Overcrowding In Emergency Department

Document Type:Thesis

Subject Area:Health Care

Document 1

et al. Others studies have also demonstrated that there are high mortality rates at between 7 and 30 days of patient visits, especially among patients who got admitted during the high hospital occupancy period or those who had to stay long hours in the emergency department (Waugh, William, & Streib, 131). Strategic management refers to the processes that an organization develops and implements to espouse the organizational goals and objectives (Waugh, William, & Streib, 131). This is often a continuous process that takes shifts as the corporate objectives and goals take an evolutionary angle. Small and large organizations resort to strategic management approaches so that they adapt to the trends as well as the external changes within and outside the organization’s environment such as globalization (Zinns, Lauren E. et al. Overcrowding in the emergency departments is a management problem and should be solved through management (Trzeciak, & Rivers, 402). That is why this task makes a managerial approach while trying to come up with the best strategies that could be employed to ensure that the health sector, and especially the emergency department serves the interest of the public without jeopardizing their health and safety. According to Di, Salvatore, et al. numerous studies have presented the ability of the emergency health departments to handling the increasing demands raised by emergency cases. The overcrowding of the emergency department is the widespread concern across the world, including the developed nations like the US (Di, Salvatore, et al. In fact, it is a significant concern in cities within the US. This task purposes to present a vivid description of how the crowding of the emergency department threatens the performance and service delivery of the healthcare department, and how public safety is not guaranteed under such circumstances.

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It also sets out to suggest the best strategies that can be employed to arrest this poor situation, their implementation and how things can be brought back to normalcy (Derlet, & John, 64). Key concepts That the emergency department is an essential component of the healthcare department • That the overcrowding witnessed at the healthcare facilities are a threat to the public health through compromising the safety of patients in tandem jeopardizing the dependability of the EDs. • That even though the causes of overcrowding of the emergency department are seen as complex, the primary cause of this situation is regarded as the inadequacy in the inpatient capacity for a system that is characterized by increasing severity of conditions and illnesses The potential solutions for overcrowding in the emergency department require a multidisciplinary approach that has worldwide support (Hemmat, Shirin, et al.

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n. p). Overcrowding in the Emergency Department The impending hazards of congestion in the emergency department have captured the attention of many including that of governments across the world. Many reports on the same in the lay press have intimated the fact that the emergency department has become an unsafe environment on account of overcrowding (Callahan, Edward J. The manifestations of the emergency department overcrowding include; • Ambulance diversion • Boarding of patients in the hallways • Increase in risks of treatment errors • Threats to emergency or disaster preparedness • Eroded reliability of emergency care systems Causes of Overcrowding In the Emergency Departments Despite the healthcare management initiatives that were geared towards limiting the emergency department limits, the emergency department has seen an increased utilization witnessed by ballooning patient visits every year. In the past, the overcrowding in the emergency department was primarily attributed to the fact that there was an inappropriate use of the department by many patients being admitted without any emergency at all (Hammerle, Anna, et al.

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To this end, there have been varied opinions suggesting different takes on the appropriateness of individual visits to the emergency department by patients with diverse needs. Objectively speaking, this task finds the discussion on the appropriateness of those seeking emergency department admissions as a risky affair given its weighty matter (Derlet, & John, 66). This is based on the fact that aside from the patient’s safety concerns, the impetus of have patients from the emergency department has not resurfaced. Some of the established causes include; • Higher severity of conditions and • Restructuring of the hospital system The American Hospital Association has intimated that the total number of beds in hospitals for inpatients has decreased by 39 percent in the US (Zinns, Lauren E. et al. As one of the intervention measures for containment purposes, hospitals had eliminated the inpatient beds so that high census is maintained, that is, ensuring that the hospital remains a full house (Kessler, Adam, & Paul, 693).

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It is however unfortunate that the impact of this initiative on the overcrowding in the emergency department has not seen any change and the safety of patients throughout has not been acknowledged. Incidences of understaffing are also seen as one of the causative factors of overcrowding in the emergency departments (Hooper, Craig, Janvrin, Wetsel, & Reimels, 423). This is to say when the hospital mergers abruptly eliminate the emergency departments or if they come under closure, there comes a burden on the nearby facilities’ emergency departments. The elimination of the emergency department has been witnessed at such a time when visits to the emergency department were on the rise than was ever observed and this brought about complications in the department (Thomas, 75). Overcrowding in the emergency department is an internal issue and affects hospital facilities all over the world.

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The case is not only limited to the US. Inpatient capacity is an issue that has widely been certified as the primary contributor to overcrowding in health facilities. It is also important to match up the staff levels with the typical volume of patients to prevent overcrowding the waiting room due to lack of porters for transporting them to respective wards. For there to be a sustained change in the emergency department, there is need to have a worked out well-performance management. This is possible through ensuring that the operational accountabilities are well defined, and the performance metrics apparently worked out for purposes of goal achievement (Johnson, n. p). Aside from this, it is essential to take note of the fact that there is need to have sufficient leadership in place as no improvement programs can ever succeed without there being effective leadership in place (Derlet, John, & Richard, 155).

