Category: Emergency Department

Introduction

Emergency care and medical services are offered to play an important role in the life of every person, who is in need of professional medical help. The way how emergency care is offered in special rooms may define the quality of life and even the future of human life. As a rule, all emergency departments have to follow a particular triage system based on which medical workers can gain control over patient crowds and improve the emergency care in regards to the level of care urgency (Melon, 2012). Patients are usually directed to a special registration clerk to identify what kind of help and what kind of a doctor is necessary in a particular case. This is why the concept of Emergency Room (ER) triage has to be properly analyzed, its characteristics need to be identified, and the description of the process should explain its worthiness and importance.

Such researchers like Endacott, Cooper, Sheaff, Padmore and Blakely (2010) underline the importance of triage reinstatement in the sphere of nursing management, and Saghafian, Hopp, Desmond, and Oyen (2011) explain that an American triage system has to be improved by the ability to collect the most crucial information in a short period of time and determine the methods of the information usage.

Aims and Purposes

The current paper aims at providing a conceptual analysis of ER triage, defining its meaning and characteristics, and explaining how a particular ER triage system can work under a number of circumstances. The purpose of the work is to develop the understanding of the concept of ER triage and offer a model case that demonstrates how triage is tied to the other medical processes organized in the Emergency Room.

Significance to Nursing

According to Rodgers and Knafl (2000), concept analysis helps to develop the knowledge basis about nursing and the services that have to be offered by nurses. ER triage is the process that predetermines a number of further activities that have to be done by nurses, this is why it is so important for nursing and medical care in general. With the help of ER triage, nurses become aware of what services should be offered and to what patients they have to pay their attention at first. It may happen that the presence of one patient may lead to the development of health problems among the other patients. In this case, evacuation may be needed. A patient may be in need of some urgent palliative care, and ER triage can underline such importance. In fact, triage helps both, the medical staff and patients to achieve the best outcomes of medical care.

Definition of Concept

Triage is a French word that means to sort (trier) (Saghafian et al., 2011). Many researchers offer their own ideas of how to define the triage concept using different conditions at different periods of time. For example, in the Oxford English Dictionary (OED), there is no definite explanation of what ER triage actually means. However, it is possible to find how the dictionary defines the concepts of emergency room and triage separately and unites them to comprehend what ER triage can mean. In the OED, the emergency room is defined as a hospital department that provides immediate treatment for patients with injuries and pain or a casualty department; triage is explained in two ways: as (1) the process of sorting in regards to the quality or (2) the evaluation of levels of urgency in regards to illnesses or injuries to choose the most appropriate order and method of treatment. The combination of such common definitions helps to create the following explanation of the ER triage concept that can be applied in nursing: Emergency Room triage is a process of sorting and prioritizing patients in regards to the level of their injuries in order to choose the most appropriate treatment and address the necessary doctor.

However, the OED is not the only source that can be used to define triage. There are many researchers, who make successful attempts to elaborate triages characteristics and explain how and why the process under organization is organized. For example, Saghafian et al. (2011) define triage as the process that is organized by means of streaming or prioritizing information about patients, and North (2004) underlines the fact that any kind of development in hospitals requires certain financial support, this is why ER triage is considered to be an important financial concept that cannot be neglected. Melon (2012) introduces ER triage as one of the most crucial interfaces for patients, who enter the existing care system, that aim at determining access to diagnosis and intervention. Aacharya, Gastmans, and Denier (2011) offer an ethical understanding of ER triage: it is identified as a classic example of distributive justice, which addresses the question of how benefits and burdens should be distributed within a population (p. 2).

All these definitions of the same concept turn out to be a unique opportunity to understand what ER triage is and how it should be evaluated by society. Nurses and other medical staff are not the only ones, who should know about triage.

Defining Characteristics

The identification of the characteristics that are associated with the concept of ER triage has to be based on the appropriateness of these characteristics to the purpose of the concepts exploration. Taking into consideration this principle, the following characteristics of Emergency Room triage can be identified:

1. ER triage is usually performed by a qualified registered nurse;
2. ER triage is the process that helps to organize an acceptance of patients;
3. ER triage promotes sorting patients in regards to their health problems and conditions;
4. ER triage requires from nurses the following qualities:

Good communication skills:

1. General awareness about illnesses;
2. Abilities to define the level of injury within a short period of time;
3. Abilities to make fast and thoughtful decisions;
4. Knowledge about behavior in stressful or urgent situations;
5. Understanding of cultural/ethical/racial concerns.

ER triage requires the necessity to improve overall education in the sphere of nursing:

1. ER triage is the process that depends on the current technological progress.

ER triage may be of different levels:

1. Urgent;
2. Less/non urgent;
3. Resuscitative
4. Emergent.

ER triage is the process that consists of several steps:

1. General evaluation of a patient and situation;
2. History of a patient;
3. Physical analysis of a patient;
4. Decision.

ER triage presupposes the ability to act in accordance with a number of factors:

1. Weather;
2. Electricity;
3. Communicative means;
4. Availability of a necessary doctor.

ER triage requires constant improvements in regards to patient needs and expectations.

All these characteristics define a quality of the ER triage process, its effectiveness, and necessity in nursing management and the work of a hospital in general.

Model Case

Mr. Ballot is a white 35-year old driver of a limousine driver, who is admitted to a hospital in a result of an accidental crash caused by poor weather conditions. He has serious injuries on his body because of the inability to gain control over the car as soon as a black man appears on the road. His breath is stable, still, he loses his consciousness several times.

A registered nurse, Mrs. Curly, has to accept this patient. She is able to evaluate the whole situation, take into consideration weather conditions and a threat of power outages, and even chooses a white doctor in order to avoid possible personal reactions of Mr. Ballot on the black doctor due to the recent accident. During the ER triage process, she also considers the history of the patient, discovers that she has an allergy to certain sedative and soporific drugs, informs the doctor, and informs his family about the accident. Mrs. Curly looks confident and even calm completing all these steps. She also asks Mr. Ballot about his conditions from time to time not to make him get unconscious again. Within a short period of time, the doctor comes to the patient and starts treatment on the basis of the information offered by Mrs. Curly in a printed form.

In this case, Mrs. Curly demonstrates the qualities, necessary for an ER triage nurse. She stays calm and reacts on any change properly. She also considers the possible changes of weather and the possibility of problems with electricity, so, she prints all information and makes it available to the doctor anyway. The case follows certain attributes of the concept under analysis as the triage process is organized in accordance with the patients condition and his personal history. The story shows how Emergency Room triage works and influences the work of other departments in the hospital.

References

Aacharya, R.P., Gastmas, C., & Denier, Y. (2011). Emergency department triage: An ethical analysis. BMC Emergency Medicine, 11(16), 1-13.

Endacott, R., Cooper, S., Sheaff, R., Padmore, J., & Blakely, G. (2010, June 26). Improving emergency care pathways: an action research approach. Emergency Medicine Journal, 28(3), 203-207.

Melon, K.A. (2012). Inside triage: The social organization of emergency nursing work. University of Calgary Theses. Web.

North, L. (2004). Mind the gap in see and treat. Emergency Nurse, 11(10), 16-18.

Rodgers, B.L. & Knafl, K.A. (2000). Concept development in nursing: Foundations, techniques, and applications. London: Saunders.

Saghafian, S., Hopp, W.J., Desmond, J.S., & Oyen, M.P. (2011). Complexity-based triage: A tool for improving patient safety and operational efficiency. Michigan Ross School of Business. Web.

Introduction

Emergency rooms have been incorporated in healthcare establishments as preliminary management stage for sicknesses and wounds. Persons with convoluted medical conditions were generally admitted into emergency rooms departments of the healthcare organizations.

The casualty units in healthcare institutions served as admission places for severely hurting patients. Emergency rooms were intended to serve patients twenty four hours a day and all week long. Based on emergency rooms work intensity, resources availability was considered prime. Equipments that were utilized in casualty department functions were suitably planned. The functional magnitude of emergency rooms in healthcare institutions prompted establishment of an industry.

Apparatus that assisted emergency room staff in their work had to be developed, thus, an equipment trade was created. Modern emergency rooms operations have been restricted by socio-economic factors. Functional hurdles have been experienced in most hospital casualty departments. The operational complexities were linked to patients and hospital’s financial constraints. Patients that visited healthcare emergency rooms demanded quality care at reduced prices.

On the other hand, costs of healthcare emergency room equipments were relatively high. A cost-benefit dilemma of providing healthcare in emergency rooms impacted negatively to healthcare provision. However, efforts that developed a cost friendly environment for emergency room patients were later constituted.

Healthcare provisions reforms were revised at the national level in the United States that curbed medical care costs. The American legislators sought to provide laws that streamlined healthcare cost and increased affordability of patient services. The proposed state law reforms had a direct effect on the emergency room equipments industry. This report sought to establish the profitability of emergency room equipments industry.

Literature Review

The global society had realized the need for an integrated healthcare provision industry. A major area of wellbeing services provision that required transformation was on the technological aspect. Equipments attached to healthcare services were thought to be critical in patient wellbeing provision.

