Operational And Clinical Prespectives: A Case Study

they must send them to another hospitals ED. Ambulances can drive around for unnecessary amounts of time trying to find a hospital with room in the emergency department for their victim. This can be scary for the victim. They present a huge health risk for patients seeking urgent medical attention. Ambulance diversions wouldn’t be an issue if overcrowding did not exist. Schull (2003) believes that ambulance diversion is driven by the boarding of patients and is not otherwise related to issues of staffing within the ED itself. (p.467-476)

Upon observation of the circulating nurse, I noticed that she was very interactive and involved in the surgery. One of the responsibilities of the circulating nurse is to retrieve any surgical supplies that are not available in the operating room and to make or receive any calls for the surgeon. During the surgery, I noticed the nurse call for an x-ray for the surgeon, the laboratory for biopsy samples, and the operating room floor front desk to inform them that the surgery would be later than expected. This is her responsibility as the surgeon cannot break sterility by touching the phone and it is easier for him to communicate through her and not leave the surgical site. Also in the operating room, I observed the scrub nurses’ roles. Before the operation, the scrub nurse opened all of the sterile packages, arranged them on the sterile field, and took count of what was there along with the circulating nurse. The scrub nurse did this because she is sterile during the entire procedure, and once the sterile packs are opened, the contents can only be handled by sterile personnel. The scrub nurse also was ready and waiting at the sterile field at all times to get the surgeon any equipment needed from the sterile field. This is helpful to the surgeon because it enables the surgeon to stay at the surgical site and convenient for when

Standing (2011), defines clinical decision-making as a complex process that involves observation, gathering information, critical thinking, evaluating evidence, applying necessary knowledge, reflection and problem-solving skills. Every day nurses make important clinical decisions and these decisions have important implications for patient outcomes and deserve serious consideration. Therefore, it is important for nurses to have a better insight of the decision-making process, be able to deliver holistic care and meet essential and complex physical and mental health needs of the patient.

Before the patients leave the clinic, the primary care nurse will give them a simple instruction such as doing the blood work, EKG and chest x-ray prior to pre-operative appointments. This is the end of primary care responsibility for the pre-operative process of patients undergoing surgical procedures. The accountability of making sure the patient is ready for the surgery is then handed over to the pre-operative management nurses. Cancellation of operations in hospitals is a significant problem with far reaching consequences (Kumar & Gandhi, 2012). One of the factors contributing to this cancelation is the pre-operative process itself.

Having a good patient flow is key to establishing a respected practice with patients who are happy, and healthy. Patient flow not only effects the amount of time a patient waits to see a doctor, but also effects the time and care that a doctor has to spend with their patients. There are a variety of techniques that a practices, clinics, and hospitals can implement to ensure a that the intake process is effective and maintains a good patient flow.

    The modern day emergency room is a department that is constantly busy. In the hustle of caring for patients, there are some details of the patient’s care that can be overlooked in a standard phone report to the accepting nurse. With this in mind, a change is needed so that there is an optimum patient outcome for each and every one of the people that walk through the doors of the emergency room and get admitted.

Which Tools Can Be Used to More Efficiently Manage the Flow of Patients in the Facility?

Every patients main concern when going to a hospital is to get a surgery to fix a problem that they have, or to receive prescriptions for illnesses and diseases. But a factor most probably are not worried about when they go to a hospital is how they are being treated. Doctors already have a difficult task to perform, but overcrowding the hospitals will cause them to be busy and possibly conduct their job with out the amount of care that is required. Giving out prescriptions in a hospital could also be effected. Patients vital medicine could be mixed up with someone else’s and cause even more harm.

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

St. Vincent’s Medical Center, a 501 bed facility located in Jacksonville, Florida, provides general medical and surgical care to the North Florida Region. St. Vincent’s admits over 26,000 patients annually. The average occupancy rate is approximately 84% with the Emergency Department (ED) peeking at 100% for approximately 4-12 hours daily. The hospital is struggling with availability of bed space. This shortage of available beds creates a bottleneck in the ED on high census days. Bottlenecks are created in the ED when there is a shortage of inpatient beds to place admitted ED patients. Thus, patient flow, or throughput, is becoming more and more important.

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

In this article, the authors investigated the vulnerabilities in emergency department to internal medicine patient transfers through self-administered surveys of all emergency medicine house staff. More specifically, the survey investigated adverse events due to faulty communications during handoffs. According to this survey, 29% of the emergency staff reported either an adverse or near-miss event due to errors during handoffs. Furthermore, the survey respondents identified inaccurate or incomplete information, cultural and professional conflict, crowding, and many other factors as the contributors to handoff errors. By identifying specific contributors to handoff errors, this article serves as guidance for handoff intervention.

Visit your local Emergency Room on any given day and you are likely to witness a sort of controlled chaos: nurses, doctors, transporters, patient care technicians, and other ancillary staff members all darting about, attempting to meet the needs of increasingly sick patients in oft-overwhelmed and overpopulated hospitals. All around, various alarms sound. IV pumps signal fluid bags about to run dry. Vital sign monitors ping at differing volumes and intensities, in an electronic demand for staff to mind the out-of-normal-range

Comparing my clinical experiences from last semester to this semester, I would say that I have already experienced more this semester than I would have at this time last semester. Even though I am doing LNA work while incorporating RN aspects, I feel the work that we are doing this semester is more RN aspect based rather than LNA work. Clinical was my favorite part of last semester, and it is still my favorite part of the semester. Over the past couple of weeks at Riverside, I have had numerous new experiences, including following a nurse, following the wound care nurse, and going in on my day off to follow both the wound nurse and the nurse practitioner of the facility.

A key operational challenge in most healthcare organizations is the efficient movement of patients in a hospital or a clinic, which is referred to as the