...ID#110204 PUBLISHED ON MAY 20, 2014 Emergency Department Congestion at Saintemarie University Hospital BY LAURENT HUBLET * , OMAR BESBES † , AND CARRI CHAN ‡ Introduction In late 2009, Marc Dupont, CEO of Saintemarie University Hospital, had just ended an extremely tense phone conversation with the state secretary of health. The secretary was very concerned about the wait time in the hospital’s emergency department (ED). The recent coverage of these problems in the local press, which repeatedly echoed complaints of patients and their families, was making things worse: It took them 18 hours to take care of my mother when she was admitted to the emergency department in the Saintemarie University Hospital — Saintemarie Tribune (March 2009) On September 8, Nancy (86 years old) had to wait eight hours in the ED with a broken leg before seeing a doctor — Saintemarie Tribune (September 2009) Saintemarie was a midsize European city with a population of 512,000. A few private clinics in the area provided urgent care (i.e., treatment which does not require hospitalization), but were unable to handle acute emergencies. The hospital’s ED was the only emergency care unit available in the Saintemarie metropolitan area. The only alternative to it was a hospital located 50 miles away; patients had to be transferred there by helicopter, which happened rarely because such transfers were extremely expensive. Given its central role, Saintemarie University Hospital was under...
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...OF OVERCROWDING IN THE EMERGENCY ROOM MICHELLE POWELL MSN –BL 510: NURSING PROBLEM SOLVING SKILLS DEVELOPMENT MAY 20, 2012 PROFESSOR NKECHI ILEKA The Emergency department provides an extraordinary important public service mission by providing emergency care 24 hours a day, 365 days per year without discrimination by social or economic status (Derlet, Richards & Kravitz, 2001). One of the key foundations of EDs is to provide immediate access and stabilization for those patients with medical emergencies (Derlet et al, 2001). The Emergency Department has always been there available to help, unfortunately the basic tenet is now being challenged, and the general public may no longer be able to rely on EDs for quality and timely emergency care, placing the people at risk (Favotich & Hirsch, 2003). According to the Emergency Nurses Association all people are entitled to timely and appropriate access to safe and effective health care. This paper will discuss the problem of overcrowding in the Emergency Room and strategies that the Nurse leader may do to help control overcrowding. Overcrowding in the emergency department (ED) is the most serious issue confronting EDs in the developed world (Favotich & Hirsch, 2003). Overcrowding is a situation “in which the demand for emergency services exceeds the ability of department to provide quality care with acceptable time frames (Joint Commission...
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...Failure-Mode Effects YourFirstName YourLastName University title The operational challenge selected is emergency Room waiting time. The failure modes will include the overcrowdedness, the disaster that cannot be prevented, the reduced capacity of hospitals, the financial and geographic barriers, a provider-focused approach to scheduling, and the care and reimbursement difficulty (White, 2015). Each of these failure modes is significant to explain. The overcrowdedness is the daily hospital emergency routine that has to be solved somehow. A lot of people are in the waiting lines for the medical help. The natural or humankind disasters are one of the most complicated to prevent. The human has learned how to make a weather forecast,...
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...Analysis Group F Objective of ED Wait Time Project The project is conducted at the Emergency Department(ED) of the Academic Medical Hospital (AMH), where time is a critical component in servicing patients with potentially life-threatening injuries and illnesses. Dr. Gerry Elbridge’s prime objective is to reduce the Emergency Department patient wait time. The Six Sigma methodology is employed to reduce total mean wait time of 62.5 minutes to a total mean wait time of 37.1 minutes or less. Situation Analysis The success of the Six Sigma Improvement Implementation is dependent on two variables, the quality of process solutions, and the acceptance level of stakeholders. The overall effectiveness of the results can be expressed by the equation Q X A=E. In terms of the quality (Q), the result of the pilot study is largely satisfactory. It shows a reduction, from the original lobby waiting time (15 minutes), to 12.6 minutes. The physician wait time (MD), also demonstrates a corresponding positive downward trend in to 8.9 minutes which is, however, above the 8 minute target. Although further improvements and actions are required to improve quality, the effectiveness of the Six Sigma initiative is currently constrained by the ‘acceptance’ variable (A). Due to the close collaboration of AMH and the Academic University, it is common practice that students and professors provide medical and patient care at the emergency department of the hospital. These so-called attending...