Healthcare apparatus, in an emergency room, were categorized into different groups. Equipments ranged from diagnosis, administrative, therapeutic, and care apparatus among others. Technology advancements were necessitated by the increased demand for quality healthcare services.

American administration legislators valued the probability of a wellbeing data proficiency novelty. The creativity skills measures were aimed at persons concern and abridged charges. Medical health experts proposed that creativity in wellbeing data proficiency would be significant in update and development of healthcare structure (Nolan, 2009 p. 1).

Based on an augmented insist of quality healthcare, the medical care industry was compelled to establish avenues that provided excellent wellbeing services. Development of novel equipments was necessitated by the demand for quality healthcare. In the same way, the emergency room equipments industry sprung up to meet the enlarged order.

Multiple medical services sections benefited from the increased expansion of technology into healthcare provision (Nolan, 2009 p. 1). Patient diagnosis, medical health information, and therapy equipments were distinct sections of technological advancements. Entrepreneurs invested in development of emergency room equipments to equal the stipulated demand for medical care services. Emergency room equipment production and creativity resulted into an increased supply of apparatus.

Consequently, an amplified contention was created among emergency room equipment entrepreneurs. A large number of manufactures and traders invested in the casualty department equipments industry. Business effectiveness of trade in the emergency room equipment industry must have, probably, been impacted negatively. Increased equipments supply competition must have, possibly, reduced profitability of the trade (Mallon, 2003 p. 1).

Despite the demand for emergency room equipment, an equally high reaction was witnessed from apparatus supply entrepreneurs. Attraction to deliver emergency room equipments increased the supply curve hence, reduction in sales and prosperity. The economic principle of supply and demand impacted on the equipments purchased prices.

In recent decades, proficient manufactures have increased production of equipments that offered assistance to medical services providers. Individuals have been allowed access to healthcare data for personal benefit. Information on human wellbeing could be posted on an internet website for public knowledge. Majority of the web pages provided links to physicians and patients were able to contact a general practitioner (Nolan, 2009 p. 1). Information has been regarded as a critical aspect for decision making.

Having medical patient’s accessibility to health information provided them with facts about an ailment or health condition readily. Internet technology served as an avenue for physicians and medical patients to interact freely and privately. An increased provision of medical information and facts impacted profitability of the medical care industry. However, increased medical information created more demand for emergency room services hence; more casualty department equipments were required.

Individuals, generally, have discovered that healthcare information benefited them. A large majority of eight out of ten people have browsed the internet for medical health data. Wellbeing associated websites have re-established how medical patients exist with never-ending conditions (Nolan, 2009 p. 2).

Technological advancements assisted physicians and patients to access medical data readily. Supplies of information and constant updates ensured the equipment industry remained profitable. A knock on effect might have possibly occurred when more information was made available to medical patients. Facts on a medical condition might have compelled a patient to seek emergency room services hence; prosperity in the emergency equipments industry.

Generally, emergency equipment industry success, largely, depended on demand for urgent situation services. Technology advancements on several spheres elevated medical patient insight into wellbeing. Patients recognized a need for wellbeing despite a perceived healthy status.

A demand for medical services was created and, consequently, the need lifted emergency equipment industry profitability. A purchaser strength based on price was created in the increased supply situation. A spirited contention was developed among equipment delivery entrepreneurs, abridged product charges, and condensed prosperity. Trade dangers of fresh competitors and alternate inventions might work to benefit the industry.

Discussion

This report discovered that emergency room equipment industry was directly linked to medical patient’s demand for urgent situation medical services. An increased demand for emergency room services resulted in need for equipments. However, increased need for emergency room apparatus attracted more equipments suppliers. Consequently, supplies outstripped demand for emergency room services.

Purchasers force on cost of emergency room equipments was created by the increased supply of the apparatus. In a domino effect competition, cut charges, and diminished profitability resulted in an unsuccessful venture. Nevertheless, similar technological advancements created a new demand.

Medical information accessibility twisted a demand for emergency room services. The report realized that health fact made available to individuals prompted them to seek medical services. A large number of individuals sought for health related information from the internet.

The report deduced that from the awareness a demand for wellbeing services was developed by individuals. Therefore, expertise incorporation into the medical care industry equipped the industrial growth once again. Medical patient’s demand for emergency room services resulted into claim for equipment and, consequently, the process led to increased profitability in the equipments industry.

Analysis of the emergency room equipments industry revealed that the business can be profitable. The technological advancements in the casualty healthcare departments have been increased; therefore, augmented demand for healthcare services might be certain. The supplier power effect might possibly control the market. In addition, the purchaser power that lowered prices could possibly have been cushioned by increased demand.

Lucrative nature of the emergency room equipments industry might have attracted numerous competitors. Furthermore, technological improvements might have grown steadily. However, the emergency room equipments industry appeared to progress in a sustained business trend. The industry seemed to have a system that created its own demand. Probabilities of increased areas for technology progression were available based on the latest trends.

The report discovered that the emergency room equipment industry was dynamic and could possibly develop into a novel industry. The determinant factors that shape an industry worked to benefit the trade. The report analyzed potential industry threats and discovered that the dangers could probably work out as benefits. In the end, this report concluded that emergency room equipments industry was profitable and can be considered in an entrepreneurship venture.

Conclusion

The emergency room equipments industry was realized as a beneficial trade. The industry generated its own demand and equally met the claims. Medical patients were discovered to shun emergency room services based on costs. More so, medical patients demanded quality wellbeing services from the health care providers. Ultimately, it was discovered that the emergency room equipments industry could create demand and meet the needs. The unique aspect made the equipments industry to stand out as a lucrative venture.

Works Cited

Mallon, Chris. Porter’s Five Forces Analysis. articlesfactory. 2003. Web.

Nolan, Sean. Health care: It’s time for technology. Entrepreneur Corner. 2009. Web.

Introduction

An emergency department in a hospital is an important source of healthcare in the United States of America. Although there are few emergency departments, many people prefer seeking medical attention from them (Baker & Baker, 2014). Nonurgent emergency visits refer to visits for circumstances for which a postponement of many hours would not increase the chances of an unfavourable outcome (Baker & Baker, 2014).

Many studies conducted have demonstrated that many (30%) emergency visits in the United States of America are nonurgent conditions (Baker & Baker, 2014). It would be important to indicate that care should be taken because the visits have adverse effects. For example, they could result in an increase in healthcare expenditure and superfluous testing and treatment. As a result, there would be a lack of a longitudinal relationship of emergency department visits with those of primary care physicians (Weinick, Burns & Mehrotra, 2010).

Therefore, it is vital for governments to come up with intervention measures to discourage non-urgent visits (Baker & Baker, 2014). This paper focuses on discussing the effects of nonurgent emergency visits on hospital organizations using three articles. In addition, it summarizes the findings, discusses the impacts of the variables on administration, and describes how administrators would manage and monitor the variables. It is important to indicate that it concentrates on financial data and numbers, including in-flows and out-flows.

Articles

Weinick and colleagues (2010) conducted a study to investigate effects of nonurgent emergency room visits on hospitals. The researchers demonstrated that nonurgent emergency visits contributed to gratuitous testing and treatment in hospitals. The researchers found that most people prefer emergency department because they do not access other types of healthcare services (Weinick et al., 2010).

This motivates those with minor illness, such as strains and fractures, to visit EDs because most of them have medical covers and insurance companies pay for them. According to Weinick and colleagues (2010), 26% cases of the patients who visit EDs are insured, while 17% cases of the healthcare consumers are not insured. They concluded that most of the emergency cases could be handled in retail clinics or urgent care centers.

Despite the fact that retail clinics and urgent care centers are less costly for similar services, many patients prefer EDs (Weinick et al., 2010). The researchers estimated that RC and UCC cost $279 and $414 less than EDs. They stated that if nonurgent cases would be taken to RC and UCC, national healthcare spending would save $4.4 more billion every year. Thus, the in-flow in the EDs is less than out-flows (Weinick et al., 2010). This implies that hospitals’ managements should look for alternative sources of funds to run health centers effectively.

Another study was conducted by Ruger, Lewis and Richter (2006) in the United States of America. The researchers focused on determining costs implications of ED visits on hospitals and its impacts on the administration (Ruger et al., 2006). The researchers indicated that the costs varied because it was determined by the length of stay in the ED. The researchers cited that patients who visited EDs once spent $793.12 in all departments compared with those who paid $2360.80 for 20 visits (Ruger et al., 2006).

They also indicated that the in-flow was more than out-flow, and this strained EDs, implying that they could not cater for the large number of patients. They estimated the in-flow to be 20% less than out-flow (Ruger et al., 2006). However, the researchers concluded that, it was vital for hospitals’ administration to scrutinize patients thoroughly because those that were thought to over utilize the EDs insignificantly were sicker than those that were thought to be sick according to the findings (Ruger et al., 2006). They advised that hospitals’ administration should continue with investigations to improve the health status of the population and reduce the ED over-utilization (Ruger et al., 2006).

Mistry, Brousseau and Alessandrini (2008) carried out an investigation to examine the impacts of nonurgent cases in EDs on hospitals. In fact, they visited many EDs, RC, and UCC to find out how the situations were on the ground. The researchers found that EDs in hospitals were overcrowded, and the resources were over-utilized (Mistry et al., 2008). This was evidenced by the large number of patients who were in the EDs. According to the researchers, a significant number (75%) of the patients’ hospital bills was paid by insurance company, and the large number of patients were employed.

