The issue of off load delay is becoming ever more relevant as emergency departments (ED) are filling up and having longer wait times. This isn’t always an issue when there are free paramedic crews in the area but it often results in coverage lapses. The question becomes, should paramedics be leaving their less urgent patients in triage with walk-in patients so that they can get to other people in need? A balance needs to be found between leaving the CTAS 4 and 5 patients in the waiting room and leaving 911 callers at home to wait.
According to the Basic Life Support (BLS) Patient Care Standards, Section 1 M, if the ED won’t be able to accept responsibility for the patient in a reasonable time, the paramedics may “remain on standby for return
Although the hospital was following the directive in order to maintain legal immunity for its hospital staff, the rights of the family were violated along with the medical fundamental principle to “first, do no harm”. First of all, despite the wishes of Marlise Munoz, she continued to receive the help of machines and hospital staff at John Peter Smith Hospital even after being declared dead. Marlise was found on her kitchen floor after more than an hour without oxygen on November 26, 2013. Arriving at the hospital, the staff placed Marlise on life support in accordance with section 166.049 of the Texas Advance Directives Act. The directive states, “A person may not withdraw or withhold life-sustaining treatment under this subchapter from a pregnant patient.”
...o get a do not resuscitate order. That is an order that the families may sign so the hospital does not have to give effort to bring a person back to life anymore once they have stopped breathing.
Calls to outpatient areas such as radiology, rehab, and the hospital lobby are also on the rise, with family members, visitors, and employees being added, besides the inpatients, to the list of eligible Code Rescue calls for the ICU nurse to respond to. With Code Rescues involving a Stroke Alert, the ICU nurse must accompany the patient to the CT Scan area for a STAT CT of the brain, which takes the nurse away from their assigned patients for an even longer period of time based on the status of that patient. When a nurses take their break, another nurse is required to monitor those patients as well as take care of their own patient assignment. The attention given to the other patients is not considered to be extensive, basically “keeping an eye” on them until their nurse returns. This patient assignment could be at a safety risk if their nurse is also the one assigned to respond to Code Rescues at any time during the
Wake County EMS responds to almost 90,000 requests for service annually and serves almost 1 million people, which places the WCEMS system in the top fifty EMS systems in the country based on call volume and size of population served. ("Wake county department," 2012) In response to ever-increasing call volume, a decrease in primary care, and the universal changes in healthcare, which have resulted in more people using EMS and the local emergency room for primary care and non-life threatening events, the EMS Department elected to change their service structure. The department would move away from the traditional EMS mantra of “you call we haul” and having a system being designed around reactive responses to healthcare issues in the community to an evidenced based incident prevention structure. No longer, would it be considered prudent or correct to just continue to add transport resources to address the increasing call volume and continue to place the actual burden of care on the local hospitals, it would become the burden of the EMS system to provide alternatives to properly address the actual healthcare needs of those who called 911. Wake County EMS had already utilized evidenced based ...
The responsibility of the health care provider is to make sure the patient is stabilized if they have an EMC and determine if the hospital has the all of the appropriate capabilities to provide medical care for the patient's diagnosis. If the hospital does not then it is the hospital's responsibility to transfer the patient to the appropriate hospital that has the specialized services. If the hospital that I work for does not have a burn unit, then I need to know ahead of time what hospital do, so that I can make sure to send the patient to the appropriate hospital. The hospitals that have the appropriate specialization are required by this law to accept the transfer. Therefore, it is also my duty to know what specialties the hospital I work for has and understand that we have to accept a transfer patient. You are also not allowed to slow down the screening process, for example, requiring and gathering insurance information. You can get demographics and basic insurance information, but delays like authorization or calling the insurance company for verification or preauthorization for scans or test is considered a delay. Under this Law, it is my duty to make sure that any individual, with or without Medicare, any individual exhibiting the
“Code Blue”, that the last thing anyone wants to here at the beginning or end of a shift, or for that matter at any time during their shift. With the development of rapids response teams (RRTs), acute care nurses and ancillary departments have a resource available to their disposal when need in uncertain situations. Many times nurses struggle to maintain a patient deteriorating in front of them all the while make a multitude of calls to the physician for orders or concerns. Having a set of “expert” eyes assisting you in these times helps alleviate stress and encourages collaboration amongst staff. (Parker, 2014)
... revealed that longer waiting times has negatively impacted the lives of not only patients, but also healthcare providers . Some QI strategies implemented such as simulation tools, fast -track and reorganization of the ED by several hospitals has shown some improvement in workflow thus decreasing overcrowding and the length of time spent in the ED. As healthcare leaders, the focus should reside on ongoing advocacy for new policies or guidelines to resolve the waiting time issues and addressing limitations of previous interventions. Addressing the ED issues, Leaders should abide by the IOM report considering overcrowding as a mostly external or a system-wide issue. Implementing preventive measures described earlier will help not only to decrease WT in the ED, but also to avoid future incidents similar to the one recently experienced in St Barnabas Hospital.
