Finnie-HSA-515-assignment-4

“Code Blue – Emergent Care”

HSA 515

Code Blue – Emergent Care

In this paper I will be playing the part as a chief operating officer (COO) and I am responsible for a 15-bed Emergency Room (ER). In this scenario I am facing many complaints within the last year regarding inadequate care, poor Emergency Room management, long wait times, and patients being sent away because of lack of space, staff, or physicians to provide appropriate care. I am asked to (1) Thoroughly diagnose the root causes of the complaints about the clinic, (2) thoroughly devise a strategic plan for overcoming the problems associated with the current Emergency Room, (3) thoroughly justify how the “Good Samaritan Law” affects the appropriate treatment of the Emergency Room patients, (4) thoroughly analyze how the different levels of emergency services (basic, intermediate, transfer, and trauma) should be prioritized in the strategic plan, (5) thoroughly formulate a plan to treat adults, minors, or incompetent adults in the new Emergency Room organization, and (6) thoroughly create a procedure to provide care to those who refuse to consent to treatment.

(1) Thoroughly diagnose the root causes of the complaints about the clinic. There are many root causes for the complaints that have been recorded regarding the Emergency Room. The main problem would be the overcrowding and the lack of beds and personnel to take care of overflow of patients in the emergency room which creates a chain reaction which in turn leads to inadequate patient care, long wait times, patients being sent away because of lack of space, etc. According to most research there is an increase everywhere in Emergency Rooms in the U.S. This results in the increasing uninsured Americans and enrollees in public programs, for example Medicaid coverage. The emergency room that I am in charge of only has 15 beds for emergency room patients. This in turn can cause a backlog because there is no room to put patients and then could eventually lead to sending patients back home or away because of the lack of space. With the overwhelming amount of patients coming to the Emergency Room and no place to put them and the lack of staff results in poor care, long wait times and poor Emergency Room Management due to lack of staff to deal with certain duties to make the Emergency Room run efficiently. The problem that seems to exist is the lack of organization and care planning of the Emergency Room patients and categorizing them according to their needs and critical care. There needs to be a reevaluation of new job duties and departments on what they will be doing in the process of admitting patients in the Emergency Room. Also the lack of staff can cause a lot of problems and which the Emergency Room will need to add more nurses, physicians, Physician Assistants to the mix so that people are not waiting long lengths of time to be seen. Also I would start a new team called the Constant Quality Improvement team. They will be responsible on making the corrections implemented to stay in place or to improve these changes to make the Emergency Room more efficient and they will be constantly reviewing the complaints and positive feedback from patients. Also they can investigate the issues and if a staff person needs to be replaced then that is what will need to be done. This tool will help the Emergency Room become more efficient. With the complaints from the past year it looks like the Emergency Department needs a big overhaul and a lot of work to improve the quality of service. (Briscoe, 1998)

(2) Devise a strategic plan for overcoming the problems associated with the current Emergency Room. For starters one must step back and actually see the surrounding areas, departments and what is actually going on with the knowledge of the complaints. Observing first hand can give you the exact idea and reasons why these complaints exist. Then I would get together with each manager from the department and state what the complaints are and what needs to be done to correct these issues. If it is due to the lack of beds for the increasing amount of people coming into the Emergency Room then I would seek to expand the Emergency Room department and add the amount of beds that are allowed by the state and government. The staffing will have to be a top priority and make sure that we have enough staff to cover and have the backup staff to cover people when they are calling in sick. I would also concentrate on the admissions process of the patients and the triage time and accuracy of these patients. Each step and specific need of the Emergency Room patient intake and follow up may need a special worker to make sure that their stay at the Emergency Room is fast and efficient. This would start with the first people to see you, which is triage. The nurses must have a special room to take down the information and why the patients are at the Emergency Room. These nurses also need to see how critical the visit is to the Emergency Room and address them accordingly. For example if you have someone with a broken arm you want to get their vitals and into the exam room as fast as possible. If you have a patient who is coming in for a headache and is just seeking some medication then they would not be as critical as the person who has a severe cut, heart attack, broken limb, etc. Then you have the Registration personnel come and take care of the necessary paperwork and see if someone else is able to do it for the patient while they are being treated. Then assign a case worker for the patients to help figure out the next step for the patient after being treated and if they need to be admitted or sent home with discharge paperwork. You can also utilize case managers who will serve as knowledgeable personnel who will help ensure that patients receive the necessary level of care at the particular time in their treatment. The case managers can also determine and identify alternative delivery methods other than inpatient hospitalization, when appropriate. The case managers can also identify and determine if the patients can be transferred to less acute units within the hospital to remove them from the Emergency Room to make room for other critical patients who need the bed. Also the personnel can coach the patients who did not have an emergency need to utilize their primary care physicians and if they do not have one they can help them find one nearest to them and set up an appointment to get them established with a primary care physician. These can help alleviate the patient from repeating the incident. Emergency Rooms are for life/health threatening issues that cannot wait till the next day. These different personnel can help the doctors that are scheduled to work at the Emergency Room can concentrate on the best care of the patient. The Emergency Room would flow more efficiently when each personnel has their specific task to accomplish and to the best of their ability. (Nooner, 2004) (Birriterri, 2002)

