The Problem of Emergency Room Overcrowding - Research Proposal Example

THE PROBLEM OF OVERCROWDING IN HOSPITAL EMERGENCY ROOMS David VanSlyke NEC College The problem of overcrowding is not unique to government or private institutions alone. The problem persists even in hospitals due to a myriad of reasons and causes. This kind of overcrowding causes inefficiency in emergency rooms and further compounds other problems that exist in such facilities. There is a pressing need therefore to identify and come up with solutions to this problem. This proposal discusses the problem of emergency room overcrowding and goes ahead to try and establish causes that may not have been identified by past research studies. The research will involve the collection and analysis of primary and secondary data with an aim of determining the gravity of the matter, its impacts on service delivery, and to determine the best possible way to tackle this problem. Table of Contents Abstract……………………………………………………………………………………….2 Emergency Room Overcrowding Introduction Overcrowding of public and private facilities in different locations and regions is not an uncommon phenomenon. Unfortunately, when people overcrowd a facility or place, several negative things may happen. Some diseases, for one, are easily spread from one individual to the other through the air. Yet again, overcrowding in many cases leads to inefficiency and those who are charged with the duty of providing service may be hampered in their bid to provide their vital services as noted by Gupta, Sharma and Wickramasinghe (2005). Yet again, overcrowding may present vital opportunity to ill minded individuals to engage in certain unethical activities including pick pocketing as noted by Miller (2010). Hospitals being places that are visited mainly by people from various diverse backgrounds have not been exempted from experiencing problems related to overcrowding. In fact, the last couple of years have seen more emergency rooms facing overcrowding. This has led to health experts ringing an alarm over the risks that people expose themselves to due to this worrying trend. There may be many causes of overcrowding in the emergency room as noted by several experts in diverse fields. Some of these causes include higher acuity and need for more complex treatments in some hospitals, rising number of older patients, the existence of fewer healthcare facilities and rising need for emergency cases according to the Joint Commission Resources (2004). While a number of studies have been conducted with respect to hospitals and emergency rooms, very few have been conducted with an aim of addressing the problem of crowding. There are several causes of emergency room overcrowding most of which can be significantly eliminated through the realignment and reorganization of hospital operations (Joint Commission Resources, 2004). Hospital overcrowding has negatively impacted the level of service delivery in both private and public hospitals. This research will be aimed at unearthing the various causes and impacts of overcrowding in emergency rooms and will seek to come up with solutions to this problem. This research will focus on only one state; the state of Oklahoma owing to the complexity of this research. In thirs respect, the research will preclude other states and geographical areas. The sample will be chosen from different hospitals spread across the state and will be limited to healthcare centers that have emergency rooms. Objectives 1. To establish the causes of emergency room overcrowding in various healthcare facilities including county hospitals, state hospitals, not-for-profit hospitals, and university hospitals. 2. To determine the impact of emergency room overcrowding on healthcare facility service delivery 3. To establish ways of reducing emergency room overcrowding in various healthcare facilities Literature Review Causes of Emergency Room Overcrowding A survey conducted in the United States that included four thousand hospitals, in 2002, indicated that ninety percent of major hospitals operated either at or above capacity (American Hospital Association, 2006). Additionally, sixty percent of the hospitals included in the survey indicated that they were filled to capacity and would be difficult to accommodate more patients. Poor policies and poor management of the emergence resources were the major reasons for the overcrowding as revealed by the survey. Yet another cause of emergency room overcrowding as noted by … is the tendency of people without means opting to keep up at hospital emergency rooms as they hope to finally get treated. This is especially the case in underdeveloped and developing countries like China (Derlet, Navarro & Richards, 2000). Other factors that were highlighted to contribute mainly to the congestion include: population growth, health care workers shortage and a growing population of the elderly. The survey revealed that in hospitals where there were less emergency workers relative to their sizes, there were higher chances of overcrowding in their emergency rooms. Furthermore, elderly people were noted to be the most frequent visitors to emergency