Health Care Involvement Real Time Emergency time Reporting

Introduction

Emergency departments require advanced support in order to help in monitoring and controlling its various processes like the clinical, financial, and operational processes. Most hospitals represent areas where simulation and modeling can be effective equipments in evaluating patient care and patient access policies and efficiencies. In most occasions, the operations in emergency departments are normally over taxed because they present the necessary cooperation between the competing priorities. Several practices and strategies are carried out over time in order to reduce the patient wait times and other care restrictions. The agent-based model (ABM) and the queuing model (QM) techniques can be applied to the operations of emergency department with respect to patient flow and patient access through the emergency department.

Improving Delivery

The understanding of wait times that patients face enables the health care professionals to implement strategies that can lead to improvements across the health care systems. Real time information collected helps in improving patient flow, inform decisions on the distribution of resources for communities and hospitals and reduces the emergency room wait times. The initial efforts have focused very much on the modeling basic aspects of emergency room treatment process. In the current model, patients arrive by walking in or by ambulance. Due to the need of an immediate care they are directed to a treatment room. McHugh says that the ones who do not need immediate treatment wait in the queue in case the registration desk is busy at the moment. Once the registration is complete, the patients are directed to the triage station and wait in the queue for their turn to come. The staff at the triage station assigns the patient a priority level depending on the severity of the condition. The arriving patients are expected to wait with other patients in the queue as they wait to be assigned to the treatment room. The patient is expected to wait for the physician staff to attend to him after being assigned to the treatment room. The physicians provide patients with treatment in the order of urgency and later in order of arrival. The patients that have been treated leave the room for the others to be attended to. The patients therefore follow the trend until the last patient is treated.

Emergency Cases

 Overcrowding is a major problem that has become a chronic state in the emergency department. Overcrowding is a situation in which the demand for services is greater than the ability to provide care within the required time. This condition makes the physicians unable to provide quality care in a timely manner. According to the Canadian Association of Emergency Physicians and the National Emergency Nurses Affiliation, there are several causes of overcrowding. First, they stated that lack of beds for the admitted patients causes this problem. The main cause of the emergency department overcrowding is the increased waiting times for transfer to an inpatient bed.

Sachdev claims that the other cause is lack of access to primary care, nurse practitioners and specialist physicians. In most cases, there is always a shortage of family physicians, and many specialists including nurse practitioners in various health centers. Furthermore, the primary care physicians take a lot of time while attending to the patients. Patients do seek emergency department care when they can’t see their physicians within an appropriate period of time or when the waiting times for the tests or procedures of the specialists are very long. As the patients conditions worsen and become frustrated, they seek help in the emergency department. This is because they are aware that in emergency departments there is a specialist ready to help in any time of emergency and the presence of an advanced diagnostic technology.

In addition, the shortage of the nursing and physician staff contributes to the overcrowding in emergency departments. Nurses are very few making most hospitals to be unable to attract enough nurses to staff their emergency departments. Some nurses are unqualified to work in emergency departments thus causing overcrowding. As the population increases in the emergency departments, the patients with chronic conditions are forced to wait for the services making their conditions even worse.  Some patients die even before being attended to due to overcrowding and long waiting times. The non-urgent patients crowd in emergency departments due to lack of enough qualified physicians and nurses. Moreea claims that the few qualified physicians are overworked thus leading to the provision of inappropriate services to the patients. Some patients are normally forced to wait for long hours due to lack of 24-hour tests in the emergency department. Other patients are informed about the tests the following morning making their conditions to worsen off.  Davies asserts that the unavailability of operating area time and delayed access to surgical services causes an increase of outpatient and inpatient waiting times leading to lack of efficient use of hospital beds and recurrent emergency department visits by the patients waiting for treatments.

Effects of Overcrowding

Overcrowding of patient has many effects most of which result from the inefficiencies of the emergency departments. Due to overcrowding, nurses and physicians feel rushed. This may result into increased rates of errors leading to adverse patient outcomes. In addition, the prolonged delays in treating pains make the patients suffer for long before being attended to. The increase in wait times causes patients to take long hours waiting in chairs and stretchers. The relief of pain is therefore delayed beyond the limits. This leads to more risks and worsening conditions. Finally, the emergency department personnel usually have less time to teach and conduct some reasonable research. Education of patients in the departments and delivering instructions to the discharged is limited due to overcrowding, all of which lead to inefficiency.  Overcrowding in emergency departments contributes greatly in the increased wait times. It makes patients have a hard time in flowing through the system in the right way. This leads to several consequences including patient dissatisfaction, suffering and inconvenience, poor results, poor quality of care, and contribution to outbreaks of infectious disease. Further more, it leads to increased risks of medical errors as well as deteriorated level of services.  

Probable Solutions

Davies asserts that in order to find solutions that would help this condition, the physicians should provide adequate care to patients who are admitted. The patients who present acute surgical, medical or psychiatric conditions deserve an appropriate access to ED care. The public and the government should identify how overcrowding is a great problem in the emergency departments and should consider it as a high priority health concern. Furthermore, the public should know that long ED wait is unacceptable to patients who are admitted. The solution to overcrowding requires more community care options for the chronically ill, the improvement in efficiency in hospital situation and better access to surgical, diagnostic and acute care services. Solutions to this problem require total financial and philosophical support and attention from the government, the community and the health communities.