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This, therefore, makes the early signaling tool as one of the significant components of adversity preparedness. Such means can be in the name of radio communication systems that can help in managing the bed capacity for the acute care patients in such cases as terrorist attacks. Strategic Management and Planning Strategic planning and management are crucial when it comes to solving the issue of overcrowding in the emergency department. While at it, having a PESTLE analysis in place serves as a good tool for devising environmental factors defining the project. It is imperative to have a valid plan ahead of admission of patients who are affected by the overcrowded emergency department. • Ability to move from one patient to the next in quick succession • Ability to multitask • High acuity patient care in the EDs Oppportunities • The ED has the chance to embrace shifts and dynamics in department culture • The department has the chance to adopt ED specific debriefing tools • Growth in patient admission • Financial returns for the improvement of patient satisfaction • Community trust in the ED • Another opportunity is the adoption of new director who would come with new strategies Weaknesses • Acknowledge compasssion fatigue or stress • Discuss feelings • High staff turnover Threats • Staff support neglect • Culture change • Lack of staff resources Optional Appraisal As a matter of practice, the management strategy of the crowded emergency department should be well planned and a proper guidance forged to ensure that the considerations of available options are done and systematic approaches to the option appraisal implemented.

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Table 3 Appraisal I Adopt technological approaches of recording data from patients upon admission in ED. When this is not done, chances are that the manual approaches will lead to more crowding. Appraisal II Assessment of current position Appraisal III Consideration of options (defined objectives, develop options, collect relevant information pertaining overcrowding ED, Assess options, analysis of the options, holding consultations, choosing the preferred option, then reporting the findings) Step IV Development of the Plan Step V Implementations of the plan Step VI Monitoring, review and Evaluation of the plans Recommendations for achieving the plans • Initiating plans for the delivery of care and treatment to the patients yet to be placed under temporary beds • Coordinating with the healthcare facilities on long-term settlements to see to it that they expedite the discharges in hospitals, • Incorporating the overcrowding initiatives in the emergency department into some system quality development goals Primarily, premeditated planning interventions are put in place to ensure that the hospitals improve their performance and also be able to anticipate while at the same time preparing for the emergency department overcrowding, instead of reacting to the emergency department overcrowding, after all, has happened and nothing to solve in the end.

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Development As part of the rollout for quality improvement intervention, the management of the ED especially concerning bed management calls for retrospective reviews of the inflow of patient information and their time to come up with the best baseline data. Strengths and Weaknesses The healthcare department prides itself on the advancement of care in the emergency department. An efficient emergency department has at least a few helicopter pads that aid in accommodating incoming as well as discharging outgoing patients thereby decongesting the facility from unnecessary overcrowding (Thomas, n. p). This should serve as the emergency department’s greatest strength, something that seems to lack in almost all emergency departments, hence this study. Since this is lacking, the EDs are mostly underperforming, and this forms the basis for their weakness. As such, the physicians can reach the stakeholders by telephone calls informing them of the presence of bed.

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Works Cited Adriaenssens, Jef, Veronique De Gucht, and Stan Maes. Causes and consequences of occupational stress in emergency nurses, a longitudinal study. Journal of Nursing Management 23. Boin, Arjen, Eric Stern, and Bengt Sundelius. Batcheller. On-Boarding a New Chief Nursing Officer to Lead a Magnet Redesignation Visit: The Value of Relationships. Nursing administration quarterly 40. D’Andreamatteo, Antonio, et al. Lean in healthcare: A comprehensive review. Frequent overcrowding in US emergency departments.  Academic Emergency Medicine 8. Di Somma, Salvatore, et al. Overcrowding in emergency department: an international issue. Internal and emergency medicine 10. Nursing management 48. Hemmat, Shirin, et al. Performance Measurement and Target-Setting in California’s Safety Net Health Systems. American Journal of Medical Quality (2017): 1062860617708393. Hinderer, K. Journal of Trauma Nursing, 21(4), 160-169. Hooper, C. Craig, J. Janvrin, D. Wetsel, M. Annals of emergency medicine 65. Lavoie, Stéphane, et al.

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An exploration of factors associated with post‐traumatic stress in ER nurses. Journal of nursing management 24. Madsen, Ida EH, et al. Christopher, D. P. Patel, B. Implementation of Ríos-Risquez, Mª Isabel, and Mariano García-Izquierdo. Patient satisfaction, stress and burnout in nursing personnel in emergency departments: A cross-sectional study. After compression, time for decompression: debriefing after significant clinical events. Infant 10. Stang, Antonia S. et al. Quality indicators for the assessment and management of pain in the emergency department: a systematic review. International archives of occupational and environmental health 89. Trzeciak, Stephen, and E. P. Rivers. Emergency department overcrowding in the United States: an emerging threat to patient safety and public health.

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