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Nosocomial Infections in Urgent Care
Several macro- and microsystems contribute to the flow of patients through the department from entry to admission or discharge. The patient’s inability to move through the department smoothly can adversely affect their health and well-being as well as their satisfaction with the healthcare system. It can also be argued that patient dissatisfaction can lead to them leaving emergency care without being examined by the doctor, potentially exacerbating their condition. Thus, nosocomial infections or hospital-acquired infections (HAIs) are an unfortunate outcome of patients not being able to efficiently navigate the emergency department system. Barrasa-Villar et al. (2017) state that nearly 8% of hospitalized patients develop HAIs. Furthermore, it should be noted that emergency departments generally present a higher risk for developing HAIs due to patients coming into contact with other patients and medical personnel (Liang et al., 2018). Thus, it is essential to consider all factors influencing poor navigation and associated HAIs transmission in emergency departments and consider potential strategies to address the issue.
Macrosystems in Urgent Care
An emergency department can be described as an ecosystem, with both patients and medical staff influenced by the numerous macro and microsystems. In emergency care, macrosystems can be identified as the “legal, regulatory, and economic barriers and enablers” (Smith et al., 2019, p. 4). Furthermore, they may include broader societal and family influences (McCluskey & Middleton, 2010). Patients may often misjudge their condition, believing it is more severe than it actually is, contributing to overcrowding in the emergency department. For example, a family member may be apprehensive about a client bumping their head and insist on visiting the hospital. Furthermore, many of the patients arrive at the department in a heightened state of anxiety, misunderstanding the instruction given by the medical staff and how to proceed after the triage. Thus, the macro system accounts both for systemic factors and factors related to the patients themselves.
Microsystems in Urgent Care
Microsystems in emergency rooms and departments concern smaller systems and factors. According to Smith et al. (2019, p. 7), the micro-level “relates to day-to-day practice.” Thus, micro-level factors can describe the issues of the given emergency department. For example, the nursing practitioners’ poor understanding of their roles can be viewed as a micro-level factor. Furthermore, poor leadership exhibited by the nurse manager and shift managers and lack of appropriate departmental training for the nurses can lead to misunderstanding of their day-to-day duties and translate into patient dissatisfaction. Scheduling issues, overlapping designated lunch breaks, and interprofessional tension between nursing practitioners and doctors can also lead to clients not being satisfied with the care they receive. In addition, the understaffing issues can lead to overcrowding, patient dissatisfaction, and the development of hospital-acquired infections due to long waiting.
Desired Outcomes
The primary issue is Dr. Mendez’s department is challenging to navigate for patients. This difficulty leads to increased waiting times, overcrowding, and a higher risk of developing HAIs. Thus, there is a need for several strategies to be implemented to address the discussed issues. The navigation-related outcomes include the development of an overall navigation system that would be easy for clients to understand and the nurses to implement. Furthermore, the desired results involve an increased flow of patients throughout the department, decreased average waiting time, and increased patient satisfaction. HAIs-related outcomes involve lowering the average rates of HAIs infections among emergency department patients. Notably, the HAIs-related outcome can be achieved on the condition of achievement of the navigation-related outcomes.
Strategies for Addressing the Issue
To achieve the desired outcomes, Dr. Mendez is recommended to evaluate the daily flow of patients in each shift and determine at what stages the patient queues are the longest. Furthermore, it is crucial to assess the sequence of activities performed by the nursing practitioners and eliminate those that generate waste and contribute to queues (Improta et al., 2018). Patients can also be questioned on what stages in the emergency department were challenging for them to navigate. After the initial evaluation, Dr. Mendez is advised to change the shift schedules so that every shift has an adequate number of practitioners working to avoid overcrowding. Thus, a concrete plan of activities and areas of responsibility for every nurse must be created. Any ambiguity patients may experience must be eliminated through careful instruction by the emergency department receptionist. A brochure with relevant steps can be distributed to the arriving patients. In addition, the layout of the department can be reassessed to improve flow. All patients must be given the names of the nurse and the physician they were assigned to contact promptly if their symptoms are worsening. Finally, an additional area for patients with non-serious conditions should be created to decrease overcrowding.
References
Barrasa-Villar, J. I., Aibar-Remón, C., Prieto-Andrés, P., Mareca-Doñate, R., & Moliner- Lahoz, J. (2017). Impact on morbidity, mortality, and length of stay of hospital-acquired infections by resistant microorganisms. Clinical Infectious Diseases, 65(4), 644–652. Web.
Improta, G., Romano, M., Di Cicco, M. V., Ferraro, A., Borrelli, A., Verdoliva, C., Triassi, M., & Cesarelli, M. (2018). Lean thinking to improve emergency department throughput at AORN Cardarelli Hospital.BMC Health Services Research, 18(1), 1- 9.
Liang, S. Y., Riethman, M., & Fox, J. (2018). Infection prevention for the emergency department: Out of reach or standard of care?Emergency Medicine Clinics of North America, 6(4), 873–887.
McCluskey, A., & Middleton, S. (2010). Delivering an evidence-based outdoor journey intervention to people with stroke: Barriers and enablers experienced by community rehabilitation teams.BMC Health Services Research, 10(1), 1– 15.
Smith, T., McNeil, K., Mitchell, R., Boyle, B., & Ries, N. (2019). A study of macro-, meso- and micro-barriers and enablers affecting extended scopes of practice: The case of rural nurse practitioners in Australia.BMC Nursing, 18(1), 1– 12.
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