They estimated that in-flow in hospitals was $759, while out-flow was $1049 every thirty days (Mistry et al., 2008). Arguably, the out-flow figure is worrying. It indicates that hospital organizations are straining to meet the patients’ needs. In addition, hospital resources were inadequate, and this worsened the situation. This is for the reason that there are a few EDs beds in hospitals, making it a challenge for those who have genuine cases.

It is significant to point out that, the hospital administration is struggling to cater for the huge number of patients. With regard to congestion in hospitals, the researchers cited that it was as result of many nonurgent room visits, which could be handled in retail centers and urgent care centers (Mistry et al., 2008). Mistry and colleagues (2008) advised hospitals’ administrators to come up with policies to make healthcare services affordable and accessible to every citizen. This is for the reason that patients prefer EDs due to the fact that there is no queuing and one is attended to even before he or she pays (Mistry et al., 2008).

Impacts of variables on the administration

The huge difference in variables, i. e., between the in-flows and out-flows in EDs in hospitals’ administration has effects on the administration of hospitals. Notably, what patients in EDs pay is less than what the hospitals’ managements spend. For example, in-flow is estimated to be $759, while out-flow is approximately 1049 every thirty days as aforementioned (Baker & Baker, 2014).

It is imperative to note that there is higher expenditure in EDs than other sources of medical healthcare services. As a result, the administration strains to reduce expenditures in other areas to cater for the patients in nonurgent emergency room visits, yet, they could not be serious cases (Mistry et al., 2008). It also forces hospital management to work for more hours to ensure that every sick person is tested and treated (Baker & Baker, 2014). Furthermore, hospitals’ managements are required to employ many medical practitioners to sustain the huge number of patients.

How an administrator would monitor the variables

It is crucial for hospital’s administration to plan and prepare in advance to cater for health status of patients. Mistry and colleagues (2008) contend that administrators should multi-disciplinary so that they can distinguish between real cases that are emergency from those that are fake. Policymakers should ensure that reforms are introduced in the healthcare sector to reduce congestion. Other sources of healthcare services should be given attention and be equipped with enough health equipment so that nonurgent emergency cases can be handled (Baker & Baker, 2014).

With regard to limited medical practitioners, more of them should be employed. In addition, hospital administration should set aside funds for handling emergencies. For example, constructing ambulatory to deal with severe cases. Patients should also be provided with alternatives beside the EDs (Baker & Baker, 2014). Options would include improving primary healthcare to reduce the number of patients who would be visiting the EDs. Piloting should be done to investigate the effectiveness and efficiency of the EDs in hospitals (Baker & Baker, 2014; Mistry et al., 2008).

Conclusion

In conclusion, quality healthcare is important for every citizen. It is also the right of every individual to access good healthcare. Nonurgent emergency room visits cases have increased for the last five years as indicated by the above studies. The cases have made EDs congested and have strained the few medical practitioners. Despite the fact that most patients visiting emergency rooms do not have urgent issues, sick people should be provided with alternatives for their health status to be promoted. A lot emphasis should be put on EDs in hospitals to improve the hospital environment. Moreover, more of money is spent on EDs compared with other departments in the health industry. Therefore, it is vital for different organs that are involved in the running of hospitals to play their roles correctly so that issues relating to nonurgent in emergency room visits would be handled.

References

Baker, J. J., & Baker, R. W. (2014). Health care finance: basic tools for nonfinancial managers (4th ed.). Burlington, MA: Jones and Bartlett Learning.

Mistry, R. D., Brousseau, D. C., & Alessandrini, E. A. (2008). Urgency classification methods for emergency department visits: do they measure up?. Pediatric emergency care, 24(12), 870-874.

Ruger, J. P., Lewis, L., & Richter, C. (2006). Analysis of Costs, Length of Stay, and Utilization of Emergency Department Services By Frequent Users: Implications for Health Policy. Academic Emergency Medicine, 13(8), 879-885.

Weinick, R. M., Burns, R. M., & Mehrotra, A. (2010). Many emergency department visits could be managed at urgent care centers and retail clinics. Health Affairs, 29(9), 1630-1636.

Abstract

This paper issues an analysis of best practices for promoting flow, minimizing wait times, and optimizing the quality of care of patients in the emergency department. This paper discusses the problems linked to long waiting times in the emergency department. This paper will show that crowding, long wait times as well as poor conditions in the waiting room compromise the quality of the patient satisfaction.

This study begins by investigating the relationship between patient satisfaction and wait times. Best practices towards minimizing wait times are identified. The objective of this research is to identify the varied approaches that healthcare providers can use to minimize waiting times. The literature review provides a proposal to act as a guide for the National Health Care Reform in the United States. This article proposes the Emergency Medical Treatment and Active Labor Act (EMTALA) as a useful framework for lowering the costs of healthcare and improving patient care. The last section focuses on the implications of the study and provides an analysis of learned lessons.

Time frame

The search for related sources took one month.

Introduction

Patients in a hospital expect that their medical needs will be addressed thoroughly since it has been an assumption that health is the number one priority of hospitals. However, even if the hospitals would like to address these needs thoroughly, they have been limited due to their resources and some other factors like inefficiency in the reception of patients. Such inefficiencies in receiving patients would be more detrimental if this is true for the emergency room department.

In a bid to minimize waiting time in emergency rooms, it is imperative to highlight and understand the factors that contribute to delays. A delay may come because of the absence of a specialist. A majority of the medical professionals specialize in specific areas. Thus, the absence of a specialist that can handle a certain health condition may lead to a patient spending a lot of time in the emergency room.

In the United States, emergency physicians are always available to handle different cases. Nevertheless, medical specialists like cardiologists, neurosurgeons, and orthopedic surgeons are summoned in the case of an emergency. Thus, a patient might be forced to wait while the emergency physicians try to reach the available specialist. Many patients who visit emergency rooms end up being admitted. Inpatient, services are a major cause of the increase in waiting time in the emergency rooms. Medical practitioners monitor the admitted patients regularly. Thus, they do not get adequate time to attend to the incoming patients resulting in overcrowding. Indeed, patients wait for approximately four hours in the emergency rooms in the United States. Handling the factors that contribute to increasing waiting time in emergency rooms can go a long way towards reducing delays and enhancing service delivery.

The majority of the hospitals in the United States have managed to reduce waiting times. For instance, at Queens Hospital in New York, the waiting time has gone down from 146 minutes to 60 minutes over two years. This decline is largely attributable to the emergence of online booking services since they assist in predicting the number of patients expected in a particular day. Despite the progress, the level of patient satisfaction is still low.

Most patients continue to complain that they do not receive emergency services on time. On average, in most hospitals across the U.S, patients wait for at least 45 minutes before they receive emergency services (Atkinson, 2009). Thus, it is the focus of this paper to address the long waiting times in the respective emergency room departments of hospitals. The paper will discuss the possible measures that can be taken to mitigate the problem.

Background Information

Overcrowding of patients in the hospital’s emergence departments is an emerging threat to patient health and the health sector globally. Ding et al. (2010, 819) define crowding as “a condition in which the determined need for intervention services overwhelms the available resources for patient care in the emergency room”. In today’s changing scenario of health care, emergence rooms are not only a source of care for the sick, but they also act as a rescue point to offer care to patients regardless of their capability to pay. The emergency rooms have been seen as convenient compared to family doctors due to poor timely appointments.

This factor has led to a substantial increase in the number of patients visiting the emergency rooms. There are many causes of crowding most of which are related to the availability of resources, patients perception about emergency services, and response from other hospital departments. Consequently, the concerned institutions have focused on improving the patient experience.

Emergency room wait times is a prevalent concern across the globe with report emanating from all corners about escalating capacity and prolonged wait times for patients. With the increasing rate of crowding in the emergency rooms, the U.S government sought to understand the factors that influenced patient care, and identify major practices that could be adopted in the emergency divisions. Since it seems there may be no perfect solutions available to this complex situation, an increase in waiting time will lead to a high mortality rate since most patients leave the emergency rooms without being treated (Prakash, 2010). This paper will conduct a systematic literature review to understand patients experience concerning waiting times.

Statement of Research Problem or Purpose of the Proposed Research

Medical practitioners cannot minimize waiting times in the emergency rooms if they do not understand the factors that contribute to the delay. Addressing factors like the absence of specialists and coming up with a proper triage can go a long way towards minimizing waiting time in emergency rooms. The objective of this research is to identify the varied approaches that healthcare providers can use to minimize waiting times. Delays in the emergency room may result in fatalities or complications. A majority of the patients that visit the emergency rooms are normally on the verge of losing their life. Apart from identifying how health practitioners can minimize waiting times in emergency rooms, the research also seeks to identify the dangers of spending a lot of time in the waiting room.

