Theoretical Basis of Emergency Department Overcrowding Emergency Departments (EDs) worldwide are in a predicament due to the increasingly crushing nature of soaring demand, increased number of visits, overuse and misuse, and escalating costs. Adding to the catastrophe is the fact that for the past 20 years the number of ED’s have decreased due to closures. The disproportion of demand versus capacity has ultimately caused overcrowding, long wait times, and patients departing without being seen (Love, Murphy, Lietz, & Jordan, 2012). Furthermore, studies suggest overcrowded ED’s result in reduced quality of care; causing treatment delays, patients dissatisfied, and increases in morbidity and mortality (Hayden, Burlingame, Thompson, & Sabol, …show more content…
External factors such as poor primary care access, health care reforms, and economic hardships as well as internal factors such as staffing and hospital bed shortages have all contributed to ED overcrowding (George and Evridiki 2015). Stang, Crotts, Johnson, Hartling, and Guttman (2015) report that ED overcrowding results in adverse consequences, such as treatment delays, rises in error and undesirable events, and increased morbidity and mortality.
The Emergency Nurses Association, American College of Emergency Physicians, and the Institute of Medicine have focused on strategies that will improve the efficiency and quality of crowded EDs (McHugh, Van Dyke, Yonek, & Moss, 2012), but research is lacking in how nursing theory can impact this particular phenomenon. The use of nursing theory to examine ED overcrowding would serve as a guide, directing nursing practice to explain the nursing domain.
Nursing
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The environment that surrounds a patient can greatly affect their emotions, their attitude, and their ability to comprehend new information. In order to benefit all parties, it is necessary to create an environment that provides both assurance and security. The overcrowded, fast paced, and loud environment of the ED is normally not conducive to providing quality nursing care. It is a constant but necessary battle for the ED staff to ensure an environment that allows for the safety and security of all patients. Environment could also refer to fewer ED’s nationwide, reduced access to primary care, and decreases in inpatient beds; however, few of these factors are open to interventions. Even though there is no conceivable solution, nurses have a valuable and unique perspective in identifying safe and secure care and are pressed to explore practices that support positive patient outcomes, regardless of a crowded environment (Johnson and Winkelman,
Monitoring staff levels is an important factor. Also leveling the flow of patients in and out institutions could help to reduce wide fluctuations in occupancy rates and prevent surges in patient visits that lead to overcrowding, poor handoffs, and delays in care. Studies show that overcrowding in areas such as the emergency rooms lead to adverse outcomes, because physicians and nurses having less time to focus on individual patients. One study found that for each additional patient with heart failure, pneumonia, or myocardial infarction assigned to a nurse, the odds of readmission increased between 6 percent and 9 percent (Hostetter and Klein, 2013). All of which costs the hospital money.
The challenges that all acute care hospitals and facilities faces are the demand for highly specialized services has increased. The US population is constantly aging and the elderly tend to need more acute care services. Because many people lack health insurance, they tend to use emergency rooms in the hospitals as their source of care. The increase demand in acute care prompted hospitals to expand their facility
There are pros and cons. Some medical people believe that the EMTALA legislation creates some problems for hospitals. Knowing that hospitals must take care of every person, people may use the ED for routine doctor visit situations. These people believe this contributes to the sometime overcrowding of ED’s. Another problem is that EMTALA legislation mandates caring for everyone no matter what. The hospital therefore, may not get paid. “According to the American College of Emergency Physicians, 55 percent of emergency care goes
The Crowded Clinic Case Study (Colorado State University - Global, n.d.) discusses the issues of practice management as they apply to access to care. Access to care may be as inconvenient as lengthy patient wait times to issues far more serious that may have a profound effect on the health and well-being of a single patient or an entire cohort.
The state of emergency medical care currently practiced in this community involves an excellent pre-hospital phase under the jurisdiction of Los Angeles City paramedics. The paramedics have jurisdiction of about thirty-five emergency rooms to which their patients can be transferred after beginning medical treatment at the scene of the accident. This is where the problem occurs. To provide the best possible emergency care at the hospital, two factors play an important part. First, the staff must work on at least two to three severely injured patients daily to maintain their technical skill at top level. Second, surgeons and operating rooms must be available within 15 minutes notice, twenty-four hours a day, 365 days a year. In the San Fernando Valley, this level of care is not met anywhere. In greater Los Angeles, this level of care is met at less than six hospitals. The problem involves too many emergency rooms for the population. The cost of maintaining an operating room on fifteen minute standby day and night would put hospitals out of business, since even the busiest hospitals only receive three to four severely injured patients each week. The patient load would not support the very high cost of this service.
