Analyzing the Issues Linked to the Ambulance Ramping - Assignment Example

? MINUTES forming ENCLOSURE to File X Reg X THE OFFICE OF THE MINISTER FOR HEALTH AND AGEING RE: RESPONSE TO RAMPING MEDIA ARTICLE PURPOSE The basic purpose is to provide the minister: With a draft response for consideration in reply to the recent media article on ramping of ambulances at metropolitan hospitals. The identified and established occurrences and observation of Ambulance Ramping at metropolitan and SDEDCN hospitals With information of the nature of the delays that affects the patients that are directly related to Ambulance Ramping With the effects of the current mechanism and their effects that are causing Ambulance Ramping With the effects of Ambulance Ramping on the functioning of ED With the effects of Ambulance Ramping to generate an efficient response in return SUMMARY OF ISSUES The current report is to generate a ministerial response to analyse the issues that are linked to the ramping as well as access block. The phenomenon of ambulance ramping is present for a long time in the environment. Currently however, there have been a lot of articles that have been raising awareness on this issue. It has been observed that the hospitals are being forced to take solutions that are temporary in nature and therefore, a long term solution is in need that requires considering issues like ramping and the overcrowding of ED. While considering this issue, the cost of ambulance along with the response times as well as the outcomes that can be expected from the patients must be measured. BACKGROUND Information from various sources has confirmed that the SDEDCN, more specifically, the Southern Districts Emergency Department Clinical Network, has a total of 10 emergency departments (EDs). In the previous days, due to the presence of a high demand in the services of ED, second hand account has stated that hospitals ramp ambulance patients are not being admitted safely into the hospitals since there is a shortage of physical space, medical staff, as well as the nurses. As far as ambulance ramping is concerned, here it is referred to as the situation in which the patient stays within the ambulance stretcher along with the paramedics. As for the research in ambulance ramping, little amount of studies is available but overcrowding and diversions in the EDs are well documented. Since ambulance ramping is the reason of an overcrowded ED, the statements from the SDEDCN as well as ED state that ambulance ramping has increased to a great extent (Sloan, Callahan, Duda, Sheaff, Robin, Barrett, 1989; 1990) Over the last 20 years, the problem of overcrowding has increased significantly. In earlier studies, the causes of overcrowding were attached to the inappropriateness of the attendees, which means these are the type of patients that are best managed by the practitioners that are general in nature (Liggins, 1993; Sempere, Peiro, Sendra, Martinez, Lopez, 2001). Now however, the cause of overcrowding is directly linked to the hospital access blocks. This occurs mainly due to a decrease in the hospital beds and their insufficiency (Gallagher and Lynn, 1990). While the overall number of beds in the country has been reduced, it has also been observed that the patients’ conditions regarding acuity as well as complexity have directly affected the time patients spend in the hospitals, thus increasing the time of stay in the EDs. This condition also leads to an increase in the burden on the health services (Derlet & Richards, 2000). Therefore, the issue of overcrowding as well as the access block has had a lot of effect over the emergency services as well as the EDs. The effects, therefore detrimental in nature, have also been recorded and explored in the context of the patients’ quantity. Other than that, the presence of over crowding as well as other related problems makes the control of viral and infection control very difficult, thereby increasing the chances of medical errors and decreasing the satisfaction level of the patients to a great extent. Studies have also stated that due to the earlier presented problems, the result was also the occurrence of violent behaviour by the patient as well as from those who are directly related to them, and an abundance of workload over the staff of the EDs. In return, this affects directly the staff, as observed over the EDs, including factors like stress, burnout, and a high rate of turnover (Cameron, 2006; Schull, Morrison, Vermeulen and Redelmeier, 2003). One solution mentioned for such a problem is to cope with the increasing abundance of overcrowding in ED or even consider bypass in which the hospitals are forced to take the patient in EDs that are not diverted. However, there have been poor outcomes of this step in the past that therefore resulted as such because of the presence of large travel times. With such results, other factors like the delays in the treatment as well as longer turnaround times of the ambulance have also been observed. No doubt, hospitals have considered dealing with the issues mentioned before and have tried to deal with them through changes in inputs and throughputs (Ashby, 2003). Still, ambulance ramping is an increasing worry as it is enhancing in frequency within hospitals and SDEDCN more specifically. Such problems