Delays In Emergency Department

Running head: DELAYS IN THE EMERGENCY DEPARTMENTS IN HOSPITALS DUE TO OVERCROWING

Delays in the Emergency Departments in Hospitals Name Institutional affiliation

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DELAYS IN THE EMERGENCY DEPARTMENTS IN HOSPITALS DUE TO OVERCROWDING

Delays in the Emergency Departments in Hospitals Problem: Although emergency departments are there to deal with the emergency situations (accidents, medical issues, surgical procedures) yet there are number of issues which causes delays in provision of care in hospitals. The hospital have developed some of the policies to provide emergency care on urgent and emergent basis still it has been seen that there are delays in emergency care and moving the patient from the emergency to the wards. Emergency departments (EDs) are the main part of the health care organizations which provide emergence and urgent care to those patients who need it. In fact the EDs are having a unique and important place in the hospitals that play an important role in provision of care and safety. Moreover, these are open for 24 hours and these also work during the emergencies such as natural disasters and human made disasters. Background: EDs are playing a critical role during emergencies on regular basis by providing access to the emergency care to the patients regardless of their ability to pay to the provided care. However, it has been noticed that the patient care is delayed in the EDs and even after diagnosis the patients are transferred to the preferred wards and units of the hospitals. Krall, Cornelius, & Addison, (2014) have explained that the emergency departments (EDs) are facing extended delays in the evaluating patients and provision of care. There are number of reasons which cause delays in dealing the patients such as; staff shortage, rooms shortage and delays in reports of blood tests done on emergency basis (p. 158). It is a critical issue that endangers the health and reliability in the health care organizations. The crowding is one of the reasons that can cause delays in EDs. According to George & Evridiki, (2015), emergency crowing is the serious issue that is causing serious problems around the globe. According to the American College of Emergency Physicians “crowding is a situation in

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DELAYS IN THE EMERGENCY DEPARTMENTS IN HOSPITALS DUE TO OVERCROWDING which the identified need for emergency services exceeds available resources for patient care in the emergency department, hospital, or both.” (p. 1). The crowing and delays are having a direct relation with each other. Agreeing to the aforesaid point the Erenler et al., (2014) have explained that ED is one of the most overcrowded part of the inpatient delivery service. Furthermore, the delays in the ED are having most unpleasant issue for the patients and families. Crowding is defined as the more number of patients than the available rooms and staffs whereas, the overcrowding is the dangerously crowded with the large volume of the patients beyond the limits and capacity of the ED (p. 60). Thus, it can be said that the emergency departments are the core of the hospitals however; these are overcrowded more often and can cause serious consequences on the patient’s care and on the families as well. According to Krall, Cornelius, & Addison, (2014), the increased number of visits of the patients in EDs and decreased number of EDs in the hospitals have become an important issue of the health care organizations. Additionally, the lack of EDs cares resources and efficiency are also serious issues that need prompt attention from the hospital management (p. 159). Therefore, it can be said that lack of resources, staffing and infrastructures are affecting the patients and their families in a number of ways (physically, psychologically and emotionally). Qualitative and Quantitative Description of the situation: Overcrowding in the emergencies is a worldwide phenomenon that affects the patients and the care they get. In a study Pascasie & Mtshali, (2014) have found that there are number of factors which are causing the delays in care provision to the patients. They found that about 42% of the patients have to wait for 30-60 minutes in emergency department to be seen by the physician. On the other hand, the 37% of the respondents have said that they have to wait for more than 30 minutes to be checked by the doctors of emergency. In contrast, there

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DELAYS IN THE EMERGENCY DEPARTMENTS IN HOSPITALS DUE TO OVERCROWDING were major respondents who wait for more than one hour because of unavailability of the beds in the emergency department (p. 180). Adding the above mentioned data Salway, Valenzuela, Shoenberger, Mallon, & Viccellio, (2017), have explained that 50% of EDs are facing the issue of overcrowding. Moreover, about 90% of the US hospital directors are reporting the issue of recurrent overcrowding as a serious issue and these are causing 50% of diversion. Thus, it has been found that overcrowding and diversions have become alarming threats for the patient care (p. 216). In the qualitative studies by Mellor et al., (2015) and Patel et al., (2017) it has been found that the road traffic accidents and strokes are the most common problems after heart issues which bring the people to emergency departments. However, it has been seen that delays are related to traffic issue, non-recognition of the issue abruptly and distinguish between emergent and urgent situation. According to George & Evridiki, (2015), a number of studies have shown that there is a relationship between ED crowding and delayed management of pain, assessment, and administration of the analgesia. Thus, it is affecting the care and treatment of the patient (p. 2). So, to speak I have seen the same issue in delaying the patients care in emergency. About 50% patients were diverted from the hospital as there was no availability of the bed and staff. Similarly, the patients and attendants were waiting so long to be treated in emergency with non-emergent and non-urgent situations. However, there were protocols which helped to treat and manage the urgent and emergent patients at the priority. Strategies and pros and cons: Though management of overcrowding in the hospitals is an important issue still it needs efforts and time. Undoubtedly, overcrowding in emergency centers is a great problem that is not ignorable. The authorities of the hospitals have planned trainings for the nurses and doctors dealing the patients in emergency departments. The authorities have also used the

