zip codes were frequently transported to higher cost per patient facilities also located inside of the high income zip code. Whereas, patients located inside of lower income zip codes were frequently transported to lower cost per patient facilities

Patient state at arrival: this shows if the patient planned the admission or it was a case of emergency. According to Healthcare Analysis and Forecasting, the financial risk associated with emergency admissions is up to 3-times higher than due to chance variation alone. There are considerable implications to the longer-term bed requirements of hospitals, to health care costs, commissioning and financial risk. We should also consider if they are coming in with one or more conditions.

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 emergency room serves as an important point of entry to healthcare for those who are poor, have no insurance, or governmental coverage as provided to the military and veteran population (Torrens & Williams, 2002). Obviously an important component, it is one that treats the acutely ill and if necessary, acts as a ferry into inpatient treatment that is often needed.