Emergency departments of hospitals are fundamental in the treatment of time sensitive conditions such as acute stroke (Trzeciak & Rivers, 2003). A stroke occurs when there is an interruption of blood flow to brain tissue, and therefore is a condition that relies on apt and adequate access to healthcare (Panagos, 2006). Patients who have experienced a stroke will most often present to emergency departments in order to receive treatment (Kothari et al, 1998). However it has been found by Chan et al (2010) that approximately 48% of American hospitals are operating over capacity and therefore not providing satisfactory healthcare. Overcrowding can be defined as the overabundance of patients requiring treatment and may be attributable to the misuse of the emergency area by non-critical patients (Chan et al, 2010; Trzeciak & Rivers, 2003). This has the potential to negatively affect outcomes for stroke patients. The aim of this essay is to investigate factors such as patient knowledge, wait times and patient safety in order to examine the effects of overcrowding of emergency departments on stroke patients.
Nobody is perfect. We all make mistakes. Some of the best lessons in life are learned from making a mistake. But in the healthcare world making mistakes means losing lives. This has started to happen so frequently there has been a term coined – Failure to Rescue or FTR. Failure to rescue is a situation in which a patient was starting to deteriorate and it wasn’t noticed or it wasn’t properly addressed and the patient dies. The idea is that doctors or nurses could’ve had the opportunity to save the life of the patient but because of a variety of reasons, didn’t. This paper discusses the concept of FTR, describes ways to prevent it from happening; especially in relation to strokes or cerebrovascular accidents, and discusses the nursing implications involved in all of these factors.
The facility should have written statement to refer to in case of emergency to help and protect the health care workers that are onsite. So that it would minimize the confusion. We all know that in the case of cardiac arrest time is very critical. The nurse wasted the patient greatest opportunity of survival by standing there and refusing care. It’s the policy of this facility to not make care for cardiac arrest patient difficult. I understand at 87 years of age the end result is most likely not going to be a promising, but I would help to know that there are some people who are willing to help. I hope the nurse learned her lesson and stand clear of confusion for future patient that reside the
In addition, those potentially nearing the end of their life may be asked a DNR, or “Do Not Resuscitate,” Order. This states that in a life-threatening emergency where one is facing possible death, no actions shall be done try and “resuscitate” the individual in an attempt to restore life to the person. However, if a DNR Order is not filled out, actions including CPR, or cardiopulmonary resuscitation, mechanical ventilation, h...
Emergency care has always been an important part of history all over the world. It has been said that medical assistance has been around and prevalent since as far back as 1500 B.C. Around the 1700’s is when EMS systems first began to experience large advancements, and ever since then, the field continues to grow and improve every year.
“Summary Report for: 29-2041.00 - Emergency Medical Technicians and Paramedic.” O*Net. 2008. Web. 18 Feb. 2010.
Naturally you'd hope and expect the hospital to have enough resources to facilitate the return to health, or to prolong their lives,
Commonly throughout most countries of the world, citizens of the society at large establish the system for Emergency Medical Services. In the case that the public is not willing or capable of summoning such a service, the country often finds other emergency services, businesses, or the government and authorities who act to employ a system. In other parts of the world, the emergency medical service additionally takes on the role of transporting patients from one medical facility to an alternative one. This occurs with some frequency because once a patient is analyzed and provided care at the immediate hospital; it may be more appropriate for a variety of reasons the patient needs to move to another facility. As one can see, the relat...