are also the cause of an increase in the time of patient and the time of definitive treatment. For this case, the earlier mentioned solution of the bypass has been a matter of criticism. It is, therefore, essential that the paramedics must work towards reducing the response time and hand the patients to the staff of the hospitals. Over the years, the issues identified above have not been efficiently dealt with, even though turnaround times have already been defined for ambulances of 15 to 20 minutes. Other than the issue of offloading patients and ambulance ramping at the EDs, sources have also associated with the access block and diversions created due to the earlier mentioned reason. Therefore, deaths of the ramped patients have also been recorded and therefore, the current issue is being brought under light for the safety of those around us that may be patients, staff, and the community at large (Canadian Association of Emergency Physicians, 2003; Committee on Pediatric Emergency Medicine, 2004). As for the current legal clauses available in the law, it can be stated that those practices that are parallel to the ambulance ramping are no doubt illegal and come under the act of Emergency Medical Treatment and Active Labour. Considering this act, it is the duty of the hospitals to provide immediate attention and care to any patient that is in need and is requesting the care. Under the same act, if the hospitals do not provide immediate treatment to the patient, then as a consequence, the Medicare funding can be easily taken back when contravention is proven (Garza, 2004). Within the current areas, the legal issues of ramping of the ambulance have not been completely determined and are still under consideration. Nonetheless, it can also be stated that since there is proximity of patients with the hospitals, the hospitals also have a duty of taking care of the patients that are not delegable. As for the individual clinics, their legal obligations are different that is related to the policies being carried out at those hospitals (Forrester, 2005). ADVICE FROM OTHERS In order to deal with the issues earlier mentioned, the advice as well as the information that can be taken from others are as follows: EDIS- Emergency department of Information system eARF- the electronic Ambulance of Reporting Form EHRC- e-Health Research Centre HDI- Health Data Integration The retrospective examination of the data collected from the above mentioned sources will enable a facet examination of the issues. The advice will also be able to answer questions like the delays that have been experienced in the EDs, the ambulance ramping, and the complaints that have been recorded by the patients in response to ambulance ramping (Hansen & Maeder, 2007). COSTING COMMENT An additional budget for the suitable treatment space is needed. RECOMMENDATION(S) Considering the situation earlier presented, the basic criteria for the Ambulance Ramping and Off-stretcher Delayed conditions must be defined. It is recommended that the Minister for Health gives consideration to recommendations: 1. Albeit the true degree of off stretcher interval is hard to estimate, the time delay for the off stretcher time interval must be less than the set up benchmark period (which is usually 15-20 minutes).Thus, the time duration for off stretcher time must be as short as possible. 2. The fundamental criteria for the ambulance ramping and off stretcher delayed state are only applicable for the patients who are brought to the hospitals via an ambulance. Thus, it is important that the Ambulances should have trouble-free access to the emergency department. There should be present sufficient capacity for off loading the patients, and the arrival area for the ambulances should be clearly designated and separated from the other incoming vehicles. 3. During times when the flow of patients into ED is irregular and they arrive concurrently, it is of immense importance that triage should occur immediately. This is done in order to determine the priority of the patients' treatment based on the severity of his condition. Ambulances bringing less urgent patients are to be redirected to other hospitals. This is done since the less urgent patients may opt to seek alternative care rather than wait for treatment during over-crowded times, or be redirected to another hospital. This results in sorting out the patients who need critical attention and immediate transport to the hospital. 4. There are times when the demand for services exceeds the capacity of the ED to treat all patients in a timely way. In such cases there remains no chance to make suitable treatment space. This usually occurs when there are many patients arriving for treatment to an emergency department in a short period of time, or when the hospitals beds are full. In such a case since there is no treatment space available for the patients in the ED, ambulance ramping is carried out. This, thus, requires the need for developing an ED emergency plan to act in response to the amplified requirement for triage assessments, including ambulance arrivals. 5. Wherever the patient is located that is either in the ED or else where, the Paramedics should collaborate with the ED team to ensure that instant needs of the patient are met. The paramedics are to remain with the patient until the patient is out of danger. 