Urgent Care Policy Structuring: Urgent Care Inclusion and Exclusion Policy - Essay Example

? Urgent Care Policy Structuring: Urgent Care Inclusion and Exclusion Policy The lack of urgent care service inclusion/exclusion policy in Alberta health facilities, coupled with the trend of increasing numbers of urgent care visitors indicates that this is a severe problem for healthcare. This paper addresses the problem of how best to satisfy the need for clear definitions of urgent care inclusion and exclusions to prevent confusion to staff and patients. An inclusion/exclusion urgent care policy for Alberta Healthcare Services embedded in the tenets of transparency, trust for staff and patients is suggested to address the problem. After research, expert brainstorming and objective mapping, two policy alternatives are generated; the Urgent Care Services and the Emergency Severity Index. The former is recommended as it fulfills the effectiveness, efficiency, equity, and responsiveness needs. Procedures for implementation and evaluation are detailed, before arriving at the possible limitations of the policy. Scope and Severity of the Policy Problem The number of patients arriving at emergency care departments has been continuously rising, resulting in overcrowding and undesirably poor health outcomes in these departments (Derlet, Nishio, Cole and Silva, 1992; Bernstein et al., 2008). The numbers of ED visits have increased by 3.9% annually between 1996 and 2006, from 90.3 million to 113.2 million individuals. Meanwhile, the number of hospital EDs has decreased from 4019 to 3883 over the same period (Pitts, Niska, Xu and Burt, 2008). The situation is worsened by absence of planning and policies for urgent care inclusion. This problem is replicated in Alberta, where analysis indicates that among the 6 urgent care facilities present in Alberta, none had a formal policy to clearly define urgent care service inclusions and exclusions. This lack of a prioritisation policy results in overcrowding which is accompanied by problems such as poor patient-physician communication, compromise on confidentiality and privacy among others. Thus, the lack of an urgent care and inclusion policy is a serious problem warranting all efforts to address the issue. Problem Statement Dunn (2004) stresses that adequate formulation of the policy problems is a crucial step in generating policy solutions. The problem addressed in this paper is how to best satisfy the need for clear definitions of urgent care inclusion and exclusions to prevent confusion to staff and patients. This policy statement is refined from a clear analysis of the ED issues facing Alberta Healthcare Services. An environmental scan of all 6 urgent care service sites is undertaken to determine the informal inclusions and exclusions in place. A brainstorming session by expert site stakeholders identifies the missing inclusions and exclusions for the urgent care services in Alberta. Further, there is use of object mapping to validate inclusions and exclusions so as to validate outcomes. Based on this clear analysis, the issues addressed in this paper is whether a provincial urgent care inclusion/exclusion policy will meet needs of the various urgent care sites throughout the province. The expert brainstorming and objective mapping undertaken in analysis provides a number of insights on the urgent care services in Alberta. First, the main stakeholders in the issue are discerned as including; the Emergency Clinical Network, Health Link Alberta, the physicians, the Triage RNS, hospital managers and clinical educators, legal units and the clinical policy unit. In terms of prioritisation, the Triage nurses and the clinical policy unit have very crucial roles to play, since the nurses will be the first line of contact with urgent care visitors while the policy formulation process largely derives drive from the clinical policy unit. The physicians and legal unit constitute the next level of prioritisation since they play important roles in urgent patient care and policy formulation respectively. The remaining stakeholders; the hospital managers and clinical educators, the Emergency Clinical Network and Health Link Alberta form the next level of priority stakeholders. However, their input, deliberations and support are necessary in order to ensure smooth development and implementation of the inclusion/exclusion urgent care policy. Hence, all the stakeholders identified have clear and crucial responsibilities in enabling the proposed policy. Policy Statement The analysis further helps determine the objectives and goals of policy-making in a bid to address the urgent care inclusion/exclusion problem. The purpose driving the policy is to ensure Alberta Health Services complies with Alberta Health and Wellness Directive D4-2007 and the associated guidelines. The main goal is to develop an inclusion/exclusion urgent care policy for Alberta Healthcare Services embedded in the tenets of transparency, trust for staff and patients. The objectives of the policy are as follows: To develop a transparent and ethical inclusion/exclusion urgent care policy To promote trust among patients and staff in implementation of the proposed policy To develop a responsive and evidence-based policy An appraisal mechanism is an important aspect of policy formulation. The main consideration for appraisal in this policy statement formulation is whether there is a reduction in the number of patients’ complaints in regards to lack of communication for exclusions and inclusions. This criterion correlates with patient satisfaction with the urgent care services in Alberta and, thus, fulfills one of the major