Long Stay in the Emergency Department at the Al Iman Hospital - Literature review Example

Name Instructor Course Date Causes of Long Stay in the Emergency Department at the Al Iman Hospital Literature Review The chapter explores the causes of the extended remain in the Emergency Department (ED) at the Al Iman Hospital Department of ED. The literature will be discussed as follows the subheadings. Introduction People need to be rushed to the hospital for many issues such as injuries, accidents, and the acute illness. Often, the first place for this people to accesses is the ED department in any particular hospital. As a result, many EDs in the world mostly hold a large number of individuals. ED are supposed to cater for the fast most appropriate healthcare for people with life-threatening situations since it is the first responder to disasters. In Al Iman Hospital, ED gives emergency care at any hour of the day, every day in a year. Additionally, to taking care of the critically ill patients, the ED helps to give the primary healthcare to the people regardless of their ability to pay. Therefore, ED provides appropriate care to all the patients regardless of why they are in the hospitals (Bashkin et al. 38). According to Boyle et al. (2012), the EDs have unique characteristics such as visiting the Eds in unexpected and unscheduled times so as to have immediate assessments. On other occasions, EDs decisions must be made rapidly by taking direct actions. Thus the role of the EDs is of paramount importance to the public sector. Erenler et al. (56) noted that the long delays in the EDs and the ability for these departments to give the required care to the patient’s leads to the great crisis in the public health. Currently, the highest problem in Al Iman Hospital is extended stays in the ED department which not only leads to overcrowding but also inefficiency. Talleshi et al. (134) stated that ideally, a patient should last in the ED for not more than six hours. If patients stay for longer than these then they cause overcrowding, less patient quality care, and satisfaction in Al Iman Hospital (Al Iman Hospital). For a decade now, the ED crowding due to extended stays has been described trough the Input-Throughput-Output conceptual model. However, in the modern conceptions, extended stays in the ED are associated with reduced resource and bed management. Causes of Long Stay in the ED A study analyzing the long stays in the ED found out that the three most important factors that contribute to it are: input factors that are associated with the sources of the patients and inflow of emergencies. The others are the throughout particles that are the bottlenecks within the ED, and the output factors that issues that are associated with the other parts of the healthcare system. The patient length of stay (LOS) is the major measure of the ED output, and it is also the significant cause of hospital issues and overcrowding. Consequently, previous studies show that there is also a probability of people leaving the ED without treatment due to the long stays (Erenler et al. 58). Another study by George and Evridiki (2015) showed that there is excess inpatient LOS for the patient in the ED. The researchers defined LOS is an exceeding the stated benchmark for the original diagnosis-related group. In these researches, the researchers found out that there are those patients who stay in the hospital for 4-8 hours, while others stay for 8-12 hours, while more than 20% remain in the hospital longer than the national average relevant admission period. Surprisingly, the number has risen to more than 50% in Al Iman Hospital for ED patients who stay in the hospital for more than twelve hours. Another study by Krall, Cornelius, and Addison (2015) examined the direct factors that cause the LOS in the ED is known as "access block" where the patient requiring the ED admission remain in the hospital for more than eight hours waiting to be allocated the appropriate hospital inpatient bed. The access block has defined as the total time that the patient initial arrival time in the ED to the time that they are transferred to another department or LOS inpatient exceeding eight hours. In this study, there was 7.7% access block to the patients who were admitted. Interestingly, the mean LOS was 4.9 days for the patients who had access blocks while the others who did not have access had 4.1 days. The authors discovered that the ability and effectiveness of the access block depend on how severe the diagnosis and illness of the patient. Patients with cardiac diagnosis and have access block seems to have fewer days of the LOS mean than those who do not have any access block. In another study, the researchers identified that there are independent variables that cause ED LOS. The researchers found out that these were the triage level, consultations, and diagnostic tests. Additionally, the waiting time those patients wait to be examined by the nurse or the physician causes the longest stay in ED departments. This study also showed that if a patient requires diagnostic imaging or other processes such as laboratory tests, and then they will apparently give longer stays in the LOS which varies with whoever prove that they are going to undertake. Specialty in consultation increases the prolongation of the LOS and its effect highly depends on the service that is being consulted (Talleshi et al. 134). Wang et al. (100) confirmed that the ED is facing extended delays when evaluating the patients. It is not yet certain what exactly leads to these situations. Over the decade, there have been evaluations such as allowing additional beds in the hospitals or the ED, improving patient discharges or throughput. The researchers identified the major factors that cause LOS in hospitals to be input, throughput, and output factors. Input Factors The input factors show that there is increased need for people to be admitted into the ED even when they have low-acuity diseases. George and Evridiki (1) started that over the past ten years, the EDs have seen an increase in patients attending to their patients. Some of the reasons are the fact that there is an increase in the elderly, residential, and nursing home patients. These senior peoples’ homes contain patients that whenever they get ill, most probably will be taken to the ED compared to the patients who rarely go to the EDs. A study by Boyle et al. (2012) showed that the input ratios are not only about the volume, but also the type and acuity of patients. Additionally, there is no any good explanation of why the number of ED patients has grown. The authors argued that with evidence, the primary care and ED have significantly increased its activities over the past twenty years. Moreover, the patients who have the mental illnesses and other critical issues require the services of the ED department, thus leading to the inappropriate attenders. Furthermore, when a hospital is unable to give the primary care to the patient's way end up in the ED. Evidently, these