Various patients who check into emergency departments experience long wait times in the room waiting area. The wait times are caused by the triage processes. The emergency departments wait times causes delay in treatment of patients that require immediate medical care. It is upon the hospitals to ensure that the amount of time spent by the patients in the wait rooms is reduced. Some ways of reducing wait times is to stop boarding patients. Patients should be placed in hospital beds and department hallways instead of crowding them in emergency wait rooms waiting for a free bed. Patients can also be registered in their beds instead of making them wait in the registration desk.

Increasing the number of emergency department staff can help in reducing the wait times. This will enable a collective work leading to provision of efficient services. In addition, the use of technologies that report and monitor emergency room waiting times help to solve the problem of prolonged waiting times. Some centers provide real-time information to patients concerning the emergency wait times through the internet and telephone texts. This helps the patients to view wait times before proceeding to the emergency room. In addition, it helps the patients whose conditions are not very complicated and does not need immediate attention to report to the room when the waiting room is less crowded. Furthermore, the non-emergent patients can be educated on ways of using emergency rooms properly and directed to a non-emergency service provider.

Programs can be developed where the public can be informed about the present health care systems in order to understand the services that can be provided in the emergency departments. In addition, training institutions can be expanded so that they can produce physicians and nurses that are well experienced in dealing with issues as those of overcrowding and prolonged wait times. The implementation of computer databases assists the emergency department managers to analyze the acuity profiles, waiting times, visit volumes, the length of stay and the admission rates. It is good to implement real time Emergency Department information system in the emergency departments to enable physicians and nurses to use computerized data in order to help patients through their stay in emergency departments more efficiently.

In order for the health clinics to ensure that there is efficient flow of work, it is necessary to use Ascribe Symphony. Ascribe Symphony is an electronic patient record system that is designed to improve the patient flow in the emergency department. This system ensures that data entry is directly done from the tracking grid. The system was developed to improve the patient’s outcome, reduce risks, reduce the wait times and increase the level of efficiency. It also provides the administrative staff with care solutions for documentation and access to patient information and the retrieval of real-time clinical data. Additionally, Ascribe symphony is used in various locations and departments. This allows management and monitoring of the department workload and access to the records in several locations. A patient list may include the waiting for treatment, triage category, bed location and time in department. Moreover it provides clinical order management system for real-time patient and clinical care orders at the care point. The support tools used by the clinician help him in making appropriate decisions in clinical orders so as to improve on the patient’s safety and the clinical quality. It also helps in overcoming the overcrowding problem.

Ascribe symphony can be used to provide clinical decision support for care through the web links to the decision support databases and the department guidelines on the documentation build within the symphony. It therefore helps clinical officers to access the latest clinical procedures at the point of care. Ascribe Symphony helps in improving the efficiency of workplace by enabling one to examine the efficiency of support services. The emergency departments are serious point of access to health care organization as they offer an essential service to the population in general and should therefore be well equipped in order to offer the best to the patients.  

Public involvement

In order to promote better public access to easy understanding of the performance of hospitals, most hospitals have developed a new website which is intended to make public information concerning health organizations. The information from the website helps the public to know the period time one can spend in an emergency room. This may help the patients and other individuals to have better timing of the emergency room. In addition, report cards are also used as the most publicly visible aspects that can improve the quality of hospital management and performance. The public reporting of comparative information concerning the quality of health care is an accepted way of improving quality and accountability.

Emergency departments have become the access point to health care for many children and adults. Most hospitals need to be improved by both the government and public in order to enable the physicians to offer high quality services. Patients overcrowd due to availability of few beds. The public is required to assist in raising funds that would help to increase the number of inpatient beds. This would help to reduce the rate of overcrowding and the waiting times. Furthermore, the public helps in constructing many emergency department stations to decrease the number of waiting time due to overcrowding in few emergency departments.

Additionally, most hospitals have developed most programs that enable the physicians to teach the community important issues concerning the emergency department and how to make good use of the departments. They are educated on the kind of conditions that are required to be directed to emergency departments such as chronic conditions. This helps to reduce cases of overcrowding. Moreover, health organizations should be open and accountable to the community concerning the performance and the quality of service they offer. Through their support, the government and the community can inspire the improved performance, strengthen their confidence and enhance patient safety.         

Conclusion

The public and health care organizations are expected to be improved in order to reduce the risks that may result due to overcrowding that causes prolonged wait times. The prolonged wait times can make patient situations to worsen off and even lead to death. Furthermore, the physicians and nurses feel rushed and therefore can make various medical errors or carry out incorrect tests that may result into many other complications or even death. Additionally, some patients receive inadequate treatment because the physicians become very tired after attending to many patients. This also results due to lack of enough qualified nurses and physicians. The physicians are few and therefore become overworked due to overcrowding. It is appropriate for the public to be educated on various ways of using emergency departments. This may help to reduce the attendance in emergency departments because most individuals who visit emergency departments have non-emergency conditions.