aims of healthcare provision. The analysis undertaken also queries all the potential solutions to the stated problem; policy formulation, proceeding without a policy or using an informal variable policy. The scope and severity of the inclusion/exclusion problem in Alberta translates to a situation where strong policies are needed to tackle the problem. Continuing urgent care operations without a policy is a recipe for disaster as confusion and poor health outcomes are likely to arise. The problem also bears a large magnitude and importance; hence, an informal invariable policy is categorically not appropriate. Based on these views, the policy statement for Alberta Heath Services is as follows: Alberta Health Services is committed to supporting the role of Urgent Care Services as a transitional step between communities and hospitals for unscheduled Patients with urgent but non-life-threatening health needs. Policy Alternatives This study compared to policy alternatives; the Urgent Care Services and the Emergency Severity Index. The former policy recommendation is customised for Alberta Healthcare Services and involves five elements; specification of urgent care services locations; specifications of the core mimimum services to be provided for all urgent care visitors; detailed description of the service inclusions; details of clinical services (assessment, diagnosis and treatment); and lastly, details of the service exclusions. On the other hand, the Emergency Service Index (ESI) is an AHRQ research-based policy initiative that entails four decision points and the clinical steps involved. Decision Point A queries whether the patient is in need of life-saving services/attention; B concerns with whether the patient is one who should not wait; C involves determining the number of resources the patient may use; and lastly, D entails assessment of the patient’s vital signs. The triage nurse also considers how the time to treatment influences the ESI categories just described (Gilboy, Tanabe, Travers and Rosenau, 2008). The two policy alternatives are analysed in terms of cost, effectiveness, constraints, and political feasibility as follows: The Urgent Care Services policy is customised to Alberta Health Services and thus takes care of cost considerations. On the other hand, the ESI is a template generated through AHRQ research and may not be sensitive to the cost considerations of Alberta health Services. The two alternatives offer strength in effectiveness; the ESI is a product of extensive research and has been shown to produce positive results in urgent care outcomes and patient satisfaction (Durani, Breecher, Walmsley, Attia, and Loiselle, 2009). However, the Urgent Care Services alternative is based on research that is specific to Alberta, and thus is highly applicable to the given context. The main constraints that may face policy implementation are cost and legal problems. The Urgent Care Services policy alternative, as the analysis undertaken shows, adds no cost to AHS to implement policy. Instead, it is likely that the cost in form of manager time may go down in addressing patient and staff complaints regarding urgent care inclusions and exclusions. The legal unit has reviewed the policy to ensure there are no legal risks that would be associated with redirecting care. This has been mitigated by giving the patient information regarding where they can seek advice for seeking the care they require. Political support would be prevalent among, front line, and legislative support from provincial perspective. It is expected that with transparency and informed patient rights patients will accept inclusions and exclusions. The ESI is a more complex urgent care policy and would involve additional costs for implementation. The legal unit would have no problems ascertaining legality as the benefits are clear to all stakeholders. In terms of political feasibility, the Urgent Care Services policy alternative is based on the views of the front line triage nurses. Hence, the uptake of the policy should be quick as the primary caregivers are for the policy. The customised nature of the first alternative to the plight in Alberta gives it an advantage over the ESI in terms of political support. Policy Recommendations Dunn (2008) discusses the relevant criteria to be used to recommend a policy, including effectiveness, efficiency, adequacy, equity and responsiveness. In terms of effectiveness, the five elements of the policy cover all aspects a triage nurse may come across in urgent care patients. Each element and step is backed by specified relevant clinical practices to ensure the desired outcomes are achieved. The customisation of the urgent care inclusion/exclusion policy to Alberta from the perspective of the triage nurses also enhances the effectiveness. The policy will also be highly efficient as all the stakeholders are expected to be supportive. Efficiency will also be boosted by the structured approach of the urgent care, which provides stepwise guidance to the nurses and physicians. The development of the policy based on the views of the stakeholders means that the policy will not appear alien and would be readily acceptable and, thus, highly efficient. The recommended policy also adequately meets the needs of the Alberta population as it is based on research on healthcare facilities in Alberta. Aacharya, Gastmans and Denia (2011) correctly state that urgent care services form a sensitive area, fraught with ethical dilemmas and at times controversies. This is especially true due to the lack of a clear definition of what medical emergencies entail (Guttman, Nelson and Zimmerman, 2001). The issue of