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...Waiting time for elective care is defined as the time that elapses between firstly the physician’s decision to admit a patient for elective surgery following clinical assessment and secondly the date of hospital admission1The 2005 edition of the Fraser Institute Report on Hospital Waiting Lists in Canada indicates that wait times for plastic surgery are the second lengthiest of all specialties2The objective of our study was to study the relation between various types of patients admitted in the department of plastic and re-constructive surgery at Sher-i- Kashmir Institute of Medical Sciences,J&K and their respective waiting times.The study was conducted for a period of one year from 1st October 2013 to 30th September 2014.It was a prospective observational study carried out on the patients admitted in the ward of plastic and re-constructive surgery. The study was done based on the interviews from relevant informants, study of records .Out of the total of 2238 patients admitted 495 cases were that of RTA(road traffic accidents), 162 bear mauls, 135cleft palate, 117 cleft lip,99 tin cut injuries,90 PBC(Post burn contracture) hand,72 cases of...
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...As a Chief Operating Officer of New Guinea Medical Campus, I am responsible for the 15-bed Emergency Room (ER) and its performance. There have been many complaints within the last year regarding inadequate patient care, poor ER management, long wait times, and patients being sent away because of lack of space, staff, or physicians to provide appropriate care. I have come up with a strategic plan that would allow the ER to overcome the shortcoming and to increase performance. 1. Diagnose the root causes of the complaints about the clinic As the Chief Operating Officer (COO) of New Guinea Medical Campus, there are many responsibilities that fall under the position that holds one of the highest executive positions of an organization. This position reports to the Chief Executive Officer (CEO). The COO’s responsibilities coincide with the needs of the CEO and the organization. Responsibilities and roles of the COO are many and include the daily operations of the facility, the development and design of the operations and to implement efficient and effective management that aligns with the goals of the organization. As a healthcare professional this operating officer must set ethical standards and guidelines which they themselves abide by and also integrate it into the organizational culture and the employees’ expectations. “Ethics complement and balance legal guidelines. Ethics are a set of moral principles that serve as a guiding philosophy for behavior. Most professional...
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...Shortening the Wait: A Strategy to Reduce Waiting Times in the Emergency Department Introduction Emergency Department (ED) nursing is fast paced and complex in nature. Their goal is to assess quickly and prioritize the patient needs so that those with emergent needs are seen before those with urgent or non-urgent needs. Causes of ED overcrowding and lengthening wait time include, influenza season, inadequate staffing, inpatient boarding due to inadequate hospital beds and patient population larger than hospital capacity (Hoot and Aronsky, 2008). The length of stay in the ED has a correlation with the quality of care a patient receives. Many EDs struggle with patient overcrowding and there appears to be no silver bullet to adequately address this challenge. It will be in the best interest of all involved to effectively address this issue. Different institutions have tried various solutions to their ED overcrowding including a program to shorten the wait times leading to reduced crowding and increased patient satisfaction. Background of the Study ED overcrowding is a complicated problem that affects virtually every institution that offers emergency services. Contributing factors include the intake, processing and discharge aspects of emergency service. The phenomenon of ED overcrowding takes a toll on both patients and ED nursing staff and addressing it will reduce stress on the nursing staff, improve the quality of care and increase the satisfaction of all involved. This...
