Patient Care and the Affordable Care Act

Evidence Based Practice
University of Illinois Evidence Based Medicine Resources: Lessons Learned
From the search resources I learned that in evidence based medicine, patient values comprising of their unique concerns, preferences, and expectations introduced to the clinical encounter ought to be integrated in determining the ideal care for patient. This integration will guarantee that the individual patient’s clinical state, the clinical setting and best patient outcome prevail in ideal decisions on optimal service delivery to the patient (Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996).
The second aspect learned is that in order to integrate Evidence-Based Nursing and clinical care, there is the need for a basic comprehension of the attributes related to the inherent published evidence. Resources in Evidence-Based Practice are categorized in a hierarchy relating to the quality of the research or evidence. In Evidence-Based Practice, decisions making on best care to patient are not just basically guided by selecting the highest ranking evidence or research in the hierarchy level. Instead, it is essential to critically assess the searched information, select the highest ranking and most relevant evidence available relating to the query, patient’s circumstance and needs. Essentially, the highest ranking evidence article is not necessarily the ultimate go-to guide for ideal decisions. Instead, the ideal guide for decision has to be the highest ranking that depicts the patient’s attribute and through critical assessments reflects considerable best patient outcome (Sackett et al., 1996).
Comparing CINAHL Keyword Search Result with Other Search Engines
According to Houde (2009), the choice of a search engine in systematic reviews will significantly have an impact on Evidence Based Practice (EBP). The search engine will influence the number of retrieved records, the application relevance of the records, resultant adequacy of care given to the patient, and the subsequent time and money resources used in reviewing the results.
In practice I undertook to search broad based terms and thesaurus terms in reviewing the experiences of patients living with leg ulcer. The result indicated that CINAHL database was effective in identifying all broad based terms while the conventional search engines (Bing and Google) provided a number of the information under the broad terminologies but not all. In the thesaurus terms category, CINAHL database was equally competent and it provided all the searched terms. The conventional search engines could only provide less than half of information under these terminologies. This leads to the conclusion that various search engine databases have different forms resource that are useful in EBP but CINAHL generally has a more articulate information in its database that affords medical practitioners exhaustive, relevant, reliable and objective information ideal to guide Evidence Based Medical Decisions (EBMD) (Davies, 2011).
My experience where I could have used Evidence-Based Practice for a better outcome
In one my previous clinical duties I failed to aspirate a syringe while undertaking an injection in an intramuscular region instead choosing aspirating intramuscularly. During subsequent training on clinical practice and subsequent personal reviews it was highlighted that following medical practice reviews relating to intramuscular injections aspirating intramuscularly is no a standard practice anymore. From evidence based practice reviews there is no evidence to support the practice as a conventional medical practice and evidence indicate that aspirating intramuscularly can result to cause trauma among some patients. From this past experience, subsequent reviews and evaluation using Evidence-Based Practice, it is asserted the use of EBP in nursing practice is important. Evidence-Based Practice will ensure medical practitioner have ideal guidelines in making decisions relating to patient care and measures to avoid adverse effects in the course of providing treatment to patients.
How Affordable Care Act has affected the Community Where I Practice
Following the enactment of Affordable Care Act there has been a significant upsurge of patients streaming in for care in the hospital. The increased number of patients visiting the hospital have put a strain on the available staff and significantly affected the quality of care to patients. The higher nurse-to-patient ratio have in the recent past contributed to increase in mortality and morbidity. In the hospital, staff are facing increasing work relate pressures, increasing demand for services and the institution is struggling to keep up with the system of pay-for-performance. Essentially the hospital administration inadequately compensates its workforce in relation to the work done (Samuel, Maizel, Shane, & George, 2009).
The hospital the environment has slowly become unsafe considering the high influx of patient, the strained workforce, delays in admission and discharge of patients and inadequate opportunity for both the medical practitioners and patients to talk over treatment options (Samuel et al., 2009).
How Access to Care Issues Affect the Economy
The access to healthcare propagated by Affordable Care Act (ACA) has injected an increased demand for healthcare service in the economy. The increased demand for healthcare services is however not matched up with an increased capacity of the healthcare institutions. Subsequently there is a creeping bottleneck towards individual access and service delivery in the healthcare industry. In effect there is a reduction in access to healthcare in the economy on the overall (Samuel et al., 2009).
Current Events in Health Care
Following the enactment of the Affordable Care Act, healthcare institutions, group practitioners and individual physicians have considered consolidation and merging. This is in an effort to remain strong and cushion themselves from the adverse business outcomes. The option to merge or consolidate activities is to reduce risks related to small scale operations and spread business related risks. The growing number of mergers, consolidation and acquisitions is raising concerns for unchecked monopolies in the industry. Further, there are worries for growth of anti-trust operations that may lead to erosion of the competitive incentives to improve care thus reduction in quality of service (Samuel et al., 2009).
Community Needs: Major Health Care Issues and Solutions
The major problem faced by healthcare institution currently is the financial burden related to uncompensated care provided to the uninsured individuals mostly in emergency cases. Information obtained from medical research indicates that the annual cost to hospitals for uncompensated care has risen to US $ 41 billion. The amount includes the related services to underinsured and uninsured patients unable to pay related medical bills (Samuel et al., 2009).
To counter this challenge hospitals have taken up to charge uninsured patients for cases otherwise considered as non-emergency. This effort seeks to deter emergency room hospital visit and divert patients from the emergency room to the offices of primary care physicians (Samuel et al., 2009). Another measure would be to undertake measure to link and match underinsured and uninsured patients with identified charity care and financial assistance. Also the hospital can undertake to make follow-ups for unpaid bills from patients and provide patient with a manageable bill payment plan.
Implementing the Solution
In implementing the solution, I would formulate a taskforce that is in general tasked to oversee fee collection and source alternative funds. The taskforce will undertake implementation of a measure to collect from the uninsured or underinsured patient detailed information right at the onset of their visit to the hospital. Within the taskforce, we shall seek to provide the patient with information relating to insurance, extended period payment plans and option to consider cheaper primary health care as opposed to expensive visit to the emergency rooms. Within the taskforce some members will be tasked to make follow-ups on patients in relation to the agreed extended payment plans. Others within this taskforce will be tasked to identify potential charities and donor agencies that would contribute to the uninsured and underinsured patients’ financial obligations.
References
Davies, K. S. (2011). Formulating the evidence based practice question: A review of the frameworks. Evidence Based Library and Information Practice, 6(2), 75-80.
Houde, S. C. (2009). The systematic review of literature: A tool for evidence-based policy. Journal of Gerontological Nursing, 35(9), 9-12.
Sackett, D. L., Rosenberg, W. M., Gray, J. A., Haynes, R. B., & Richardson, W. S. (1996). Evidence based medicine: what it is and what it isn't. BMJ, 312(7023), 71-72.
Samuel, R., Maizel, Shane, P., & George, D. P. (2009). The Financial Crisis Facing America’s Hospital Industry: Part I Am. Bankr. Inst. J., 16(55), 56.