equity is an important determinant of the perception of patients about the quality of urgent care, and thus an indicator of achievement. The proposed policy seeks to remove the randomness and lack of guidance that currently pervades urgent care service in Alberta. Hence, it is an attempt to bring objectiveness and evidence-based order to the services, which in turn assures equity. Proper communication to the community will be undertaken to inform the public on the ethical inclination and equitable nature of the Urgent Care Services policy. This meets the main goal of developing an inclusion/exclusion urgent care policy for Alberta Healthcare Services embedded in the tenets of transparency, trust for staff and patients. As stated earlier, one of the objectives of this formulation of policy is to develop a responsive and evidence-based policy. Through exhausting all areas of urgent care services and involving all the relevant stakeholders, this policy has been formulated well enough to deliver and uphold responsiveness to the patient and the other stakeholders. The policy details the inclusion and exclusion criteria for urgent care visitors based on the urgency of their health condition. A clear outline of the implementation process is important in determining the adoption and operations of the recommended policy. Once policy is approved, all the involved units will hold a dissemination/launch meeting to officially set off the application of the policy. Orientation material will then be posted on the internal provincial urgent care website for staff. This will be followed by training to ensure all the relevant staff members are equal to the task of implementing the policy to achieve effectiveness, efficiency and patient satisfaction. Clinical educators will disperse information and educate policy as to nursing staff and clerks as required. The orientation material will also be emailed to all the relevant staff members to ensure availability for reference and revision during practice. The policy will also be incorporated under urgent care services’ best practice guidelines. To sensitise the Albertan community on the new policy, posters will be availed in hospital waiting rooms and patients tear aways at triage. The policy formulation unit will mediate evaluation of the policy. The urgent care policy committee will meet for an annual policy review to appraise the achievements of the policy; determine weaknesses and negative unintended consequences and thus propose policy revisions; and institute new measures in the policy to keep up with emerging issues or do away with outdated measures. Policy complaint or concern forms will be available for staff and patients to complete and will be mailed or emailed to the urgent care policy committee for annual policy review. The number of tear away forms handed out will be noted. The unit will also institute a patient relations concern report. Determination of patient satisfaction will be undertaken through qualitative survey by managers, educators and triage nurses to tell whether patient complaints have decreased or increased. One of the limitations of the recommended Urgent Care Services Policy lies in the failure to gather patient input and perceptions during the development. Contemporary healthcare practice is shifting towards patient-centered practice, which involves seeking patient input in decision making. The policy makes amends for this through providing the patient with sufficient knowledge and information on the policy while also promoting transparency to empower the patient. The failure to provide for appraisal by an external and independent entity is a limitation that should be addressed at the earliest possible point. The studies undertaken in analysis were largely based on Alberta, taking for granted the need to take note of global developments and practices in urgent care inclusion and exclusion issues. One of the unintended consequences visualised due to implementation of this policy revolves around inertia against such radical change. Some sections of the stakeholders may fail to adopt the policy readily. This period of uptake may be characterised by confusion and poorer outcomes for urgent care patients. References Aacharya, R. P., Gastmans, C., & Denier, Y. (2011). Emergency department triage: an ethical analysis. BMC Emergency Medicine, 11(16), 1-13. Bernstein, E. L. (2009). The effect of emergency department crowding on clinical oriented outcomes. American Emergency Medicine, 16(1), 1-10. Derlet, R. W., Nishio, D., Cole, L. M., & Silva, J. (1992). Triage of patients out of the emergency department: Three-year experience. American Journal of Emergency Medicine, 10(3), 195-199. Dunn, W. N. (2008). Public policy analysis: An introduction (4th ed.). Upper Saddle River, New Jersey: Pearson Prentice Hall. Durani, Y., Breecher, D., Walmsley, D., Attia, M. W., & Loiselle, J. M. (2009). The Emergency Severity Index version 4 reliability in pediatric patients. Pediatric Emergency Care, 25(8), 504-507. Gilboy, N., Tanabe, P., Travers, D., & Rosenau, A. M. (2012). Emergency Severity Index (ESI): A triage tool for emergency department care. AHRQ, 4. Retrieved 12 March 2012 from http://www.ahrq.gov/research/esi/esi1.htm Guttman, N., Nelson, M. S., & Zimmerman, D. R. (2001). When the visit to the emergency department is medically non-urgent: Provider ideologies and patient advice. Qualitative Health Research, 11(2), 161-178. Pitts, S. R., Niska, R. W., Xu, J., & Burt, C. W. (2008). National hospital ambulatory healthcare survey: 2006 emergency department summary. Retrieved 12 March 2012 from http://www.cdc.gov/nchs/data/nhsr/nhsr007.pdf Appendix Read More