(3) Justify how the “Good Samaritan Law” affects the appropriate treatment of the ER patients. For starters the Good Samaritan Statute is to encourage physicians and other professionals to extend aid to strangers at the scene of an emergency. (Showalter, 2012) Therefore with that being said since the accident did not happen at the Emergency Room the medical professionals or doctors that are on duty are not covered under the “Good Samaritan Law”. This is where the malpractice insurance of the hospital and the physicians, medical professionals must have malpractice insurance.

(4) Analyze how the different levels of emergency services (basic, intermediate, transfer, and trauma) should be prioritized in the strategic plan. The different levels of emergency services will determine how to make the emergency room more efficient. Based on the different emergencies that are out there the emergency room will have different rooms set up for specific emergencies. For example one trauma room would be dedicated to patients with cardiac emergencies. This room/department would be equipped with all the necessary equipment needed to treat and stabilize patients with cardiac issues. Then another department in the ER would have all the necessary x-rays, MRI, ultrasounds, etc. to deliver faster results and less waiting time to get the tests done and read. You would have a general area of the Emergency Room that would be dedicated to those who do not have life threatening or special need for equipment for example a patient with a minor cut that just needs simple stitches could be put in this general department of the Emergency Room. Then you have another section of the department for people with illnesses caused from viral or bacterial infections to try to contain their exposure to the other patients. This is where the registration and triage comes into play. They are the first to see the Emergency Room patients and they can screen for the different emergencies and let these patients know they could be waiting a bit if their injuries are not critical. (Nooner, 2004) The Emergency Room has make sure that they do not violate Emergency Medical Treatment and Labor Act (EMTLA). This law is consistent with the philosophy that healthcare at time of an emergency is a moral right and must be provided regardless of the patient’s ability to pay. (Showalter, 2012)

(5) Formulate a plan to treat adults, minors, emancipated minors, or incompetent adults in the new ER organization. In a plan to treat different dynamics of patients, whether they are minors or adults, competent, not competent there needs to be a plan in place to know where these patients need to be taken care of and if they need special requirements. This is where the Emergency Room would have different areas that would take care of these patients’ needs and privacy. If you have a patient who is under the influence of alcohol and/or some form of medication/drug would need to be contained from other patients till they can become controllable and stabilized according to their medical needs. The stress level of the Emergency Room is already at a high and other patient and staff does not need to become more stressed by commotion from other patients. Also designated and confidential triage rooms where the nurse can take the information and vitals of the patients that come to the emergency room. The last thing you want is an overcrowded waiting room where everyone under stress. The emergency room has to treat everyone that comes through their doors regardless of whether they can pay for their treatments or not. The patient cannot be turned away unless they refuse treatment and want to leave or be transferred to another facility. However even that needs to have its own procedures and paperwork. Everyone who works in the Emergency Room must know ahead of time what they are expected to do and they must be able to complete their job duties so that the next person that is contact with the patient has all the required information to do their job. All of the departments must pull together and work as a team to make the best environment and efficiency in the Emergency Room. (Cesario, K.S., 2009) I would also add to the plan of a more efficient Emergency Room is to try and deal with the Emergency Room being filled with patients who are just coming to the Emergency Room for non-emergency care. Many people without insurance come to the Emergency Room because we cannot refuse them treatment. If the patients are counseled as to what Emergency Rooms are put in place for then maybe it can help cut down the amount of repeaters and attempt to encourage them in seeing a primary care physician instead of making the Emergency Room congested with patients who do not necessarily have an emergency. It is also been shown that patients with government insurances for example Medicaid are frequent flyers of the Emergency room that do not have an emergency and could have been taken care of by a regular physician. This has become a common thing in Emergency Rooms. These types of patients need to understand what they need to do and what they don’t need to come to an emergency room for.

