Service Provision in the Emergency Departments - Research Paper Example

? SERVICE PROVISION IN THE EMERGENCY DEPARTMENTS The research problem in this analysis was identified as ‘Of the emergency room patient population, are visits negatively impacted due to extended wait times, nursing staff shortages, and high acuity?’ In analyzing the research undertaken by Mastandrea et al (2008), the population that was considered included a sample that represented all sexes, the major ethnicities, and an accurate representation of all age groups. The entire population was 297 persons. The issue under consideration was to investigate the impact of wait times on the emergency room population. The research aimed to investigate the impact of waiting time on the emergency department patients in St Barnabas Hospital. The comparison was the availability of timely and effective service in the emergency department. The outcome of the research was that the conditions of patients who were kept waiting for long worsened. The research was carried out in a timeframe of one month in October 2007. The research of Munro et al (2007) was also considered in analyzing the research question. Munro et al (2007) conducted a research to investigate effective measures of reducing emergency departments’ waiting times and the impact of the reduction of waiting time. The population of the study was medical professionals that worked in emergency departments in England. The issue that was investigated by the researchers was to determine the measures that the emergency centers had put in place during the national monitoring week. The researchers were also interested in determining which of the measures were effective. It should be noted that the issue of long waiting times in hospitals in the area had become of major concern. The comparison was between the changes in waiting time during normal operations of the emergency departments and during the national monitoring week. The outcome of this research was that the reduction in waiting times of emergency room patients significantly reduced the worsening of the patients’ conditions. It was noted that serving patients quickly helped to solve the patients’ problems before they could escalate. The emergency departments increased the number of doctors, increased number of nurses and improved access to emergency beds. The third research that was analyzed in relation to the research problem was by Cimona (2010). The research was conducted at the Saint Rita’s Hospital in South Africa. The emergency department in this hospital catered for both casualty and medical emergencies. The study population was all patients who attended the emergency department in the hospital. On average, there were 120 patients per day and over the entire study period a total of 2,400 patients attended the hospital for the period of the study. A random sample of 30 patients were used for the study every day form Monday to Friday during the month of July 2010. The outcome of this research was that longer waiting time meant that patients suffered more sometimes leading to preventable deaths. For instance, a patient with severe injuries suffers more when he or she has to wait for extended periods before receiving the service of a doctor. The outcome of the study was that patient waiting time was affected by availability of emergency beds, number of nurses and general laxity in service provision. Thus, the number of available staff and their work ethic had an impact on the quality of service that emergency room patients could receive. The fourth research considered was a study by Arkun et al (2010). The study was conducted on a sample population of 1,543 patients in the emergency department at an urban Level II Trauma center. In this research, the comparison was between the door-to-doctor periods in the emergency department in relation to the level of satisfaction of the clients. The outcome of the study of the 1,543 patients was that the average wait time to see a doctor was 1.8 hours. Also, the average dwell time for the patients was obtained as 5.5 hours. Patients who spent long time in waiting had their health conditions worsening. The factors that determined the waiting time included the triage category, the bed occupancy and the day of the week. Imperatively, it was observed that the waiting times varied depending on these factors. The research was conducted over a period of one and a half months. The results were collected for patients who visited the emergency department from Monday through Friday. The cohort study was conducted on adults who were waiting to be seen at 8 p.m. Research Summary Table Author (year) Purpose Sample/Number of Participants Design/Level of Evidence Findings Limitations Study 1 To evaluate patient satisfaction in emergency departments 297 Adults Data was analyzed statistically to obtain frequencies and then cross tabulated with sex, race and time of the day It was noted that longer waiting times led to worsening conditions of patients The study was conducted over a short period and the patients might have been still sick Study 2 To evaluate effective measures for reducing waiting time in emergency departments 198 Respondents The study was conducted by use of questionnaires. The data collected was analyzed by generalized linear interactive modeling and fitting binomial models An increase in number of staff (doctors and nurses) lowered chances of patients’ condition worsening Some of the questionnaires were not returned thus the data may have been incomplete Study 3 To investigate the factors the influence waiting times in Saint Rita’s Hospital emergency department 600 Respondents The study used observational study design. proportional hazard regression models were used to analyze the variables Long waiting times led to worsening patient conditions and sometimes even death . The study was carried over a short Study 4 To investigate the factors that influence emergence department crowding 1543 Respondents The respondents were chosen through a random survey. The validity of the data was achieved through conducting a pilot study. Lack of capacity and insufficient staff led to long waiting times and worsening of patient conditions The findings of the research may not be applied to other scenarios as they are for a specific case. period of time. The research question in this study intended to evaluate the status of service provision in the emergency departments in hospitals. Specifically, the research question inquired the consequences of extended wait times, nursing staff shortages, and high acuity on emergency room patients. The research question presented a framework for investigating the factors that negatively impact service delivery in emergency departments of hospitals and its consequences. The studies that were evaluated used various research designs. Most of the research used descriptive cross sectional studies that were conducted over a period of time. Other studies were based on observation. The results of these studies were that bed availability and the numbers of doctors were the major factors that affected service delivery in emergency departments. Patients were dissatisfied with the long waiting times in the emergence rooms. An improvement in bed availability and the number of personnel in the emergence room significantly lowered the waiting time. The answer to the research question was that long waiting time impacted negatively on patients’ satisfaction and their health status. It was noted that long waiting times led to the worsening of patients’ conditions and sometimes led to preventable deaths. It should be noted that the samples and number of participants were inadequate. This is because there is a large number of people who visit emergency departments and therefore a larger sample was required. A large sample would offer a truly representative finding that is applicable to the majority of the population. One of the limitations of the study was the short periods within which the research was done. Also, the research limited since it was carried out in single areas. To overcome these limitations, sufficient budget has to be provided to allow for longer periods of research and more locations. Based on the findings of the research, the evidence collected is sufficient to warrant a change in practice. It is imperative that bed capacity affects service delivery in emergency departments and thus hospitals should improve emergency rooms’ bed capacities. Also, the issue of nurse and doctor shortage has to be addressed to reduce the waiting time of emergence room patients. References Arkun, A, Briggs, W., M, Patel, S. Birkhahn R H. (2010). Emergency Department Crowding: Factors Influencing Flow. West J Emerg Med. 11(1):10-15.Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2564124/ Cumona, K. (2010) Factors Influencing Waiting Time in Saint Rita’s Hospital Emergency Deaprtment and Its Effects. Africa Med J. 25(3): 7-15. Retrieved from: http://ul.netd.ac.za/bitstream/10386/539/1/Part-2-Dissertation-Dr%20Cimona-Final.pdf Mastandrea, D, Angelo M, Antonio L, Scott L, Juan F. Acosta, D.O. and David Y. (2008).Patient Satisfaction of an Inner City, Level One Trauma Center’s (St. Barnabas Hospital) Emergency Department Waiting Room. New York Medical Journal. 11 (4) 23-31. Retrieved from:http://newyorkmedicaljournal.org/index.php/articles/patient_satisfaction_of_an_inner_city_level_one_trauma_centers_st._barnabas Munro, J., Mason, S. and Nicholl, J. (2007). Effectiveness of measures to reduce emergency department waiting times: a natural experiment. Ann Emerg Med;35(1):63–8. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2564124/ Ramesh, P., Gastmans, C. and Yvonne , D. (2011). Emergence Department Triage: An Ethical Analysis.Bio Med Cenntral. 45: 5-9. 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