A patient’s wait time begins as he/she enters an emergency department and extends until the patient is assessed and admitted or discharged. The factors leading to long queues vary depending on each emergency department. The patient’s visit comprise of various steps or services that are termed as patient flow. These services involve triage, registration, assessment, consultations, and treatment. Therefore, a delay in one or two of these steps lengthens the patient’s stay and can lead to loopholes in the emergency department. Research by Crow et al. (2002) suggests that activities outside the hospital often influence the emergency department wait period.

These effects include things such as how fast and effective in-patient beds are vacated and prepared for the next patient to occupy. Additionally, the order and time taken to assess a patient vary on the urgency of the patient’s condition. However, these dynamics have caused confusion and inefficiency within the emergency department (Ding et al., 2010). Therefore, this paper seeks to address these issues and generate an effective formula to minimize the wait time that a patient needs to spend before a physician attends to him.

Research Methodology

This study conducted a comprehensive search of relevant literature to identify many scientific articles related to the issues of emergency department and crowding. This review utilized the Goldschmidt’s Information Synthesis as a conceptual framework for the literature review. This research identified thirty references but only ten studies were found most suitable because they had undergone peer review.

This review used Medline, PubMed, ProQuest, and EBSCOhost databases to search for relevant sources. The key words included patient satisfaction, emergency rooms, wait times, patient flow, and EMTALA. The search for related sources took one month. The inclusion criteria considered original peer-reviewed articles and published in English. This study excluded articles that did not tackle issues of the emergency department. This study consulted two colleagues to review the selected topics and abstracts for the relevance of the article. The information is readily available and of good quality because it has undergone peer assessment. This secondary information is used to clarify the research questions by comparing data from various sources. This secondary method offers answers to the uncertainties and narrows down the subject hence creating a basis for future research.

Patient Satisfaction as Proxy Gauge of Healthcare Quality

Society with functioning or healthy citizens is ideal to attain the maximum potential for development in many fields and aspects such as labor work and services. In response, many institutions, including private and public institutions, have been created to make sure that the poor health of the society does not hinder development. Hospitals are one of these primary institutions among many that ensure that the citizens are healthy, and they must continue to operate effectively to provide necessary healthcare (Crow et al., 2002).

There are many requirements imposed on a hospital to continue operating. One of these requirements includes the overall well-being of an outgoing patient. No hospital would continue operating when most of their patients continue to suffer from bad health despite the efforts that were made. An inability to make patients better will render the primary goals of hospitals to make citizens productive and healthy moot. Likewise, the improvement of their patients serves as a gauge for the measurement of the quality of health care that hospitals provide (Crow et al., 2002).

Aside from the overall well-being of a patient, patient satisfaction is also an important gauge for the measurement of the quality of the healthcare that hospitals provide. This is because “patient satisfaction does not only reflect the mood of the patients but also on their retention, clinical outcomes, and medical malpractice claims” (Crow et al., 2002, p. 48). Moreover, if the patient satisfaction proved to below, it may affect the hospital even if they provide an effective patient-centered delivery of excellent healthcare.

Unsatisfied patients tend to be more problematic as hospitals may be using up all their time and efforts in disproving their malpractice claims. Likewise, no hospital would continue to operate if most of their patients were not satisfied despite their healthcare quality (Prakash, 2010). In summary, a hospital must satisfy their patients to keep on providing healthcare services and focus on improving the healthcare services they provide.

Reducing Waiting Time in Emergency Rooms to keep Patients Satisfied

After establishing the relevance of patient satisfaction, it is essential to devise schemes that will see to it that patients that respective hospitals serve will be satisfied. In a report released by the Institute of Medicine in 2001, “they set forth six goals for quality health care system patient safety: (a) equitable, (b) safe, (c) evidence-based, (d) efficient, (e) timely; and (f) patient-centered” (Ding et al., 2010, p. 817). Being efficient, timely and patient-centered were said to influence patient satisfaction. Moreover, timeliness is important when dealing with patients, especially in emergencies. If time is not an issue and patients can wait since their concern is not urgent, patients usually set appointments; however, from time to time they require immediate attention that emergency rooms promised to provide. Moreover, if a hospital fails to address emergencies because of time constraints, it is no doubt that no patient will be satisfied, and their health will be put into jeopardy.

Simple measurement of waiting time of the patients in the emergency room cannot provide a conclusive data for since many factors in the emergency departments need to be taken into account. Therefore, using Quantile Regression model can be of huge benefit in estimating the service completion experience of the patients (Arya et al., 2013). After extracting information about the time spent in emergency rooms as well as other important information about the patients, Quantile regression is used to evaluate the service given by the hospital staff members through the amount of time that the regular and new patients have spent in the emergency room.

Quantile Regression is used so that the 10^th, 50^th, and 90^th percentiles of each of the service times of the different types and levels of healthcare provided in the emergency are estimated room. The different Quantile Regression obtained based on the data are then compared and put into observation. From the observation and data provided, mathematical models of different service times will be formed. This method is expected to produce highly accurate results as opposed to the current methods regarding the patients’ experience in the emergency rooms (Ding et al., 2010).

Efforts Done to Minimize Waiting Time in the Emergency Rooms

Many hospital management teams did several efforts to address the problem involving waiting time in the emergency rooms of the hospitals. Some hospitals now provide online booking services for their emergency rooms through an application that can be downloaded online. Patients can schedule appointments regarding the urgencies just by paying the right amount of charge. However, many debate this kind of proposal. This is because time is vital in emergencies, and if emergency slots are reserved, then the importance of time will not be valued and such cases will not be emergency anymore (Sadick, 2014).

As the emergency slots become less as many books them, patients with more urgent needs that walk right into the emergency rooms that have failed to make their reservations will more likely be neglected as a result.

The importance of a minimized waiting time, especially in emergency rooms to guarantee patient safety has been emphasized by many hospitals. In response to this, many hospitals in the United States have embarked on campaigns to improve services in their emergency departments. As part of their effort to make the institution successful, they advertise their waiting time, which proves to be inaccurate at certain times. Accuracy is hard to attain because emergencies cannot be planned for since they occur unexpectedly. Some emergencies are intense than others and may require much time compared to less intense situations. When the advertised wait times are exceeded, patients become agitated and lose trust in such organizations (Ding et al., 2010).

It has also been reported that one of the greatest concern to patients is their long door-to-doctor waiting times (Eller, 2009). Seeing that the inflow of patients greatly affects a hospital’s standard emergency room wait time it is important to focus on the inflow of patients among many other factors. To manage this, emergency departments, doctors and hospital management have devised strategies to cope effectively with the increasing flow of incoming patients to prevent overcrowding and increase patient satisfaction. One strategy to reduce the waiting time for patients is the triage-driven bed placement.

This strategy minimizes the wait time for patients by taking patients directly to areas where they will be given immediate treatment after triage and a “mini” registration. This mini registration, unlike the most common registration practices, asks minimal necessary information like their social security number, name, and age. Complete information is later asked once the patient had settled down. Asking minimal information proves that a hospital’s priority is not gathering insurance information but to take care of its patients. This strategy improves the wait times for patients and demonstrates a hospital’s ability to cater to one’s health needs. In turn, greatly increase the satisfaction of patients (Karpiel, 2004).

Another method used to manage patient inflow is the use of Split Emergency Severity Index 3 Patient Flow Model, or simply Split 3. Patients are distinguished based on the level of acuity and utilization. Patients assigned at levels 1 and 2 require more medical attention and emergency response is severely needed, which includes diagnosis and other preliminary tests. This is because patients in levels 1 and 2 have unstable vital signs and prolonging their wait time will have serious repercussions. Patients assigned at levels 3, 4 and 5, on the other hand, relatively require less attention as their vital signs are relatively stable compared to those at levels 1 and 2.

They are considered less acute and can be responded to and treated with quick analysis, such as an immediate check-up. This strategy allows a more customized and more capable process by reducing wait times and increasing the responsiveness to patients about their needs. Aside from that, it also reduces the accumulation of patients in the emergency room. This strategy, among its many benefits, had been proven to increase patient satisfaction (Arya et al., 2013).

Aside from advocating and promoting certain medical reform and categorizing patients by their needs, most emergency departments are now are training their staff on management skills. Likewise, these tools and principles from production companies had been used to assess better the processes that have proven to be ineffective and flawed. Toyota Production System uses LEAN in its manufacturing process and it has delivered quality cars that are produced in a timely and efficient manner.

This methodology, LEAN, improve process efficiency by reducing wastes or parts of the operation that do not contribute to making the process efficient. This methodology may be applied in a hospital setting by relying on hospital staff and management in identifying the said wastes. They identify the waste by observing the wait time, registration, triage, and physician time. Through the identification of the wastes that aggravate the whole process, standardization may be achieved. Besides, quality service that promotes patient satisfaction may also be guaranteed (Eller, 2009).

From a basic knowledge and understanding of the matter at hand, the literature review must be directed towards specific goals. Thus, research questions that need to be addressed had been formulated. The following are some of the research questions that the research seeks to address:

1. What problems does a longer waiting time in the emergency room pose?
2. How can waiting times in emergency rooms in the hospital minimized?

Literature Review Findings

The studies used in this research are credible based on the analysis given on the summary table.