rooms as they experienced age-related ailments. The overall increase in population has seen greater strain in public resources (Joint Commission Resources, 2004). This state of affairs has not been uncommon in many hospitals. Hospitals which were designed to handle a given capacity of emergency patients sometimes have to exceed their capacities as the population has grown and so the number of emergency cases can be attended to (Joint Commission Resources, 2004). According to Derlet and Richards (2002) in the year 2000, in the US alone, more than one hundred and eight million people visited the emergency room in different hospitals around the world which was an increase of fourteen percent from a previous study conducted in 1995. The ability of many physicians to attend to their patients has decreased due to the lack of affordable liability insurance according to the U.S. Department of Justice and Federal Trade Commission (2004). This in one way contributes to the emergency room congestion as the patients await physicians to examine their illnesses. The need for urgent attention among patients can differ greatly and those with urgent conditions are attended to more promptly than those with a minor illness. Therefore, patients with minor illnesses are the majority in the emergency rooms since they are the ones who are left unattended while the patients who are critically ill are being managed (Joint Commission Resources, 2004). In a more particular survey carried out in urban University in the US, on the care of patients suffering from chest pains and complications, it indicated that more than ninety one percent of the patients had to wait for more than three hours before admission. A further survey carried out by the American College of Emergency physicians, noted that patients with less threatening conditions are always asked to wait. According to the Joint Commission Resources (2004), the unavailability of bed space in many hospitals also contributes to the increase of this problem. Once a patient is admitted, there is not always a vacant bed for them to be admitted but they have to wait until an inpatient is discharged for them to be admitted in some cases (American Hospital Association, 2006). This, without doubt, means that the patient will have to wait in the emergency room as their placement is being evaluated. Surprisingly sometimes, there are bed spaces available but the rooms are not cleaned up ready for the next patient; meaning that the patient will have to wait until clean up is done in order to be permitted access to this vital facility. Further, the hospital staff relies on paper work and telephone calls to search for a bed space (American Hospital Association, 2006). This eventually will lead to empty beds lying empty while the patients remain poorly attended in the hallways of the emergency room. In England, the situation is no better than other countries as indicated by a survey conducted by Lewin Group (Joint Commission Resources, 2004). The survey indicated that the critically ill patients are more likely to wait the longest to be attended to in many hospitals. The argument here is that the bed capacity in the Intensive Care Unit is limited and for one to secure an empty bed in the ICU is quite a hassle. When the bed capacity is reached, the patients are left in the hallways and in the emergency room until empty beds are found (Joint Commission Resources, 2004). In addition, the shortage of nurses and other hospital staff plays a major role in ensuring that the majority of the patients have to wait for their turn to see the physicians (Trude, 2007). The fear of prosecution and the rising costs of uncompensated health care lead to many specialists declining from attending to many patients leading to congestion of such patients in the emergency rooms as they seek medical care from responsible practitioners (Derlet, Navarro and Richards, 2000). The other most obvious reason as to the overcrowding in the emergency rooms in the hospitals; is the lack of financial aid to cater for the high population. For instance, in the US, while the government passed the bill on the right of every one to acquire emergency care, the funds to implement this project was not disbursed in some areas (Stevens, 2006). This means that emergency departments are few and therefore cannot handle the increased population. The financial position of the patients also contributes to the delays in the emergency rooms, leading to overcrowding. In some third world countries where there are no policies that cover emergency health care, the patients wait in the emergency room as family and friends raise funds for financing the expenses. I have seen this first hand in several different hospitals in China and Honduras for instance, where I was involved in the health care system. I also have friends from many different countries that have had either themselves or family members deal with raising money to get treatment. According to Derlet, Navarro, and Richards (2000) there are many reasons that cause overcrowding in the emergency room. Among the reasons that have been put forward include population increase, complications