Improving Patient Throughput in the Emergency Department Essay

A huge effect of boarding patients/overcrowding emergency departments is ambulance diversion. It occurs when a hospital ED cannot accommodate any more emergency patients so

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

According to Fort Belvoir Community Hospital Emergency Department head COL Timothy Barron, M.D., the FBCH emergency department sees 52,000 patients per year. This makes it the busiest emergency room in the Defense Health Agency and the 5th busiest in the Department of Defense (T. Barron, personal communication, May 12, 2016). Despite this high flow of patients, the emergency department continues to use paper charting. This increases the risk of error in documenting, ordering and time wasted tracking down the chart delaying patient care. The Fort Belvoir Community Hospital emergency department should move away from the outdated paper charting system to an electronic charting system since many other hospitals as well as departments within FBCH currently use this electronic system; it would save time for patients and providers, and allow for better tracking of care for patients.

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

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 ER has a variety of patients come through the department, but everything depends on the severity of the condition to whom is seen first. Patients with chest pains will be seen first rather than a patient with a stuffy nose. When the patient first walks into the facility they are greeted by the nurse at the window. The nurse then will call them in and do an assessment which is the triage part of the ED. Triage is the first person you see when you enter and the one who set you up in a room. Triage assesses the severity of the patient and they decide along with the facility's policy who should be seen first. When the patient has been assigned a room a nurse then will enter and assess the patient's condition with a more focused assessment. The nurse then will hook the patient up to the blood pressure machine with the O2 monitor. Then the nurse will take a temperature to include the assessment of

This problem statement was based on observation and discussions with the ED management team within the primary investigator’s (PI) place of employment at a facility in the mid-southern United States. The acuity levels of patients at this facility were assigned by ED nurses having no formal education or training in Emergency Severity Index Algorithm. These nurses were noted to consistently over-triage and or under-triage patients. Consequently, patients were being assigned inaccurately, slowing down efficiency, frustrating providers, and tying up resources, rooms and nurses.

Emergency departments are facing a shortage of trained nurses that are capable of functioning in the fast-paced environment such as an emergency department. The problem is the emergency room is not retaining nurses and faces a continuous influx of untrained, new nurses to fill the void. This unstable staffing situation leads to hazardous care environments for both patient and nurse. This is a perpetual the cycle that worsens with time and becomes a viscous cycle of departure. The nurses who stay become fatigued, overwhelmed and burned out, which causes more nurses to leave. The nurses who remain face short staffing, the burden of training new hires without help and no team to rely on for support.

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

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. When ED’s 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. Wait times can also negatively affect patients financially. While untreated medical conditions can lead to reduced productivity and ability to work. 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 the ED. This would decrease mortality rates as well as patient satisfaction.

154). The emergency department nurses provided some options to improve these problems along with set nurse to patient ratios. Some of these options included small meetings throughout the shift to potentially shift patients around if someone has multiple high acuities, continuing education, having a good mixture of experienced and newer nurses and providing a supportive emergency department environment to help others when needed. Since there is not one sole solution, administration will need to work closely with nurses to find the best

Soleimanpour et. al (2011) explained that patient satisfaction is an essential component in the Emergency Department (ED) because it is the entrance for patients to receive their initial treatments. The most important and single possible cause for ED patients’ flow problem is the availability of inpatients beds (Peck et. al, 2012). The American College of Emergency Physicians (ACEP) (2011) explained that the primary cause of ED overcrowding is boarding; which was defined as holding patients in the ED after the admission had been completed due to unavailability of inpatient beds. Lutheran Medical Center faced this problem and in his paper will discuss analysis of the problem, determination of possible quality lapses, identification of performance measures, designing and evaluation of the interventions and reporting of the results.

As medical reimbursement begins to focus on patient satisfaction, hospitals around the country are focused on achieving full funding for their Medicare and Medicaid patients (Dyos et al., 2015). In fact, “emergency care remains consumer-driven, and the ultimate success of a hospital ED is defined by positive patient satisfaction and optimum patient outcomes,” (Love, Murphy, Lietz, & Jordan, 2012, para. 1). One of the most common dissatisfactory complaints for emergency department (ED) clients remains length of stay (LOS). Patient flow, or throughput is frequently described when discussing LOS. The flow of a typical emergency room begins with the triage process

In a hospital, the Emergency Department is the most crucial area (Girija & Bhat, 2013). With many challenges, the Emergency Department must operate efficiently in an effort to deliver quality care in a timely manner while meeting the patient demand based on volume size (Richard & Jarvis, 2016). If there is an unbalanced match with the patient demand with the Emergency Department capacity and staffing to deliver care within a timely manner, it can reflect on the patient flow and can create crowding and long throughput times (Richard & Jarvis, 2016). As a result, it can lead to poor quality of care and patient outcomes (Richard & Jarvis, 2016). On the other hand, the shortest throughput time while operating efficiently with the needed staffing can lead to good patient satisfaction and better outcomes (Richard & Jarvis, 2016).

Capacity issues are something hospitals are facing more and more every day. Patients who have been admitted wait sometimes for hours up to days for a bed to open up on an inpatient unit. This delay takes up bed space and resources in the Emergency Department leading to increased delays for others to be seen. Waiting to be seen is a huge dissatisfier to our clients and can pose a safety risk when patients are not seen quickly.