Emergency Department Overcrowding - Essay Example

Emergency Department Overcrowding Literature Review Samela Rainey BSN, RN Walden Emergency Department Overcrowding It would be superfluousto mention that throughout history the overcrowding in emergency rooms has been a problem. There are several reasons for this: Lack of medical support, small emergency areas, and many emergency procedures. There are almost 5,000 emergency departments (ED) in the United States of America that provide health care to patients, services 24 hours a day through 365 days a year (Derlet & Richards, 2002). According to the Connecticut Hospital Association [CHA], ND), there are many cities reporting an increase in emergency departments (ED), wait time, and ambulance diversions, thus implying, problems in the health in patients and the poor healthcare given to them. They stated that in a national survey in April 2002, “…62 percent of all U.S. hospitals reported being “at” or “over” operating capacity, with this proportion rising to 79 percent for urban hospitals, and 87 percent for level 1 trauma centers”. CHA advocated to, reduce emergency department overcrowding. Their propositions were included and approved in the 2007 CHA Legislative Agenda (November, 2006) by the Board of Trustees. Derlet and Richards (2002) performed a study in Florida, New York, and Texas. They stated that these states have large populations and that they have approximately 800 EDs. They wanted to determine the incidence, causes, and effects of the overcrowding in emergency departments. They sent 300 surveys and 210 (70%) were returned by mail. Of those 194 reported overcrowding in EDs. New York reported 90%, Florida 92%, and Texas 95%. According to their study the reasons for ED overcrowding were: Hospital bed shortage, high medical acuity of patients, the increase of patients, few examinations spaces, and the shortage of Registered Nurses (RN). They continued stating that due to the overcrowding there were deaths, permanent disability, additional procedures, and an increase in hospitalization time. They concluded that overcrowding was consistent and that poor medical results may happen due to overcrowding. Derlet and Richards continued in that this is not only a national issue but an international issue as well. Washington, Stevens, Shekelle, Henneman, and Brook (2002) wanted “To determine the effects on health status and access to care of systematically referring patients with nonacute conditions to next-day primary care” (p. 707); this study was conducted in an emergency department public hospital. There were 156 adult patients that met the criteria for deferred care between March, 1997 and May, 1998. They had a total of 1176 patients, 421 (36%) met the criteria and 299 met the study inclusion criteria. They had 75 patients that were assigned to the deferred care intervention group while 81 were assigned to the customary care group. Their participants were adults, ethnically diverse, poor, and had no insurance. They found that 95% of the patients had been evaluated by the physician at least once, 4% continued their health services after their first evaluation, and no patients were either hospitalized or died. Although they found that clinically standardized criteria may be used to identify patients for referral to next-day care, they emphasized that larger studies are needed to identify adverse effects. They posited that their study is one of the few “…that evaluates the safety of explicit deferred care guidelines, and it is one of the first to use a randomized, controlled design”. Yoon, Steiner, and Gillis (2002) found in their study that was conducted at the ED of the University of Alberta Hospital, similar results of overcrowded emergency departments in prolonged waiting times, patient care delays and scarce resources. They stated that patient length of stay (LOS) measures ED throughput and marks overcrowding. Their study consisted of a 7-day period with 1047 patients registered in the ED. There were several exclusions from the study: 113 (10.8%) patient charts due to incomplete documentation and 40 (3.8%) due to patients leaving without seeing the physician, leaving 894 patients as part of the study. The Canadian Emergency Department Triage and Acuity Scale (CTAS) is the instrument that they used that provides objectives for ED nurse and physician response time. They stated that physicians violate triage priorities and care to non-urgent patients. They found in their study that non-urgent patients and critically ill patients were the least to spend time in the ED. The Joint Commission on Accreditation of Healthcare Organizations [JCAHO], 2004 is an organization that not only accredits but is on constant supervision of procedures and outcomes. They started announcing surveys and later changed their procedure to non announced surveys. They did not want the staff to prepare for them and obtain outstanding results. They wanted surveyors to visit and find the reality of the ED. Synthesis ED overcrowding is a common and complex problem that will affect patient care. Patients often leave the ED before receiving treatment for their illnesses or injuries because of the prolonged wait of time. ED overcrowding clearly poses a critical problem for hospitals that affect patient outcomes. ED’s have little control over the volume and type of patients they receive but the factors that affect organizational patient flow affect the efficiency of the ED. Throughput is multifaceted and each aspect of the patient’s journey through the ED needs to be dissected and evaluated. Parnell’s CHECK FOR SPELLING PARNELL OR PURNELL? USE THE SAME SPELLING IN THE REFERENCES LIST (2003) study analysis identified a successful system that decreased waiting time and ED overcrowding by instituting protocols that begin in the triage area by the nurse. This measure decreased the physician decision time by having lab and x-ray results at the time the physician examined the patient, which also decreased the disposition decision. Consistencies/Contradictions All of the studies concurred in that shortage of clinical staff; patients waiting to be seen by clinical staff; having lack of funds; and, coming from diverse ethnic groups affect the overcrowding in the ED. Washington et al. (2002) posited that emergency departments are used for nonemergency care or for a lack of insurance and that this may lead to overcrowding. Derlet and Richards (2002) and Washington et al emphasize the problems with a language other than English. Yoon et al. (2002) found that imaging and laboratory tests were associated with prolonged length of stay (LOS). They mentioned that by using the Canadian Emergency Department Triage and Acuity Scale (CTAS) which is a standardized instrument, makes them different from other studies in this area. All of the researchers concurred in that if patients are not taken care of and that if they have to wait a long period of time they tend to leave without being seen by a physician. They state that if measures are taken into consideration to better this situation better caring services will be applied to the better satisfaction of patients. There were no contradictions found in this literature review. They did mention that further studies should be conducted and in this case, contradictions may arise. Preliminary Conclusions It may be observed through the literature review that all of the researchers found overcrowding in Emergency Departments. They found that patients seeking attention would leave the ED because onf non attention; too much time of waiting; not able to see the physician; scarcity of medical staff; shortage of beds; and, not having medical insurance. All of the researchers left it open for either them to continue research and/or other researchers to continue where they left off. Since JCAHO is having surveys conducted in an unannounced way, this may lead the hospital administrators and the medical field in general to render better services in EDs by taking into account the surveys that lead to possible solutions of the problems based on their findings. REFERENCES Connecticut Hospital Association (ND). Emergency overcrowding. http://www.chime.org/Advocacy/ED_Overcrowding.html Retrieved from website 1/19/07 10:03 pm Derlet, R. W., Richards, J. R. (2002). Emergency department overcrowding in Florida, New York, and Texas. South Med Journal. 95 (8), 846-849. Joint Commission on Accreditation of Healthcare Organizations (April, 2004). http://www.mlanet.org/resources/jcaho.html Retrieved from website 2/19/07 9:56 pm Purnell, L. (2003). Reducing waiting time in emergency departments. Nursing Management. 26:9. Yoon, P., Steiner, I., Gilles, R. (2002). Analysis of factors influencing length of stay in the emergency department. Can J Emerg Med. May 2003. 5:3, 155-61. ProQuest Nursing & allied Health Source pp. 707. Washington, D. L., Stevens, C. D., Shekelle, P. G., Henneman, P. L., and Brook, R. H. (2002). Next day care for emergency department users with nonacute conditions: A randomized, controlled trial. 137: 9, 707-716. 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