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...Improving Emergency Department Throughput Time HCS/587 October 1, 2012 Improving Emergency Department Throughput Time Hospitals are experiencing patient congested emergency departments. At Baptist Memorial Hospital, the increase in patient volume and limited capacity contributes to long length of stays and patients leaving without being seen. As a result of overcrowded emergency rooms, patient length of stay becomes more important. Throughput times in the emergency department (ED) play a substantial role in patient and staff satisfaction. Length of stay in the ED is directly related to patient volume, patient acuity, lab turnaround times, and time to treatment, which is all connected to patient satisfaction. Long wait time contributes to patients leaving prior to a medical screening examination. Patients who leave without been screened is dangerous and sometimes deadly, thereby creating a liability for the hospital. Baptist Memorial Hospital has outgrown its current capacity creating overcrowding and delays. Hospital capacity is an organizational barrier faced by Baptist Memorial Hospital. Patient presentations over the past several years have increased substantially as well as an increase in hospital diversion and a decrease in overall patient satisfaction. The current ED operates out of 11 beds with one around the clock physician and a mid-level provider during peak times. Nurse to patient ratios are 4:1 with a dedicated charge nurse. The department also has...
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...medical care and insurance and how it impacts usage of emergency rooms was studied. Because of the changes in medical care and insurance, the Affordable Care Act, the emergency room has become a crowded doctor’s office. Lacking on the number of how much availability there is for patients in emergency rooms already, the need for emergency rooms continues to increase. The significance of this study is to see how the current changes in health care insurance have impacted how often or how many people visit the emergency room seeking medical attention. This study will help health care administrators with how to plan for the future when it comes to being most efficient in seeing patients in a timely manner and having the more serious patients visit the emergency room and less serious patients visiting primary care physicians. The social problem that is addressed is that there are many uninsured and underinsured individuals who turn to the emergency room seeking medical attention instead of having the opportunity to see a primary care physician. That contributes to the crowdedness of emergency rooms overall. This is an exploratory study because exploratory research is based off secondary research. For example, by reviewing available literature, data, or using qualitative approaches, which is how this study is conducted. The unit of analysis in this study is the effect of changes in the Affordable Care Act on the usage of emergency rooms. A theory that guides this research is purely to...
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...Emergency departments throughout united states face overcrowding, the challenge is due to the high demand for services, an increasing number of visits, overuse and misuse of services, and escalating healthcare costs. All hospitals follow a triage system to cope with overcrowding. When there is overcrowding, that will result in longer wait time for treatment, lengthens door to provider time, increase in number of patients leaving ED before treatment, and diverting ambulances to another facility. “Boarding” of patients is one of the main issues in emergency departments and ultimately impacts the service and quality of care patients receive. Emergency department is the front door of the hospital and is the actual revenue generating center of the hospital. Today's entire healthcare revenue cycle has shifted from a provider-to-insurer paradigm...
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...issues with it. To fully understand Canada’s health care you must start to understand it from its core. The mismanagement of health care has resulted to long wait times and made it the biggest political issue facing Canadian health care (Rachlis, 2005). Wait times in Canada has become a major issue in the health care system and a major set back in providing good quality health services to Canadians. Along with addressing the issues of wait times I will also include the problems of packed emergency rooms, what exactly these wait times are and how it can improve. When ill or in pain, there is nothing more frightening or frustrating than having to wait for treatment. Many Canadian face long wait times for health services such as waiting to see a specialist, having a transplant or simply getting a check up at their local doctor office. Wait times in the Canadian health care system has become a problem for Canadians, despite polices which states equal access to health care, this is not true. It was stated that there is two types of wait times, surgery, MRI, CT wait times and emergency room (ER) wait times (Service Ontario, 2008). Patients suffering from cancer, double transplants for example all end up all getting wait listed and not being able to get the treatment they need right away. It has been reported by CBC that wait times for referral to a...