There has been a shortage of physicians, lack of inpatient beds, problems with ambulatory services, as well as not having proper methods of dealing with patient overflow, all in the past 10 years (Cummings & francescutti, 2006, p.101). The area of concern that have been worse...
The nursing profession is a profession where people put their trust in you to provide care that is not only effective, ethical, and moral, but safe. Not all health situations are simple or by the book. Not all hospitals have the same nurse-patient ratios, equipment, supplies, or support available, but all nurses have “the professional obligation to raise concerns regarding any patient assignment that puts patients or themselves at risk for harm” (ANA, 2009). When arriving at work for a shift, nurses must ensure that the assignment is safe for not only the patients, but also for themselves. There are times when this is not the situation. In these cases, the nurse has the right to invoke Safe Harbor, because according the ANA, nurses also “have the professional right to accept, reject or object in writing to any patient assignment that puts patient or themselves at serious risk for harm” (ANA, 2009).
Patients Safety is the most crucial about healthcare sector around the world. It is defined as ‘the prevention of patients harm’ (Kohn et al. 2000). Even thou patient safety is shared among organization members, Nurses play a key role, as they are liable for direct and continuous patients care. Nurses should be capable of recognizing the risk of patients and address it to the other multi disciplinary on time.
It is clear that statewide mandated nurse-to patient ratios result in drastic financial changes for every hospital impacted. Hospitals often have to compensate for hiring more nurses by laying off support staff. Mandated ratios also result in an increase in holding time in emergency rooms . (Douglas,
...managing the environment for the benefit of the patient to help reduce risk factors. Supportive measures by the nurse such as attention to noise reduction and lighting should be implemented to all patient care settings. The nurse should be proficient in their assessment method. The bedside nurse is in a front-line position to manage and prevent delirium.
In less stressful environment, nurses able to incorporate caring relationship, improve interactions between patient and a nurse, and develop understanding of the other person’s perspective (Nicely, K, Sloane, D., Aiden, L., 2012).
The sources used were retrieved from the online Shapiro Library. Electronic databases, including CINAHL were used to do a multi-search for sources. Key works used included nursing safe staffing and nursing staff ratios and patient safety. The criteria used to select the articles were peer reviewed articles within the last five years.
On the other hand, College of emergency medicine highlighted concerns about junior doctors EM training in its 2012 annual report to the GMC stating continuing service pressures is reducing the amount of time trainers can dedicate to delivering training. Also, medical educators have budgetary constraints to improve the quality of medical education and the safety of medical care. (Vozenilek, Huff, Reznek, & Gordon, 2004)
Meredith, J.W (2008, May). The Lack Of Hospital Emergency Surge Capacity: Will The Administration's Medicaid Regulations Make It Worse? Presented at The House Committee On Oversight And Government Reform. Retrieved March 2014, from
With the “free” access to healthcare service in British, patients can utilize the healthcare service repeatedly no matter how serious disease they are undergoing, hence, it precipitates longer waiting times for those who have actually needed. The statistical data, collected by the Royal College of Emergency Medicine, illustrated that 88 percent of emergency patients were given treatment or admitted within four hours, which is outweigh the NHS target, at 95 percent (Triggle, 2015, no page given). Also, the official data published by the NHS England demonstrated that approximately 2.9 million of the UK residents are on the waiting list requesting for therapy at NHS hospitals, unfortunately, the average waiting time for therapy is currently 5.7 weeks in 2012 (Collins, 2013, no page given). Apart from the prolonged waiting list, free healthcare service in the UK is facing the insufficient hospital beds problem. A recent report from OECD figured out that 84 percent of hospital beds were unavailable at any time, which is much higher than Europe countries and the performance of British is substandard (Donnelly, 2014, no page given). Facing those dilemmas in the British, the patients in the UK cannot receive the