(6) Create a procedure to provide care to those who refuse to consent to treatment. When you have a patient who refuses treatment there are steps and documentation that must be done and followed. In my Emergency Room I would make sure that there was a procedure in the company policies of how to handle situations such as this. I would make sure that all the necessary paperwork to document a patient who is refusing to be treated is in this manual. There would be guidelines that are in place to follow to make sure the patient is able to refuse treatment or if they are in a situation which makes them unable to refuse treatment. In order to refuse care a patient must be legally and mentally capable of refusing treatment. The patient must be at least 18 years old or is legally emancipated, and fully aware of the nature of the medical condition that they have and the risks and consequences if they refuse treatment. The patient must not have impaired judgment due to a drug of some form, being alcohol, medication or any other type of drug. The patient must be very aware and oriented. When a patient refuses treatment regardless of the outcome if they don’t take the treatment then this is called Leaving Against Medical Advise. When this is established that the patient is of age and is fully competent to make their own decisions there are steps to take. You then must honor their decision. Document everything even in quotations if you remember exactly what was said by both parties. You must show that you made every effort possible to encourage the patient to allow treatment without violating patient rights. Document and make sure that you document that the patient was informed of the nature of their illness/injury and the risks of not getting proper treatment for the illness/injury. Document what the patient stated and how and why they refused treatment. You cannot hold someone against their will that is of age and capable of making their own decisions. If you refuse to let a patient leave this is considered imprisonment even if you are only doing it for the patients’ best interest. If at all possible try to get the signature of the patient stating that they are refusing treatment and want to leave and/or be transferred to another facility. If the patient has family or friends with them include them in this discussion so that they may be able to encourage the patient to get treatment for their illness. Make sure all names, date and time is documented. This policy would be in place and known to every employee and reiterated as needed and documents in all departments and even guidelines so that everyone knows what needs to be done when you have a patient refusing treatment. (Showalter, 2012)

References:

Birritteri, Anthony. (2002, April 01). “Hospitals Expand Emergency Rooms as Patient Volume Rise.” New Jersey Business, (4), 36, Retrieved from http://elibrary.bigchalk.comBriscoe, G. Arthur, G. (1998, October 01). CQI Teamwork: Reevaluate, restructure, Renew.. Nursing Management, ({29}) 73 (1), Retrieved from http://elibrary.bigchalk.comCesario, K.S. (2009, June 01). Designing Health Care Environments: Part1. Basic Concepts, Principles, and Issues Related to Evidence-Based Design. Journal of Continuing Education in Nursing, (6), 280, Retrieved from http://elibrary.bigchalk.comFelt-Lisk, S., McHugh, M., Howell, E. (2002, September 01). Monitoring local safety-net providers: Do they have adequate capacity?. Health affairs, (5), 277, Retrieved from http://elibrary.bigchalk.com

(2009). Hospital. Hospital. Encyclopedia Britannica. Retrieved from http://elibrary.bigchalk.comNooner, Kevin (2004, May 01). BOUNCING PATIENTS?. Nursing Management, (5), 38, Retrieved from http://elibrary.bigchalk.comShowalter, J.S. (2012). The law of healthcare administration (6th ed.). Chicago: Health Administration Press.