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... 2016 Danny Crawley Health Care Access Options In today’s society people want everything done right away, never wanting to wait and this includes their health care. Since people are wanting and needing care right away there is a need for more urgent care clinics. An urgent care clinic is a walk in clinic that is focused on the delivery of ambulatory care that is in a medical facility outside of an emergency room. An urgent care is meant to treat medical illnesses and issues that require immediate care but not enough so that an emergency room is required. Around the Perris, California area there are several urgent care locations, all of which take different types of health insurance. Since there are certain areas in which more people may need government assistance there is more of a chance there will be a certain genre of people who are using those urgent care centers where others may only take private insurance. The different locations of the urgent care facilities have also influenced the way the facilities are trying to bring awareness; some may use more social media while others may prefer a mailer. Going over different statistics will give a clearer understanding of which areas may need to change the way they are trying to get their name out there. Changes in urgent care Urgent care facilities have not been around for a very long time but due to the locations or the insurance the facilities took there were not many people who had known about them nor were they able...
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...HOW TO USE CLASSICAL MANAGEMENT APPROACH IN UTILIZING ACCIDENT &EMERGENCY DEPA RMENT? BY ZAHRA AHMED EBRAHIM Master in Business Administration General Management Organization and Business Management Open Asia e University 2011 Introduction Background of the Study A number of approaches to the structure and management of organizations developed during the late 1800s and early 1900s .The early philosophies are traditionally labelled classical theory while the later approaches include systems theory and contingency theory. The classical approach to organization focuses efficiency through design. Eleanor and Phillip (2009) kept four elements to build classical theory: division and specialization of labour, chain of command, organizational structure, and span of control. The first element emphasised about dividing the work reduces the number of task that lead to proficiency and specialization. The second element is the chain of command which is meant the hierarchy of authority and responsibility within the organization. However, the collaboration between staff and there managers improve the efficiency and productivity of the unit. Moreover, the third element is organizational structure that describes the arrangement of the work group. The design of the Organization is intended to faster the organization survival and success. Finally, the span of control addresses the pragmatic concern of how many employees a manager can effectively supervise. The later approaches...
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...Resource Allocation The given case presents a problem in micro-allocation of resources. The case involves allocation of limited resources among individual patients in the hospital, more specifically among the patients in the emergency room department. Facts of the Case The case provides us with limited information and leaves us with multiple questions that answer and give us pertinent need-to-know facts. There was a traffic accident that was massive enough to strain the resources in the emergency room. There is a need to find out and know the scope of how massive the accident was; the number of victims involved and their ages; and the gravity of each of the victims’ cases (minor or major injuries, stable or unstable, life-threatening or not). It is essential to note what kinds of resources were strained and limited, was it human resources or materials resources or both. There is a need to find out and know how many ER doctors, nurses, nursing aides were on duty that time; the bed capacity in the ER; and what specific materials were limited (medications, IV lines, syringes, cardiac monitors, etc.). It is also vital to know the severity of the case of the 4-year old son of the hospital board member. There is a need to find out how high the fever was, its onset, duration and any associated symptoms. A complete history of the present illness and past medical history as well as a physical examination will aid in establishing the gravity of the ear infection and the need for...
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...Reforming & Improving Emergency Care In October 2001, the Department of Health (DoH) document ‘Reforming Emergency Care’ took on the challenges of the emergency care system within Britain, stating that “too many people have to wait too long for the care and treatment they need” (DoH, 2001b, p. 1). The document outlined the key areas it felt represented the need for reform. Each stage of the emergency care system went under review, from access to GP services and ambulance response times, to the experience of the patient upon arrival in hospital through to the provision of treatment and care packages allowing them to be discharged home again. The reports objectives were to cut ambulance response times to life-threatening emergencies, end widespread bed-blocking in the NHS, improve access to GP and other primary care professionals, minimise cancellations of on-day surgery and cut accident and emergency (A&E) waiting times to under 4 hours. This would, in the reports opinion, “bring the response to everyday events up to this first class standard” (DoH, 2001b, p. 1). A number of challenges faced this reform and were highlighted by the report. Workforce issues, for example staff capacity in A&E departments, were overstretched due to the significant increase in the demand for emergency services. To combat this, the increase in funding for the recruitment of A&E Nurses and consultants outlined in ‘The NHS Plan, A plan for investment, a plan for reform’, (DoH, 2000, p. 77), meant...
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