from surgical and medical treatments, conditions needing specialized treatment and care. One other major cause of overcrowding in the emergency department is slow processing at the admission area (Strunk and Cunningham, 2002). Each time that a patient requires to be admitted in the in-patient unit, the majority of the time there is no available bed. With such a situation the patient has to wait in the emergency section until there is an empty bed. This process is what causes overcrowding of emergency rooms in the hospital. In addition the paperwork involved is tedious and the patient may refuse and leave. In order to address this problem many hospitals have come up with programs that are designed to ensure that the patients have access to healthcare (Stevens, 2006). A hospital in New York has a program with the local community of easing the pressures from overcrowding through expansion of their ER to other hospitals in the area with lower bed capacity. Many of the hospitals have made provisions of putting up additional beds for in-patients. The hospitals are also in the process of increasing more nurse and physician positions in a bid to boost the manpower in the emergency room according to Trude (2007). Many hospitals in the United States according to a survey conducted by the health department in 2006 are increasing recruitment and hiring of ER staff and nurses on a permanent basis (Stevens, 2006). This trend has bolstered the duty roster in the hospitals emergency room. Hospitals are also dealing with the staff shortage in the ER by regularly assigning the nurses in the hospitals outpatient units to the inpatient departments. A majority of the hospitals are also dealing with the bottle neck challenge by taking the least possible time when discharging patients. In addition, the hospitals discharge a patient very early in the morning hours thereby freeing up more beds for admissions earlier in the day. Some of the hospitals have also taken the effort of transferring the patients to suitable specialized care facilities to reduce the admission period according to Stevens (2006). Some of the hospitals are making use of instant remedies to the problem by postponing patient admission when the condition is not life threatening. In addition when a patient is discharged the house keeping department must be notified immediately to make the bed and prepare the ward. Sometimes it takes time before the hospitals emergency room is notified that there is an empty room. Some facilities like the Lehigh Valley hospital have specialized software that keeps track of any available inpatient bed in the hospital (Strunk and Cunningham, 2002). It has a giant screen referred to as the bed board that keeps track of the beds. Each time that a patient gets discharged the program activates the tracking system and the board displays a brown color highlighting the availability of a bed. The hospitals house cleaning is notified that a room needs cleaning and when the bed gets booked the screen displays a yellow color to show that the room is undergoing cleaning. When the room gets ready for occupation it shows a green color notifying the ER staff of the availability of a bed. Emergency waiting room period for the Lehigh valley hospital has reduced waiting time by 50% because of the software. Approach and Methodology In order to come up with a solution to a research problem, it is very important for the researcher to conduct the study in a manner that is professional. This means that the research should be done such that its findings will be credible; representing the true nature of the field. In order to accomplish the main objective of this research, the following specific objectives will have to be met: 1. The research will establish the various causes of emergency room overcrowding in different healthcare facilities including county hospitals, state hospitals, not-for-profit hospitals, and university hospitals. 2. The research will determine the impact of emergency room overcrowding on healthcare facility service delivery 3. The research will establish ways of reducing emergency room overcrowding in various healthcare facilities In this respect, the research will be dedicated to finding the views of various stakeholders of health care systems on what causes overcrowding, its impacts and how possible to solve the problem. For this study, both primary and secondary sources of data will be used. The primary data will be derived by conducting field surveys using questionnaires which will be posted to respondents in various healthcare facilities spread throughout Oklahoma. Since the number of hospitals in the country is huge, carrying out a nation-wide survey would not be very practical. This is especially so considering that there would be extremely wide variations in the data that would be collected under such circumstances. Such variations would result owing to wide differences in the types and sizes of healthcare institutions involved. This would ultimately affect the results making it less representative with the use of the relatively small sample size. The questionnaire that will be used for gathering the primary