patients are capable of getting medical attention in other departments rather the ED. Apart from those reasons, the input factors can be a sudden influx of the ill patients from issues such as Influenza season. According to Inouye et al. (913), when there was an outbreak of influenza in the Los Angeles, the County Hospital recorded a fourfold increase in ambulance diversion compared to any other time in the year. The flu cause patients overcrowding in hospitals, thus increasing the long stays in the hospitals and especially in the ED due to lack of the resources to treat the patients. Throughput Factors The throughput factors are internal issues that occur in the ED department and, therefore, cause Long stays. Such matters include the processes and requirements to be admitted in the ED, the staff experience and number, accessibility, and timeliness of getting investigation results. Additionally, it can be due to the time of the review that is taken by the inpatient teams and the layout of the ED department. Boyle et al. (2012) remarked that the ED is highly multiple units that can have a long stay due to any activity. For instance, if the department has a wrong design that does not support the flow, then this is enough to cause delays in the treatment processes. The authors advised that the ED departments should have adequate space and cubicles that flank along a straight corridor so that there can be efficiency. Furthermore, it is not only the ED that requires adequate space, but also the whole hospital so as to avoid the issues being transferred to the ED department. There is increasing stringent care standards for matters such as the sepsis, stroke, and transient ischaemic attacks that are likely to workload the ED department thus increasing the delays. Finally, there is high expectation from patients and medical professionalism from the technicians that are involved in the ED. The analysis shows that the patient is treated to 51-63% total patient waiting for turnaround time (Krall, Cornelius, and Addison 2015). Activities such as through radiological investigations, physician, and blood work also increase the waiting time. Output Factors In some cases, there are also issues that flow through the ED from the other parts of the hospital. According to Bashkin et al. (38), the output factors are associated with the overall hospital issues such lack of appropriate bed number, the ‘access’ and ‘exit blocks’. The main reason why people experience long stays in the ED is poor coordination that comes from inadequate inpatient beds or at times if there is a mismatch of the inpatient beds available with those requiring them in the ED. According to Boyle et al. (2012), the most prevalent output factor that causes long stay in the ED is the lack of enough patient beds. As a result, the patients that have already been released to another department remain in the ED as they await a bed to be vacated. Surprisingly, the global movement to reduce the inpatient beds has significantly contributed to less bed capacity that leads these difficulties. On the other hand, issues such as NHS single sex compliance, policies for controlling infections, among other quarantine activities have further contributed to patients staying longer in the EDs. In short, there is potential that these patients can be transferred to other wards; however, they remain in the ED causing extended stays in the EDs (Boyle et al. 2012). Surprisingly, there is a strong perception that seems to emphasize the fact that hospitals advocate for lucrative work rather than the emergency admissions. A study conducted by Wang et al. (2014) showed that patients with long stays in ED have an acute exacerbation of chronic obstructive pulmonary disease (COPD). The patients stay in the hospital because they are fragile and require constant attention from the health personnel. These patients do not have international accepted hospitalization of the patients with COPD and depend on an individual patient. As a result, these patients survive in hospitals in 3-16 days on average. In their research, the authors found out that the median LOS of the patient is 6.0 days. Furthermore, diseases such as heart failure, stroke, low serum albumin level, diabetes, and high arterial PCO2 have a prolonged length of stay in the hospital. Another study by Inouye et al. (2014) showed that older adults have extended period in the ED because of issues such Delirium that sometimes causes grave and costly problems. Additionally, the disease needs a lot of examinations and before treatment, therefore, delaying treatment. In brief, as noted from the literature review, the causes of the long stay in the ED are from other places and not in Al Iman Hospital. Therefore, for the best knowledge, no systematic study has been summarized about this hospital. The objective of this study, therefore, describes the scientific literature on ED extended stay causes from all the perspectives. The next chapter is the methodology. Works Cited "Al Iman Hospital." Moph.Gov.Lb, 2017, http://www.moph.gov.lb/en/HealthFacilities/view/3/188/14307/al-iman-hospital-/?facility_type=8. Bashkin, Osnat, et al. "Organizational Factors affecting length of stay in the emergency department: initial observational study." Israel journal of health policy research 4.1 (2015): 38, https://ijhpr.biomedcentral.com/articles/10.1186/s13584-015-0035-6 Boyle, Adrian, et al. "Emergency department crowding: time for interventions and policy evaluations." Emergency medicine International 2012 (2012), https://www.hindawi.com/journals/emi/2012/838610/ Erenler, Ali Kemal, et al. "Reasons for overcrowding in the emergency department: Experiences and suggestions of an education and research Hospital." Turkish Journal of Emergency Medicine 14.2 (2014): 59-63, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4909875/ George, Filippatos, and Karasi Evridiki. "The effect of emergency department crowding on patient outcomes." Health Science Journal (2015), http://www.hsj.gr/medicine/the-effect-of-emergency-department-crowding-on-patientoutcomes.pdf Inouye, Sharon K., Rudi GJ Westendorp, and Jane S. Saczynski. "Delirium in elderly people." The Lancet 383.9920 (2014): 911-922. Krall, Scott P., Angela P. Cornelius, and J. Bruce Addison. "Hospital factors impact variation in emergency department length of stay more than physician factors." Western Journal of Emergency Medicine 15.2 (2014): 158, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3966443/ Talleshi, Z., et al. "The effect of the new emergency program on patient length of stay in a teaching hospital emergency department of Tehran." Nigerian Medical Journal 55.2 (2014): 134, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4003716/ Wang, Ying, et al. "Factors associated with a prolonged length of stay after acute exacerbation of chronic obstructive pulmonary disease (AECOPD)." Int J Chron Obstruct Pulmon Dis 9 (2014): 99-105, https://pdfs.semanticscholar.org/5106/28c5594c21b145f0c012c6bc353f96fc71d0.pdf Read More