A Proposal for Jump-Starting National Health Care Reform

The study by Atkinson (2009) sought to persuade everyone, including politicians, policymakers, the medical community, and patients to believe that reforms in medical operations, particularly in Emergency Medical Treatment and Active Labor Act (EMTALA) will lower the costs of healthcare and improve patient care. Ideally, this author defines EMTALA and other available reforms that were implemented.

EMTALA was enacted to address emergencies and requires hospitals to provide a proper medical screening exam to anyone who walks in with emergency health concerns. Without the said medical screening, the hospital cannot issue the transfer of a patient to another hospital or facility that can address the issue better (Atkinson, 2009). EMTALA fails to provide guidelines for how a hospital should perform the medical screening exam and what constitutes an appropriate exam.

Thus, EMTALA promotes confusion when trying to address emergency health concerns (Atkinson, 2009). This consequently results in a longer medical screening examination that lengthens the patients’ waiting time and reduces patient satisfaction (Atkinson, 2009). To address this, Atkinson (2009) suggested that the Congress make reforms to EMTALA. This is to give hospitals the flexibility to triage patients with not so emergencies and refer them within the shortest time possible to assure their satisfaction and safety.

This scholarly work, specifically the new Emergency Medical Services, may be used by most of the hospitals to address their long and inefficient waiting time that may lead to more serious implications. However, the work lacks substance as it failed to present data that may support the aforementioned claims (Crow et al., 2002). An extensive review of related literature that focuses on minimizing the wait times of emergency departments in hospitals and patient satisfaction could be done to strengthen one’s claims. Thus, this research will try to supplement this work by selecting works that could contribute to the understanding of the operations of emergency departments and the current reforms that are proposed to address issues of longer wait times in patients.

What problems does a longer waiting time in the emergency room pose?

Long wait times hurt patient outcomes, and they increase the risk of death (Jouriles, Simon, Griffin, Williams, & Haller, 2013). In some instances, patients may become tired of waiting and opt to leave hospital premises without receiving a diagnosis. Even though emergency departments are working tirelessly to ensure the most urgent patients are prioritized and that all patients are attended within the shortest duration possible, the strategy seems lacking, and the resources of the emergency room are overwhelmed. Consequently, patients may wait dangerously for a long period and even risk losing a life before the diagnosis is administered.

Due to long wait times, overcrowding has become the norm of the emergency room. When emergency rooms hit such a saturation level that they can longer receive patients, they end up diverting patients to other hospitals. Such diversions cause life-threatening delays in care. According to Sadick (2014), about 17% of hospitals in the U.S reported that their emergency rooms were over-utilized hence compromising the quality of care. For instance, this author indicates that in 2007 alone, 200 emergency physicians confessed that they had witnessed patients die while waiting for inpatient services.

Due to overcrowding in emergency rooms, the process of care is compromised, and quality deteriorates. Doctors tend to respond to long queues by issuing quick services that might lead to staff error and lead to quality decline. Spending limited time with patients may ease the congestion, but crucial tests may be omitted, and arrangements for follow-up after discharge may be ignored. Medical errors include issuing medications at the wrong dosage and frequencies.

This insufficiency may lead to increased cases of readmission of patients who have been diagnosed in a rush. According to Prakash (2010), the mortality rate increases with increasing waiting time and ambulance diversion contributed to increased cases of mortality. Due to longer wait times, the cost of care is likely to increase incredibly. Long wait times translate to overcrowding. When there is overcrowding, emergency departments respond by diverting ambulances to other hospitals. When this happens, further expenses are incurred, and budgets are distorted. Due to long wait times, minor cases end have into complex medical cases.

How can waiting times in emergency rooms in the hospital minimized?

Every emergency department varies and attends to a unique patient population. Regardless of these variations, the emergency departments are faced with similar problems that lead to long waiting times. However, some of the common solutions to minimize the wait time are discussed below. Emergency rooms wait time can be minimized through the appropriate use of the available resources. Availability of resources such as capital, labor, and infrastructure are the common claims quoted by most of the administrators in the emergency departments. However, the number and kind of staff coupled with how they are tasked should be consistent with the numbers and timing of when patients are expected to the clinics.

The physical setting of an emergency room should be organized in a way that optimizes the number of patients seen. The layout should allow ease of movement within the premises. Moreover, equipment and supplies should be stored appropriately to reduce the time spent by staff when attending to patients (Jouriles et al., 2013).

While seeking to reduce the wait time in the emergency rooms, it is essential to consider what happens in other departments and even outside the hospital. Hospitals that concentrate only on the activities of the emergency room to minimize wait times might not be successful. Other hospital departments such as the laboratory and X-ray sections should be assessed to review how they prioritize patients in a bid to realign their programs to meet the demands of the emergency room.

In most cases, laboratory performance leads to delay in treatment leading to poor patient care particularly in high capacity patient care units. Similarly, the staff should not focus much on the urgent and critical patients to an extent of neglecting the needs of the moderate and less urgent patients. Thus, it is recommendable to balance the response rate for both cases bearing in mind that extending the wait time for moderate and less urgent patients would lead to a more complicated situation (Karpiel, 2004).

In most hospitals across the United States, it has been noted that the emergency departments are replacing the services that would conveniently be offered in the home-based programs by family physicians. Developing community-based alternatives to emergency room care, such as emergency care centers can substantially ease the burden of patient flooding to an emergency facility (Eller, 2009). The limitation with this approach is that patients tend to be reluctant to be referred to family doctors since they feel they can get better specialists and assessment of their situations by visiting emergency departments. Therefore, it is essential to provide educational programs to educate people regarding the importance of seeking alternative care rather than flooding to the emergency departments where the services are limited.

Real-time observation and the measuring of the time spent by patients before they are attended as well as issues leading to longer waiting should be noted and acted upon to eliminate them. Currently, in the U.S, most of the emergency departments are recording such data, but less action is been taken to implement changes that target limiting wait time. However, according to Jouriles et al. (2013), hospitals in the U.S are advertising emergency room wait times on social media and billboards to lure patients. Unfortunately, this report identifies that patients end up being disappointed when they find out the real-time spent in the emergency rooms exceeds the time advertised.

These authors gathered data from various emergency departments including Akron, Ohio. This study established that posted wait times were shorter compared to real wait times at all facilities on covered. Jouriles et al. (2013) concluded that many hospitals were advertising emergency room wait times to grow market share. Besides, since patients form the group that is most affected by longer wait times, it is advisable to listen to them and incorporate them in dialogues about the wait time for successful outcomes.

Strategies to minimize wait times

In a bid to fully address the above issues and minimize wait times, this paper formulates a plan that consists of five goals. The first goal entails increasing the efficiency of higher capacity emergency rooms. Enhancing how an emergency division responds might not necessarily need more funds or additional resources. Thus, the goal should be on alleviating the obstacles that block or delay patient flow (Sadick, 2014).

Each emergency department has unique needs, and intervention measures have to be tailored to consider this fact. For instance, every emergency department addresses staffing issues based on the number of expected patients and levels of patient urgency. In this scenario, the main objective should be to ensure effective staff scheduling, supportive environment and policies, and swift flow of patients. In a bid to maximize proficiency in high capacity emergency rooms, the way staff is assigned, and the roles physicians take must be addressed. Staffing procedures must be consistent with patient numbers and urgency. Skill mix should be factored to ensure that the appropriate staff members are available to cater to the demands of the patients (Sadick, 2014).

Effectiveness can depend on other indicators apart from staffing. Various hospital policies have manifested adverse effects on emergency room wait times in the past (Mowen, Licata, & McPhail, 1993). Such policies include discharge policy concerning when a practitioner makes discharge orders. Most of these policies are inconsistent with the current needs of the emergency department. Therefore, these policies need to be highlighted, reviewed, and improved to match the emergency department requirements. The physical and social environment of the emergency department can also adversely influence efficiency. Good working conditions can foster efficacy and eliminate wait times (Mowen et al., 1993).

Ensuring that large numbers of moderate urgent patients are dealt with swiftly and effectively can minimize emergency room congestion (Atkinson, 2009). Since this group of patients might not need in-patient services, unutilized spaces should be designed to cater to their needs. Front-line emergency room personnel should be trained in efficacy development to minimize wait times in the emergency rooms. Further reviews should be conducted to identify more training needs.

The second goal entails facilitating access to community-based health care services. The community-based programs should foothold the effective use of emergency services. A huge number of patients seek services of an emergency room because they lack personal doctors, or they are not capable of finding such services elsewhere. Consequently, high numbers of moderate urgent patients cause congestion in an emergency room and cause longer wait times. A 2003 report issued by the Government Accounting Office identified that about 86% of patients who visited emergency rooms were grouped as less urgency (Karpiel, 2004). Conventionally, the assumption has been that minimizing or rechanneling the number of non-urgent patients would not substantially cut demands on an emergency. However, the current study by Sadick (2014) challenges this assertion by showing that community-oriented alternatives to the emergency rooms lower the number of patients who show up there.

According to Arya et al. (2013), to fulfill this goal, the plan has three main objectives. First, facilitate access to family physicians. Some patients turn to emergency departments because their family doctors may not be available to offer timely services. Besides, most family doctors do not provide services past working hours or on weekends. Consequently, patients lack alternative but to visit an emergency department even when they experience mild illness.