data will be simple in design and easy to fill. They will be so designed as to save respondents time and to make data collection easy. Yet again, the questionnaire will be written in simple language to ensure that there is no ambiguity when it comes to giving answers on the side of the respondents. Posted questionnaires will be used during the research because of their convenience in this case, and because they are in the long run much cheaper than personal interviews which would require the researcher to travel across the country. In addition to posted questionnaires, key informants will also be interviewed. This will ensure that as many stakeholders as possible in the healthcare system of the state are engaged. Among the key informants that will be interviewed include county health ministry officials, and hospital directors. The respondents will mainly consist of healthcare workers including doctors, clinical officers, nurses, hospital managers, patients and lab technicians. The respondents will be divided into four groups. The first group or category will comprise patients; the second, hospital managers; the third, lab technicians. The last group will comprise doctors, clinical officers and nurses. Each specific group of respondents will be issued with questionnaires that are well structures to meet the objectives of this study. Tentatively, a sample size of 100 will be used with the sample being randomly chosen. A random sample of 100 respondents will be used to fully represent the general population; 25 respondents from each group/category. However, to cater for cases where respondents do not return their completed questionnaires, an additional 20 questionnaires will be sent to the field; 5 for each group. Owing to the complexity of this research and resource constraints, the sample will be chosen from different hospitals spread across Oklahoma. The hospitals from which the respondents will be drawn will have to have at least one emergency room; only one person will represent one healthcare facility. In other words, the sample will consist of hospitals that have emergency rooms with one officer providing information related to the health facility. From each county, wherever applicable, at least one county hospital, one state hospital, one not-for-profit hospital, and one university hospital (if applicable) will feature in the sample. This will ensure that all the various kinds of hospitals are represented and that each county is also represented. For each county and category of hospital, the largest and smallest hospitals will be considered to form the sample. The respondents will be of legal age according to the country’s laws, and may be of any gender. This means that there will be no need to seek extra permissions as it happens when dealing with juveniles. Participation in the survey will be out of free will and the respondents will have the right to withdraw from the study without having to give any explanations. Furthermore, respondents’ identities will be kept secret during and after the research. Secondary sources provide a wide knowledge base during research and go a long way in preventing the cases of reinventing the wheel. For this study, various sources and secondary resources will be consulted. Some of these will include books, government records, journals, reputable websites, and the websites of different health care facilities within the country. The data that will be collected will both be qualitative and quantitative in nature. The data gathered from the various sources will be coded in PASW of SPSS (Statistical Package for Social Sciences) software. The software will then be used to analyze the data which will then be presented in various forms. Implications Once this research is conducted in line with strict international principles and in a scientific manner, it is expected that the different causes of the problem of overcrowding in emergency rooms will be discovered. This is in consideration of the fact that there could be new causes of this problem that may have not been identified by those who have conducted studies earlier. The study will further reveal the loop holes that may be sealed by taking measures that may not affect significantly the operations of the hospital as they are instituted. Limitations While every measure will be taken to ensure that the research is truly representative of the field, no doubt there will be challenges along the way as it commonly happens with every research endeavor. Given the relatively small sample size that will be used, the data may not give a better representation of the actual field. A better result would be achieved by using a larger sample size. Project Plan and Timetable Given that only a relatively small number of respondents will be consulted during the survey, the research will be expected to take a maximum period of three months. The time schedule for the project will be as shown in the table below. Table 1: Project timetable Serial No. Activity Time in Weeks 1 2 3 4 5 6 7 8 9 10 11 12 1 Preliminary preparations 2 Materials acquisition 3 Data collection 4 Data Analysis 5 Report Writing and Editing 6 Presentation and