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DELAYS IN THE EMERGENCY DEPARTMENTS IN HOSPITALS DUE TO OVERCROWDING development of the more vast emergency departments to accommodate more patients and to deal more emergencies. Although these initiatives are taken by the hospitals still these are not considered as the most accurate and success full methods. The training program of the nurses and the doctors of emergency department is a good effort however, it needs time and money. The emergency departments are already facing the shortage of the staff, in such cases the shortage will increase and the hospitals will spend more money on the trainings and development of the departments. Similarly, advocating the new staff and investing more is helpful to reduce the overcrowding in emergency departments. However, it will reduce the profit for the organizations. Recommendations: In the above mentioned situation I will recommend the following strategies which can help in reducing the overcrowding and delays in the emergency departments. The patients who have come in the ED and are assigned to the wards should be moved to their concerned departments so they can be treated. This will help in reducing the delays and overcrowding. According to Patel, Combs, & Vinson, (2014), the best strategy to reduce the waiting of the emergency patients to transfer them directly to the designated inpatient floors (p. 271). The delayed patient care leads towards the increased health issues and mortality rates therefore the patients on the urgent basis should be treated promptly so the ratio of the mortality and advanced health issues can be minimized due to overcrowding and delays. Richards, Van der Linden, & Derlet, (2014), have explained that the hospital leadership and management has the system to make changes in the EDs system which will help in reducing the health related issues (p. 3). It is also helpful if the patients are discharged on the weekends which will result in vacating a number of beds. Therefore, it will help in transferring the patients from the EDs directly to their designated areas. According to Salway, Valenzuela, Shoenberger, Mallon, & Viccellio, (2017), it is useful to discharge the patient on the weekends to improve the services

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DELAYS IN THE EMERGENCY DEPARTMENTS IN HOSPITALS DUE TO OVERCROWDING in the hospitals and emergency departments. Furthermore, the results are improved in quality of care and decrease the boarding (p. 218). Furthermore, the involvement of the ministry of health and stakeholders to collaborate with the emergency experts to find out the solutions of delayed care and transfer in the emergency departments.

Major Goals:  To, develop of new policies for the emergency department.  To, prepare the plan to teach the nurses and doctors about emergency management.  To, involve the stakeholders in the process of the development of policies and its implementations.  To, expand the areas for the emergency treatments and involvement of the leaders and management for the prevention of diversions.  To, develop plans for the diagnosis and recognition of the serious medical issues in emergencies (development of the pathways to deal the emergencies and transfer) Barriers and Constrains: There are number of barriers and hurdles for the implementations of the aforesaid goals. Firstly, the training of the staff and doctors will affect the overall emergency department and patient care. Because, the shortage will increase as well as the staff and doctors will also resist. Secondly, the expansion of the departments will also reduce the profitability of the organization which is an issue for the stakeholders and they show resistance against this process. But the greatest benefit of this procedure will be decreased mortality and delays which ultimately enhance the rapport of the organization in the market. Lastly, the pathways development will also produce resistance because the people who are already working with their preferences will not accept the new changes in their work. Conclusion:

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DELAYS IN THE EMERGENCY DEPARTMENTS IN HOSPITALS DUE TO OVERCROWDING In nut shell the overcrowding in the EDs are the main and serious issues with a lot of problems. However, this problem is not uncommon and few of its factors cannot be controlled and some can be controlled. The main goals and implementation of the new policies is the main point that needs attention. However, these implementation can face a number of constrains and resistances.

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DELAYS IN THE EMERGENCY DEPARTMENTS IN HOSPITALS DUE TO OVERCROWDING

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References Erenler, A. K., Akbulut, S., Guzel, M., Cetinkaya, H., Karaca, A., Turkoz, B., & Baydin, A. (2014). Reasons for Overcrowding in the Emergency Department: Experiences and Suggestions of an Education and Research Hospital. Turkish Journal of Emergency Medicine, 14(2), 59-63. doi:10.5505/1304.7361.2014.48802 George, F., & Evridiki, K. (2015). The Effect of Emergency Department Crowding on Patient

Outcomes. Health

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http://www.hsj.gr/medicine/the-effect-of-emergency-department-crowding-onpatientoutcomes.pdf Krall, S., Cornelius, A., & Addison, J. B. (2014). Hospital Factors Impact Variation in Emergency Department Length of Stay More Than Physician Factors. Western Journal of Emergency Medicine, 15(2), 158-164. doi:10.5811/westjem.2013.12.6860 Mellor, R. M., Bailey, S., Sheppard, J., Carr, P., Quinn, T., Boyal, A., … McManus, R. J. (2015). Decisions and Delays Within Stroke Patients’ Route to the Hospital: A Qualitative

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doi:10.1016/j.annemergmed.2014.10.018 Pascasie, K., & Mtshali, N. G. (2014). A descriptive analysis of Emergency Department overcrowding in a selected hospital in Kigali, Rwanda. African Journal of Emergency Medicine, 4(4), 178-183. doi:10.1016/j.afjem.2013.10.001 Patel, A., Vissoci, J. R., Hocker, M., Molina, E., Gil, N. M., & Staton, C. (2017). Qualitative evaluation of trauma delays in road traffic injury patients in Maringá, Brazil. BMC Health Services Research, 17(804), 1-8. doi:10.1186/s12913-0172762-6

DELAYS IN THE EMERGENCY DEPARTMENTS IN HOSPITALS DUE TO OVERCROWDING

Patel, P. B., Combs, M. A., & Vinson, D. R. (2014). Reduction of Admit Wait Times: The

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Medicine, 21(3), 266-273. doi:10.1111/acem.12327 Richards, J. R., Van der Linden, M. C., & Derlet, R. W. (2014). Providing Care in Emergency Department Hallways: Demands, Dangers, and Deaths. Advances in Emergency Medicine, 2014, 1-7. doi:10.1155/2014/495219 Salway, R., Valenzuela, R., Shoenberger, J., Mallon, W., & Viccellio, A. (2017). Emergency Department (Ed) Overcrowding: Evidence-Based Answers To Frequently Asked Questions. Revista Médica Clínica Las Condes, 28(2), 213-219. doi:10.1016/j.rmclc.2017.04.008

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