Causes and Adverse Effects from Overcrowding of Emergency Departments: The Solution

2 Causes and Adverse Effects from Overcrowding of Emergency Departments: The Solution . 6 Emergency Department Workforce . 6 Causes of Overcrowding . 7 Adverse Effects from Overcrowding . 19 Solutions . 33 Conclusion . 50 Bibliography . 51 CAUSES AND ADVERSE EFFECTS FROM OVERCROWDING OF EMERGENCY DEPARTMENTS: THE SOLUTION Page 6 of 55 Causes and Adverse Effects from Overcrowding of Emergency Departments: The Solution When someone is in immediate need of emergency care, surgical, cardiac, or medical care, it is expected that they be taken to the nearest hospital. Within the hospital, the patient in need of care will be seen in a department of the hospital for which its personnel are trained and, in most cases, fully equipped to respond to certain emergency situations. This department is called the Emergency Department, sometimes referred to as the ED, ER, or emergency room (Definition of Emergency Department). Staff within functioning emergency departments from managing to working with patients will be expected to be trained on how to recognize chaos within the emergency department in order to maintain a smooth flow of patients being admitted and discharged. They must also know how to control a chaotic environment, and if possible, know how to prevent it (Celenza, 2013). Without a smooth flowing process of admitting and discharging patients, things can get out of order causing a chaotic work environment. Following an implemented organizational structure within the emergency department decreases chances of adverse effects and/or overcrowding. Emergency Department Workforce The workforce within an emergency department consists of educated medical staff; emergency clinicians, emergency physicians, and emergency nurses. All of which complete medical procedures under extreme pressure when taking on risky procedures to save a life. Although working in an emergency department may be a tough, it can be very rewarding to know you saved a life. Emergency department overcrowding places the workforce in a chaotic CAUSES AND ADVERSE EFFECTS FROM OVERCROWDING OF EMERGENCY DEPARTMENTS: THE SOLUTION Page 7 of 55 environment. Patients and family want answers but if there is overcrowding this make a patient wait for care much longer than it might need to be in the case of an emergency. There may be instances where a hospital is understaffed, causing more of a delay in patient care and an increase in patient length of stay. The good news is that all of the emergency departments’ workforce should be well trained to handle any emergency situation, they are expected to care for patients, make them feel as comfortable as possible, give accurate diagnosis, and to avoid making any medical errors. Problem is, how can emergency clinical staff, physicians, and nurses make sure all is followed with emergency department overcrowding being a national crisis? Causes of Overcrowding According to the Center for Disease Control and Prevention, from 1992 to 2002 the yearly emergency department visits increased by 23% and the number of emergency departments decreased 15% (Stein, 2005). During this time period hospitals were closing, downsizing staff, and there was even a shortage in nurses nationwide. The decrease in emergency departments, increase in emergency department visits, nurse shortage, closures, and downsizing staff contributed to the overcrowding we see today, but these five contributing causes were just the beginning of what would come as a national crisis. It would sound correct to say that an increase in emergency departments is largely due to those users who are uninsured, but surprisingly that information would be incorrect according to the Center for Studying Health System Change. The Center for Studying Health System Change CAUSES AND ADVERSE EFFECTS FROM OVERCROWDING OF EMERGENCY DEPARTMENTS: THE SOLUTION Page 8 of 55 reported a substantial fraction of the emergency departments’ visits that increased in 2001 to 2002 by 2.7 million was utilized by those that are insured users (Hwang, 2004). In a report by the US General Accounting Office (GEO), one other contributing factor the overcrowding of emergency departments is the difficulty of admitting patients and moving them from admitted to inpatient beds. Most all hospitals are running at a much higher census, making it harder for emergency departments to admit a patient. This leaves emergency departments with a limited amount of inpatient beds, overcrowding, not enough staff to tend to all, then resulting in longer wait times and longer stays (Pediatrics, 2004). Emergency department overcrowding is also caused by the prolonged time of admitting patients but is most frequently caused by limitation of inpatient beds (Hosseininejad et al., 2014). Information from the article, “Nonurgent patients in emergency departments: rational or irresponsible consumers? Perceptions of professionals and patients”, published in 2012, was documented as a semi-structured interview study on patient misuse of emergency departments, how the phenomenon of nonurgency is perceived by health care professionals within emergency departments, and why patients choose emergency departments for nonurgent complaints. With their consent, the study used information given by 34 emergency department health professionals and 87 emergency department patients that a triage nurse categorized as nonurgent. Out of the 87 emergency department patients: 32.1% had tried to contact their primary care provider before coming to the emergency department, 4.6% were referred due to medico-legal reasons, 16.1% were referred by their primary care physician, 48.3% were there due to minor traumatic problems, 79.3% were self-referred, and 76% had symptoms for less than 24 hours that were related to their chief complaint. The study results for patients’ reasons for emergency department visits were because of the advantages of the emergency department, barriers to primary care CAUSES AND ADVERSE EFFECTS FROM OVERCROWDING OF EMERGENCY DEPARTMENTS: THE SOLUTION Page 9 of 55 providers, and for fulfilling their healthcare needs. Out of the 34 emergency department health professionals, some of the main topics that emerged from the interviews on why people choose the emergency department for non-life-threatening symptoms was the issue in the definition of an inappropriate visit and a nonurgent visit, the lack of primary care provider access on weekends and long wait times for office appointments, and patients not considering the cost of an emergency department visit at time of service due to being seen without paying up front. Most all of the emergency department health professionals described those who want immediate and indiscriminate health services are irresponsible patients. As for those who visit the emergency department with nonurgent symptoms, the emergency department health professionals described them as a consumer abusing healthcare (Durand et al., 2012). Overcrowding should be recognized by the government and not solely on emergency department administrations as a public health crisis. In America, emergency department doctors (Less than 5% of doctors in America work in emergency departments) treat more uninsured and Medicaid beneficiaries with acute care than any of the American doctors together (Somma et al., 2014). To examine non-emergent patients in wait times through triaging, a study was conducted at an emergency department in West Lincoln Memorial Hospital (WLMH). This hospital was located in a suburban community and servicing surrounding areas and the community of 24, 240. (Knapman & Bonner, 2010) Table 2. Patient disposition Canadian Triage and Assessment Scale III, IV, V (Knapman, 2010 & Reay, 2016) CAUSES AND ADVERSE EFFECTS FROM OVERCROWDING OF EMERGENCY DEPARTMENTS: THE SOLUTION Page 10 of 55 Patient flow Age group 1 (18– 39) Age group 2 (40– 65) Age group 3 (≥ 65)