Prolonged or increased waiting time for patients at the Emergency Department lead to an increase in both morbidity and mortality among critically ill adult patients admitted for inpatient beds. The gathering of ED records of the St. Margaret Mary Healthcare Centers of Dyer, Indiana, aimed at developing a report on overcrowding, identified the main causes as the lack of available inpatient beds and the lack of nurses to care for patients. Long-term solutions are identified and suggested.
Background/Significance -- Overcrowding at the ED occurs primarily because of overwhelmed ED manpower and sheer physical incapability because of the massive number of patients requiring or receiving care. Overcrowding, lack of ED staff and the delay of transfer to assigned bed, the lack of physical beds and un-timely discharges lead to increased boarding times at the ED.
Problem Statement -- Patients with assigned medical/surgical beds from the Emergency Department take too long to move from the Emergency Department to their inpatient beds. Prolonged boarding times at the ED increases morbidity and mortality risks among critically ill patients.
Objectives -- to decrease the time spent from the assignment of inpatient beds until they are occupied to within 30 minutes for 60% of the patients
Theoretical Framework -- The Orlando Nursing Process Theory lists the basic concepts for nurses in meeting patients' immediate needs. Overcrowding and delays in transfer complicate her task of assessing critical patients and filling their basic and immediate needs. The Theory will help her streamline her task to immediate needs until patients are moved to their destination.
Institutions report that 50% or more of hospitals go through the ED, considered the "front door (Harrell, 2012)." But patient flow through the ED is characterized by bottlenecks, confusing messages and the mingling of self-arriving patients and those brought in by emergency vehicles. Poorly conceived first encounter systems, queuing and poorly designed treatment areas lead to delays in treatment or management of patient record, increasing stress among patients and hospital staff alike. Poor and inefficient patient throughput leads to costly and mistake-laden operations and, ultimately, patient dissatisfaction. When the beds are all full, a nurse conducts initial assessment in a triage station. The emergency staff determines the priority of care and the patient is made to wait in the inner waiting area with the family (Harrell).
Bramwell (2012) shares the three strategies, which helped improve patient throughput at the Good Samaritan Hospital of New York and increased hospital revenues, in the process. These were the opening of a logistics center, the use of an electronic bed board, and a fast-tracking ED triage (Bramwell). The Pennsylvania Patient Safety Authority (ECRI, 2010) suggests a predictive model of staffing; optimizing low-census or low-utilization times at the ED and prepare for busier times; monitoring ED capacity in real time; an accurate and reliable triage methodology; alternative triage strategies; appointing a patient flow manager; fast-track or urgent care treatment areas; and adopt environmental ED principles (ECRI). The 2007 Emergency Department Benchmarking Alliance Annual Data Survey enumerated some recognizable trends in ED data. These were increase of total arrivals at midmorning till noon, steady hold until midnight and then decrease; pediatric arrivals come sooner than adult and decrease sooner; senior citizens come in the late afternoon and wait longer; Saturdays and Mondays are the busiest days; the busiest months are July-August and December; and the most common complaints are abdominal pain, chest pain and orthopedic injuries (ECRI). The University Medical Center of Tuczon, Arizona increased its hospital capacity and consequently improved patient flow through a comprehensive approach (Enriquez et al., 2009). Since then, the hospital has been guided by its 4 keys to success. It comprehensive approach was the evaluation of the hospital total patient flow environment. Its 4 keys to success are 100% support from, and involvement by, senior executives; the key participants in patient flow are involved; perseverance; and deciding to go it alone or by partnering with outside organizations (Enriquez et al.). H&HN (2009) suggests improving patient flow through industry-wide solutions. These include improved scheduling; simplified bed management; tracking patient, staff and assets; and improving patient perception through interactive patient care. DeLia (2007) says that ED trends are most heavily influenced by the inaccessibility of primary and other specialized…