Submission of Report Preliminary Results and Discussion The results of this study should basically show three things: the impact of emergency room overcrowding on healthcare facility service delivery, the causes of emergency room overcrowding in various healthcare facilities and ways of reducing emergency room overcrowding in various healthcare facilities. This will indeed be in line with the objectives of this study. Solution to the Problems Based on the various causes of the overcrowding in emergency rooms, a number of viable solutions will be recommended for adoption under different conditions. This is in view of the fact that not all health facilities experience the same problem due to similar causes. Each emergency room needs to apply a strategy that will help it solve its unique overcrowding problems. Conclusion There is a pressing need to find a solution to emergency room overcrowding if many people are to get adequate attention in health facilities. This therefore means that the causes of inefficiency and the backlog of cases to be attended should be determined and properly dealt with. This proposal is aimed at identifying various causes of overcrowding in emergency departments and at developing new strategies for dealing comprehensively with this pressing problem. Reference American Hospital Association (2006) The State of Americas Hospitals-Taking the Pulse: Findings from the 2006 AHA Survey of Hospital Leaders, retrieved 3 rd June, 2010 www.aha.org/aha/content/2006/PowerPoint/StateHospitalsChartPack2006 The American Hospital Association (AHA) provides an over of the state of American Hospitals. Based on a survey of various hospitals, the organization notes that half of emergency departments in the US are working at or beyond their capacity. The information presented by AHA forms part of the basis upon which this research proceeds. Derlet W. and Richards J. (2002) Emergency Department Overcrowding in Florida, New York, and Texas, Texas, Southern Medical Association. Derlet and Richards provide a lot of information about the state of emergency rooms in Texas, New York and Florida. From their analysis, it is beyond doubt that hospitals in these paces, and by extension other places in the US, are prone to overcrowding. Derlet W., Navarro M. and Richards J. (2000) “Survey of Directors of Emergency Departments in California on Overcrowding” West J Med, BMJ publishing Group June; 172(6): 385–388. Derlet et al present the views of hospital directors in California with regard to emergency department overcrowding. The directors who were surveyed present a myriad of reasons that lead to overcrowding in their jurisdictions. Gupta N., Sharma S. & Wickramasinghe N. (2005) Creating knowledge-based healthcare organizations (Illustrated ed.), Idea Group Inc (IGI). This source discusses overcrowding and its effect on service delivery in emergency rooms. The authors notes that overcrowding leads to inefficiency as those who provide services have limited space to act fast. Joint Commission Resources (2004) Managing patient flow: strategies and solutions for addressing hospital overcrowding. Joint Commission Resources. The joint Commission Resources outlines strategies that have been applied in dealing with ER overcrowding. The source provides a myriad of solutions that have been tested to solve overcrowding in hospitals. Miller D. (2010) Relationship between Overcrowding and Criminal Justice Policy, retrieved 8th August, 2010 http://www.csa.com/discoveryguides/prisons/review5.php This source discusses the issue of overcrowding as it applies to different places including jails. The source notes the negative effects of overcrowding on public life. Stevens R. (2006) History and health policy in the United States: Putting the past back in, Critical issues in health and medicine, Rutgers University Press. Stevens discusses discuss US policies on various issues including the health policy and its implementation. One challenge to the enactment of the heath policy is lack funds for disbursement. Strunk C. and Cunningham (2002) Treading Water: Americans Access to Needed Medical Care, 1997-2001, Center for Studying Health System Change Tracking. Strunk and Cunningham also discuss the health and medical policy and its implementation. The source delves into the changes that have occurred as a result of policy changes. Trude S. (2007) So Much to Do, So Little Time: Physician Capacity Constraints, Center for Studying Health System Change Tracking Report No. 8, retrieved 3rd June, 2010 www.hschange.org/CONTENT/556 This source discusses the constraints that health centers experience in their daily activities. One such constraint is insufficient number of health practitioners who will serve the rising number of patients. The source in this respect treats hospital overcrowding as a result of physician capacity constraints. U.S. Department of Justice and Federal Trade Commission (2004) Improving Health Care: A Dose of Competition, retrieved 3 rd June, 2010 www.usdoj.gov/atr/public/health_care/204694.pdf This source highlights measures that the US government is taking to improve the delivery of services in hospitals. Read More