The appropriate action should involve providing incentives to family doctors to raise the frequency of evening and weekend services. Second, facilitate campaigns to encourage patients to seek alternative care services since they can be of more value as opposed to waiting in emergency rooms and increasing chances of poor quality care. Many patients may be not aware that community-based services are well equipped to address their health demands. Third, holding admitted patients who are unable to clear their bills is a factor leading to emergency room overcrowding. However, policy reforms should target effective means of addressing cases of bill clearance and abandon the traditional way of holding patients.

The third goal entails the use of the Spilt Emergency Severity Index 3 Patient Flow Model. This procedure separates high severity patients from low severity patients when determining the duration spend with a doctor. The essence of splitting patients concerning their urgency is to offer more customized and efficient services (Arya et al., 2013). This study indicated that less urgent patients required fewer resources and rarely needed significant doctor’s attention.

On the other hand, patients that are more urgently needed much attention from doctors. The split strategy ensures that each staff is accountable for a particular stage of operation to enhance the smooth flow of patients. For instance, the split system adopted a flow model that entails quick registration based on the main complaints. Arya et al. (2013) established that a split strategy accounted for 9% to 18% reduction in wait times. Moreover, this approach signaled patient satisfaction because improved flow influenced not only the quantity but also the quality of care. This approach is highly recommendable for emergency departments encountering prolonged stay for low, moderate, and high urgency patients. This approach has reduced pressure on emergency departments experiencing in-patient constraints but has enough space to allow segmentation.

Managerial policies

Management represents a link between other departments and collaboration within a department. The management determines how the emergency department fits into the entire health sector. Managerial policies are viewed to have both positive and adverse effects on wait times depending on how they are applied. Some of the managerial policies that influence emergency rooms wait times include bonus payments, quality staffing, team working, and appropriate communication channel.

According to Thiedke (2007), team working in emergency departments is formed when a major issue arises in the department and then disintegrates when the situation is handled. This study further identified that when bonuses are paid against the performance, wait times improved concerning all other measures apart from the wait for inpatient beds. Appropriate communication channel facilitates quick access to information.

Summary and Discussion

Ten articles were selected for this study. These studies offer strong and reliable findings since they are peer-reviewed. Most of the studies were consistent about the factors that cause long wait times in the emergency rooms. A study by Jouriles et al. (2013) indicated that inaccuracy on posted waiting times is influenced by the flow of incoming patients among many other factors. Thus, it is more likely that hospitals with emergency departments, which see 2,000 or fewer patients per month, have more accurate posted waiting time than hospitals with emergency departments that sees 5,000 or more patients per month.

Furthermore, despite the increased efforts to ensure efficiency in the health sector, research suggests that there are no national agreed-upon standards for wait time in the US’ emergency divisions. In most hospitals, there is a lack of emergency division’s wait time data and the information available is often inconsistent. This inconsistency limits the ability to reference and plan appropriately. The available data indicates that more urgent patients are attended quickly while the less critical patients may end up waiting for a longer time than they should (Arya et al., 2013). This approach might not help solve the problem but rather increase crowding in the emergency rooms. Promoting community-based clinics can be a suitable way to ease congestion in the emergency rooms. Therefore, realizing the factors that lead to wait times forms the basis for addressing the issue.

Table 1 below shows patient satisfaction scores for the period running from 2004 to 2007. The table shows that patient satisfaction scores went up slightly and started to show consistency after the intervention. Between April 2004 and March 2005, the Table shows that the average monthly score was recorded at 79.8%, as well as attained the governmental benchmark of 85% for five months of the year (Jouriles et al. 2013).

The table below implies that reducing emergency department delays has been inconsistent over the three years of study. However, to ensure consistency in patient satisfaction based on reduced wait times, it is essential to ensure the emergency department operates effectively. Jouriles et al. (2013) posit that such inconsistency was due to the introduction of new sets of staff members during weekends and night shifts. Health care providers who do not have sufficient knowledge about the working procedures end up working on a catch-up basis. Consequently, before they can adapt, the emergency department found itself overwhelmed by the workload.

Implications

However, reducing wait times is essential to ensure that services are improved in all areas of operation. Most hospitals in the U.S have attained strong, desirable outcomes by implementing split strategies described earlier. However, research has found that it is often hard to sustain these changes. According to Thiedke (2007), the best way to instill and sustain these changes is through continued learning and effective communication. Medical staff will be more willing to adopt change if they believe that the model’s primary objective is to promote patient care by limiting wait times.

Proper communication channel may help eliminate misconceptions that changes are meant to save money or monitor the staff. If employees are guided to think in this line, it is highly likely that they will embrace change. Additionally, communicating with the staff regularly is important to ensure that the message becomes an organizational culture. Education and training are also necessary to ensure that staff members are in a position to group patients according to their needs and urgency. Since this program might be a new approach in many hospitals, the department must clearly explain its new operational roles.

Lessons learned

Based on the analysis, managing patient expectations at the emergency department is the basis for their satisfaction. Even though this study shows the need for more staff and training, innovative solutions are viewed to be very essential in reducing waiting time. For instance, bedside registration is an approach that can significantly reduce wait times by creating space in the triage section. Innovating staffing models by engaging nurse practitioners or physicians as part of the emergency department team has benefits on patient satisfaction and patient flow. When seeking to redesign the emergency room it is necessary to consider the diversity of patients and their stress level. LEAN methods are also seen as effective in improving emergency department effectiveness, particularly in the triage section.

Conclusion

Promoting general access to the health care sector should be a priority for the government of any state. Currently, the state and national authorities in the U.S have teamed to minimize wait times in emergency rooms. The aforementioned strategies are evidence of this devotion and offer an action plan for the objectives to be met. Actions that maximize efficiency in an emergency room and reduce wait times have been explored.

Nonetheless, with the Affordable Care Act among other health reforms expected to widen the healthcare scope to more Americans, the emergency room congestion may persist. Therefore, policymakers should address emergency room congestion as a public health priority. Ideally, the implementation of the earlier mentioned goals can assist to reduce the wait times in the emergency rooms. However, the accomplishment of these goals depends on the cooperation of top executives, policymakers, staff members, other hospital divisions, as well as professionals who have vast experience with emergency room process improvement.

References

Arya, R., Wei, G., Mccoy, J., Crane, J., Ohman-Strickland, P., & Eisenstein, R. (2013). Decreasing length of stay in the emergency department with a split emergency severity index 3 patient flow model. Academic Emergency Medicine, 23(2), 1171-1179. Web.

Atkinson, W. (2009). A proposal for jump-starting national health care reform. North Carolina Institute of Medicine, 70(4), 141-153. Web.

Crow, R., Gage, H., Hampson, S., Hart, J., Kimber, A., Storey, L., & Thomas, H. (2002). The measurement of satisfaction with healthcare: Implications for practice from a systematic review of literature. Health Technology Assessment, 6(32), 23-58. Web.

Ding, R., Mccarthy, M., Desmond, J., Lee, J., Aronsky, D., & Zeger, S. (2010). Characterizing waiting room time, treatment time, and boarding time in the emergency department using quantile regression. Academic Emergency Medicine, 13(4), 813-823. Web.

Eller, A. (2009). Rapid assessment and disposition: Applying LEAN in the Emergency Department. Journal for Healthcare Quality, 1(2), 17-22. Web.

Jouriles, N., Simon, E., Griffin, P., Williams, C., & Haller, N. (2013). Posted emergency department wait times are not always accurate. Academic Emergency Medicine, 17(4), 421-423. Web.

Karpiel, M. (2004). Improving emergency department flow. Healthcare Executive, 23(2), 35-61. Web.

Mowen, J., Licata, J., & McPhail, J. (1993). Waiting in the emergency room: how to improve patient satisfaction. Journal of Health Care Marketing, 2(1), 76-81. Web.

Prakash, B. (2010). Patient satisfaction. Journal of Cutaneous and Aesthetic Surgery, 3(3), 151-155. Web.

Sadick, B. (2014). No wait at the emergency room. U.S. News Digital Weekly, 6(4), 23. Web.

Thiedke, C. (2007). What do we really know about patient satisfaction? Family Practice Management, 14(1), 33-36. Web.

The time that patients spend in Emergency Department (ED) without receiving the assistance or being transferred to the other department is usually prolonged, and it is a challenge for ED administrators and nurses who need to organize the effective process of the patient data exchange between departments. When the ED does not use the standardized procedure of filling in and sharing nursing reports, the risk of handoff mistakes increases significantly (Peterson, Gurses, & Regan, 2014). Risks are also associated with patient walkouts because of the long wait times (Love, Murphy, Lietz, & Jordan, 2012).

The problem of the significant patient length of stay in ED is also observed in Lincoln Medical & Mental Health Center, and it can be addressed with the help of applying the appropriate handoff protocols to make the process of exchanging the data standardized and efficient, using phone call handoffs, assigning a provider in triage, and implementing a super track procedure. The purpose of this paper is to describe the problem of prolonged patient stays in the ED of Lincoln Medical & Mental Health Center, identify groups of stakeholders, discuss the project conceptualization, concentrate on the nurse’s and leader’s roles and responsibilities, analyze outcomes, and explain the project’s significance.