6. A patient is said to be Off-stretcher Delayed only in two cases. Firstly, if the patient undergoes proper time criterion but the process criterion is not completely fulfilled by the hospital staff. And secondly, the term is applied due to ambulance ramping when the patient undergoes proper time and process criteria. Additionally to the suggested description of Ambulance Ramping, the subsequent key recommendations from the above mentioned study are: 7. Improvements including synchronisation of eARF and EDIS clocks are required along with other data entry processes within and across the organisation. A robust EDIS/ED EMR system should offer ample medical documentation, workflow and consequential use of compliance reporting. In order to guarantee a timely transfer process, it is very important that there is a present commitment at a local level to the current effective communication between the ambulance and the hospital staff. The basic reason for this is to prevent any hindrance in starting patient treatment and making certain that ambulances are available for another case quickly. Apart from this, the registration process should be streamlined and patient-focused so as to steer clear of needless delays. 8. It is also necessary that in order to collect data of ambulance ramping, an easily identified box within EDIS at all hospitals is present. The legal responsibility of individual staff should be examined. The policy for refusal of transport should be reconsidered. 9. Training should be provided to the hospital staff so as to improve flow throughout the hospital. It should be ensured that all actions backing up patient flow are put into practice. 10. For the transferring of patients from the stretchers to waiting rooms or wheelchairs, schooling and support should be provided for triage staff. 11. Paramedics should be knowledgeable of the procedure for triage at their entrance point into the ED. Apart from this, in order to carry out the transfer of patients from the ambulance to the hospitals certain things are to be easily accessible by the ambulance staff. These things might include certain equipment and furniture as well as availability of adequate staff at all times. 12. For maintaining an active atmosphere, it is important to keep into account the possibility of the staff suffering from exhaustion. The management staff can minimize this by implementing strategies for its prevention and by increasing the number of staff. This helps in preventing the pre triage waits by raising the number of staff at triage. Authorised by: Signature Block of relevant Manager or Director or Delegate (to include signature followed by name, title, unit and division if relevant) / / Contact: name and telephone number of author, date prepared References: Ashby RH., (2003). Responses to access block in Australia: Queensland, The Medical Journal Of Australia, 178 (3):107–108. Cameron PA., (2006). Hospital overcrowding: a threat to patient safety? Medical Journal of Australia, 184 (5):203. Canadian Association of Emergency Physicians, National Emergency Nurses Affiliation, (2001). Joint Position Statement on emergency department overcrowding, Canadian Journal Of Emergency Medical Care, 3 (2):82–88. Committee on Paediatric Emergency Medicine, (2004). American Academy of Paediatrics Policy Statement: Overcrowding crisis in our nation’s emergency departments: Is our safety net unravelling? Paediatrics, 114 (3):878–888. Derlet RW, Richards JR., (2000), Overcrowding in the nation’s emergency departments: Complex causes and disturbing effects, Annals of Emergency Medicine, 35 (1):63–68. Forrester K, Griffiths D., (2005). Essential of law for health professionals, Sydney, Elseviere Mosby. Gallagher EJ, Lynn SG., (1990). The etiology of medical gridlock: causes of emergency department overcrowding in New York City, The Journal Of Emergency Medicine, 8(6):785–790. Garza M., (2004). Last word. Memphis just says ‘no!’ to ambulance diversion, Journal of Emergency Medical Services, 29 (1):130–130. Hansen D & Maeder A., (2007). HDI: Integrating Health Data and Tools, Journal of Soft Computing, 11: 361–367. Liggins K., (1993). Inappropriate attendance at accident and emergency departments: a literature review, Journal of Advanced Nursing, 18 (7):1141–1145. Schull MJ, Morrison LJ, Vermeulen M, Redelmeier DA., (2003). Emergency department overcrowding and ambulance transport delays for patients with chest pain, Canadian Medical Association Journal, 168 (3):277 Sempere-Selva T, Peiro S, Sendra-Pinar P, Martinez-Espin C, Lopez-Aguilera I., (2001). Inappropriate use of an accident ans emergency department: Magnitude, associated factors and reasons – an approach with explicit criteria, Annals of Emergency Medicine, 37 (6):568–579. Sloan EP, Callahan EP, Duda J, Sheaff CM, Robin AP, Barrett JA, (1990). American College of Emergency Physicians. Measures to deal with emergency department overcrowding. American College of Emergency Physicians, Annals Of Emergency Medicine, 19 (8):944–945. Sloan EP, Callahan EP, Duda J, Sheaff CM, Robin AP, Barrett JA., (1989). The effect of urban trauma system hospital bypass on pre-hospital transport times and Level 1 trauma patient survival, Annals Of Emergency Medicine, 18 (11):1146–1150. Read More