Foundational Work

Issue and Context

The issue of crowding in EDs is discussed as typical of healthcare facilities providing the emergency services. The capacity of the nurse staff and practitioners is usually lower than it is necessary to address the problem (Hsia, Asch, Weiss, Zingmond, & Gabayan, 2013).

As a result, the time of patients’ stay in ED increases significantly, leading to delays in diagnosing and transferring, the patients’ dissatisfaction, problems associated with the patient safety, and even decreases in the quality of provided services (Meisel, Shea, Peacock, Dickinson, & Paciotti, 2015). Delays are observed due to an inappropriate reference to the phone call hand off procedure, problems in assigning IP beds, and issues associated with transportation (Pearce & McCarry, 2014).

In order to improve the process of working with patients in ED, administrators implement protocols that are directed to make the procedure easier, assign providers in triage (PIT), and launch super track processes. These initiatives are viewed as potentially leading to reducing the length of patients’ stay and addressing a range of associated throughput issues such as the poor quality and delays in the service provision.

For this project, the issue of patients’ staying in ED is researched in the context of Lincoln Medical & Mental Health Center. This center has recently started the project oriented to the ED transformation, and the reduction of patient length of stay is one of its goals. The implementation of initiatives to address the issue is at the final stage, and it is important to evaluate the effectiveness of using patient handoff protocols and PIT and super track processes as the ways to resolve the problem and focus on the most advantageous strategy to be used in the center.

Stakeholders

The main stakeholders associated with the project implementation are nurses, ED administrators and authorities, physicians, patients, and the community. According to Esbenshade (2015), the improvement of the procedure of filling in and sharing the information between nurses and other practitioners affects the work process of nurses and physicians directly. The outcomes, possible errors, and other implications can be assessed and resolved by ED administrators and authorities. They are also responsible for the project organization and development. Patients and the community are directly influenced by changes in the procedures of working with clients in ED. This initiative is expected to lead to reducing stay times and increasing the care delivery.

Most affected populations

Elder persons, people having problems with insurance, children, and non-English speakers are most affected by the prolonged stay times in ED and the ineffective data exchange procedure (Sun, Hsia, Weiss, Zingmond, & Liang, 2013). Elder people and children suffer from the necessity to stay in ED without the provided assistance most significantly. People having problems with insurance also cannot receive the answer regarding the possibility of the help or the actual care during a long period of time. Non-English speakers stay in ED without the help because they cannot provide the nurse with the information about their problems or the disease and family history. Thus, the factors that make these people vulnerable are age, economics, education, and language among other ones.

Other affected groups

The issue also influences such groups as relatives. In many cases, patients in ED stay with their relatives, and they cannot leave their family members till the transference occurs, or care is delivered. In this case, the meaningful factors include culture, age, language, and job position because they can prevent relatives from the effective interaction with nurses (Choi, Tsai, McGillivray, Amedee, & Sarafin, 2014).

Project Conceptualization

Theoretical framework

The theory that provides the background and framework for the problem discussion and the initiative implementation is Ida Jean Orlando’s theory of a nursing process. The main concepts of this theory that guide the intervention implementation and project are the patient’s need for help, the immediacy of the provided help, and the appropriateness of the nurse’s action (Arora, 2015).

According to Orlando’s theory, the patients come to healthcare facilities with a certain problem, and time and quality of interactions between a patient and a nurse directly affect their experience. Another important aspect is the appropriateness of the nurse’s action because she should make an effective decision while addressing each case (Arora, 2015). In this project, it is possible to observe the lack of immediacy and the importance to improve the nurse’s action in terms of reacting to patients’ needs and exchanging the information.

It is also important to concentrate on definitions of key terms and concepts related to the research. The key concepts used in the project are the ‘length of patient stay’, ‘handoff protocol’, ‘no-delay report’, ‘provider in triage (PIT)’, and ‘super track procedure’. In the context of ED, the ‘length of patient stay’ can be defined as the time during which patients cannot leave the ED and be transferred to the other department or hospital (Meisel et al., 2015).

The terms ‘handoff protocol’ and ‘no-delay report’ are used in the project to identify the standardized protocol that is used by nurses to exchange the information regarding the patient’s state and handoff recommendations (Wentworth, Diggins, Bartel, Johnson, & Hale, 2012). The ‘provider in triage’ is a nurse or physician who completes the initial assessment of patients who are identified as requiring the immediate care (Love et al., 2012). The ‘super track’ is a procedure of completing the quick assessment of a patient before finishing all registration procedures (Pearce & McCarry, 2014).

Outcomes

The first outcome of the project is the presentation of an analysis of available interventions to address the problem of a long patient stay in the ED of Lincoln Medical & Mental Health Center. The report provides the information on advantages and disadvantages of traditional and innovative approaches to administering and exchanging the patient data and ways of conducting patient assessments. The other outcome is the provision of a detailed PowerPoint Presentation including the assessment of using handoff protocols, PIT, and super track in the center to address the problem of delays.

The final outcome is the formulated recommendations to improve the procedures based on observations, interviews, documentation and patient data analysis and assessment. The effectiveness of using procedures is assessed in the context of Lincoln Medical & Mental Health Center, and the numerical and qualitative data on changes in the length of patients’ stay are provided. Baker and Esbenshade (2015) note that the focus on both quantitative and qualitative data is important to collect the objective and detailed information.

Solution

The current project provides an effective solution to the problem in terms of supporting the necessity of using handoff protocols, phone call handoffs, PIT, and super track procedures in the ED of Lincoln Medical & Mental Health Center with references to the evidence and analysis of quantitative and qualitative data. In addition to protocols, nurses often use traditional face-to-face communication channels or phones, admission and feedback reports, written or typed reports on the patient’s assessment, and computer technologies to upload reports in the system (Starmer et al., 2014).

However, the risk of errors using such reports and the time required to fill and exchange them are significant, and the application of technology-based handoff protocols is the most efficient measure to reduce stay times in ED, address delays, and increase the quality of the provided care. PIT allows avoiding patients’ walkouts, and a super track procedure guarantees immediate assessments of the appropriate quality.

Project Implementation

Nurses’ Role and Responsibility

Role and responsibility

In spite of the fact that problems of exchanging the patient data between nurses and conducting on-time assessments are often discussed as issues to resolve by administrators, they are within the nurses’ area of focus and control. The nurse’s task is to provide the assessment and care to all patients in the ED without delays and share the information with other nurses (Cornell, Gervis, Yates, & Vardaman, 2013).

If this procedure does not work effectively, it influences the speed and quality of the provided care. In this context, nurses are responsible for discussing the issues with the leader and make efforts to improve the situation because of such professional, social, and ethical considerations as the necessity to provide the high-quality care in time and avoid crowding in ED. If the required patient data is not administered and shared effectively and handoff errors are observed, this situation involves ethical and legal aspects of providing services of the poor quality (Eberhardt, 2014). Patients can leave EDs without any adequate assistance. The nurse’s responsibility in this case is to guarantee that the accurate assessments were conducted, the data were shared, and the patient length of stay was decreased to the possible minimum.

Support

It is important to note that the project supports the nurse professional standards of practice directly because it aims at identifying the tool that can guarantee the increases in the efficiency of the activities performed by nurses in ED. The aspect of excellence in relation to the nursing practice means that medical errors are avoided, and the provided treatment and care are appropriate and based on the exchanged data.

However, the problem is in the fact that the handoff procedure is usually associated with administration and medical errors. Thus, the focus on the effectiveness of technology-based handoff protocols addresses the question of the quality of nurses’ activities in ED directly (Peterson et al., 2014). Moreover, the effective realization of the PIT and super track principles is possible only while involving other healthcare providers. In addition, the connection of the project with principles of the patient-centered care is also obvious because the attention to patients guarantees the provision of the high-quality care and accurate data in protocols to ensure the on-time delivery of services.

Project Leadership

Role and responsibility

As a leader, a researcher conducting the evaluation of initiatives in ED is responsible for cooperating with nurse leaders and ED administrators whose duties are to develop and implement changes in Lincoln Medical & Mental Health Center. It is important to organize the collection of the data, consult administrators regarding the goals and objectives of their changes, and communicate with the nurse staff in order to assess the actual alternations in their work progress that are associated with the implementation of the handoffs, PIT, and super track procedures(Wentworth et al., 2012).

While performing as a leader and an evaluator, it is necessary to pay attention to standards of communication followed in the ED and certain criteria that are used to determine whether the time for care delivery is appropriate and whether the procedures were completed effectively. All details in the work of nurses are important to be taken into account. In addition, the cooperation with the project mentor and ED administrators is important to understand what recommendations can be most advantageous for this organization.

Strategies

In order to collect and assess the necessary information and data on the regular number of patients in the ED of Lincoln Medical & Mental Health Center and the initiatives proposed to be implemented in order to address the delays problem and the process of implementing SBAR (Situation, Background, Assessment, Recommendation) reports, PIT, and super track procedures, it is important to use certain strategies.

They are also important to evaluate the first outcomes, strengths, and weaknesses of the procedures to reduce the length of the patient’s waiting time. They include the use of appropriate data collection tools; the regular communication with the mentor, ED administrators, the nurse staff, and patients; the leadership strategy (Sharif & Scandura, 2014). If the importance of using the effective data collection tools is obvious, it is significant to accentuate the roles of communication and leadership strategies to implement the project as it is necessary to state the personal credibility as a researcher, a leader, and an evaluator who can objectively assess the change initiatives to address the problem and propose the best option supported by the logical and helpful recommendations.

Systems

The systems that are important to promote the effective organizational change include the professional networks within the organizations and the computerized systems guaranteeing the effective exchange of the information. While implementing the initiatives in ED, it is important to communicate their significance and usefulness to the nurse staff, provide the necessary training, and encourage the active sharing of opinions regarding the change (Baker & Esbenshade, 2015).

While using the nurse networks for the communication and analyzing the technological systems used for the initiative realization, it is possible to conduct the efficient evaluation of the change outcomes in order to state what actual positive achievements can be observed regarding the patient stay in ED after using handoff protocols and proposed procedures to reduce delays.

Outcomes and Significance

Achievement of Outcomes

The actual outcomes of the project are the report, presentation, and recommendations to follow while using handoff protocols, the PIT process, and super track procedures in the ED of Lincoln Medical & Mental Health Center. However, for the purpose of the project, the following assessment criteria were identified in order to evaluate the outcomes associated with the implementation of initiatives in the working process of ED in the center: documented decreases in the length of patient stay; documented increases in the speed of interacting with patients in ED and the speed of procedures; decreases in the patient dissatisfaction; improvements in the communication and exchange of data between nurses; increases in the patient assessment rates; decreases in the number of errors; decreases in patient walkouts.

The data analysis demonstrated the positive changes documented according to the identified criteria. Due to the implementation of handoff SBAR protocols, the average time of the patient stay in ED decreased by almost 50% when the number of patients remained to be stable. The admission and handoff processes associated with the use of technology-based protocols improved, and the efficiency increased by more than 30%. The PIT decreased the wait time by 35%.

The super track decreased the wait time by ten times. The improvements associated with the patient satisfaction were stated by more than 80% of respondents who emphasized the decrease in the wait time and improvement of the nurse-patient interaction and care. This project came to the end with the prepared report and recommendations to support the further development of initiatives in order to reduce the waiting time in ED of the center and address the needs of the larger population without errors. It is possible to state that the proposed initiatives are effective to overcome all the inefficiencies that are associated with the provision of the immediate care for patients in ED.

The unanticipated outcomes associated with the project include the increase of the nurses’ interest in using SBAR protocols, PIT, and super track procedures in order to conclude about their effectiveness independently. The reason is that the administration of the center encourages sharing opinions to improve the initiative and guarantee the effective organizational change. According to Sun et al. (2013), this aspect is important to demonstrate the positive attitude of the staff to the organizational changes.

Influencing Factors

Nursing judgment

The nursing judgment as the ability to evaluate the situation as a nurse is directly associated with achieving the outcomes of the project. While understanding the necessity of improving the procedure of performing admission, conducting assessments, and exchanging the data effectively, nurses are interested in using the proposed tools efficiently.

In addition, the interviews indicate that nurses perceive no-delay reports and proposed procedures as effective techniques to provide the patient-centered care when all the data are recorded accurately and shared with other nurses without mistakes while reducing the possibility of further medical errors and when all necessary assessments are made in time. From the perspective of a researcher, the nursing judgment is important to evaluate the actual outcomes of using the implemented procedures while recognizing objectives of their implementation in ED (Meisel et al., 2015). The nursing judgment allows making reliable and evidence-based conclusions.

Knowledge and skills

The completion of the project and the achievement of set goals became possible as a result of the knowledge gained in the sphere of nursing theory and practice, the focus on principles of the patient-centered care, and the analysis of strategies to improve the nursing process. The skills in areas of critical thinking, decision-making, problem-solving, professional communication, teamwork, and cooperation developed during the graduate program are also helpful to organize the research process, build relationships with the staff, and achieve the project goals. Critical thinking and communication skills were most important to conduct the evaluation of the initiative (Starmer et al., 2014).

Such professional values as respect, accountability, and confidentiality contribute to the effective communication with both nurses and patients on the outcomes of the procedures implementation.

Significance

Organization and stakeholders

The completed project has a direct impact on the administration of the work in ED and exchange of the data between the departments of Lincoln Medical & Mental Health Center. This project also has the practical implications for stakeholders as the principles of patient assessment and recording the patient’s data changed. As a result, decreases in delays in data sharing between the departments were addressed, and the quality of the professional interaction increased. Moreover, the project allowed nurses to concentrate on the tools that they could use in order to work with patients and share handoff reports more quickly.

Currently, Lincoln Medical & Mental Health Center is shifting from the pilot stage in implementing such changes as the use of SBAR handoff protocols, the PIT process, and the super track procedure to the final stage of changing the whole process of communicating the admission, conducting assessments, and completing the handoff data in the center. Many organizations do not realize the appropriateness of changing the process of working in ED and avoid referring to the PIT process and the super track procedure. However, the results of this project demonstrate that these initiatives provide stakeholders with significant outcomes.

Nursing and healthcare implications

The significance of the project for the community is in the possibility to receive the high-quality care without delays and possible mistakes influencing treatments (Cornell et al., 2013; Peterson et al., 2014). The reduced length of the patient stay in ED associated with the use of protocols and super track procedures leads to using the time for admitting, assessing, and transferring patients more efficiently. This approach contributes to the improvement of the healthcare delivery in the community, the increased health status, and the effective use of human and material resources by Lincoln Medical & Mental Health Center.

Personal significance

The project allows developing not only professional skills, but it also contributes to expanding the area of interest in the nursing research and practice. The project is important to demonstrate how the theory-based strategies and innovative tools can be applied to the practice of nurses and how it is possible to add to the project realization performing as a leader, an investigator, and an evaluator. The knowledge and skills received during the project implementation can contribute to the researcher’s further education, selection of the research area, and practice.

Conclusion

The problem addressed with the help of the project is the prolonged times of staying in ED. If patients do not receive the necessary care in time, and the absence of control over the situation is observed, the lack of effective measures can lead to crowding in ED and the patient dissatisfaction, as well as the low quality of care. Patient handoff protocols or no-delay reports are discussed as one of the effective interventions to be used in EDs in order to address the identified throughput problems. ED administrators, nurses, and patients are most interested in the positive outcomes of using SBAR reports and protocols.

The other approaches include the assignment of providers in triage for EDs and the implementation of the super track procedure for the quick and high-quality assessment of patients. These approaches are supported by Orlando’s theory of a nursing process. The actual outcomes of the project are the selection of the most effective initiatives, decreases in the time of patient staying in ED, and increases in the speed and quality of admission, handoff procedures, and assessments with the following provision of the diagnosis and treatment. The significance of these outcomes is the possibility to address the patients’ needs and contribute to the community’s health status.

References

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Cornell, P., Gervis, M. T., Yates, L., & Vardaman, J. M. (2013). Improving shift report focus and consistency with the situation, background, assessment, recommendation protocol. Journal of Nursing Administration, 43(7), 422-428.

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Hsia, R. Y., Asch, S. M., Weiss, R. E., Zingmond, D., & Gabayan, G. (2013). Is emergency department crowding associated with increased “bounceback” admissions? Medical Care, 51(11), 1008-1014.

Love, R. A., Murphy, J. A., Lietz, T. E., & Jordan, K. S. (2012). The effectiveness of a provider in triage in the emergency department: A quality improvement initiative to improve patient flow. Advanced Emergency Nursing Journal, 34(1), 65-74.

Meisel, Z. F., Shea, J. A., Peacock, N. J., Dickinson, E. T., & Paciotti, B. (2015). Optimizing the patient handoff between emergency medical services and the emergency department. Annals of Emergency Medicine, 65(3), 310-317.

Pearce, I. S., & McCarry, N. (2014). Let’s chat: Bedside reporting in the ED. Nursing, 44(8), 15-17.

Peterson, S. M., Gurses, A. P., & Regan, L. (2014). Resident to resident handoffs in the emergency department: An observational study. The Journal of Emergency Medicine, 47(5), 573-579.

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Starmer, A. J., Spector, N. D., Srivastava, R., West, D. C., Rosenbluth, G., Allen, A. D.,… & Lipsitz, S. R. (2014). Changes in medical errors after implementation of a handoff program. New England Journal of Medicine, 371(19), 1803-1812.

Sun, B. C., Hsia, R. Y., Weiss, R. E., Zingmond, D., & Liang, L. J. (2013). Effect of emergency department crowding on outcomes of admitted patients. Annals of Emergency Medicine, 61(6), 605-611.

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Introduction

Leadership and management tend to be regarded as distinct but related phenomena. The latter is typically concerned with the organization of the workflow (its planning, implementation, and control) while the former is usually related to the development and change, which is fuelled by enabling, motivating, and inspiring people (Algahtani, 2014). These definitions suit the nursing perspective of leadership and management (Wong, Cummings, & Ducharme, 2013). Apart from that, nursing leadership is closely connected to advocacy, in which case nurse leaders work to improve the healthcare and wellbeing of their community by developing, advocating for, and implementing health-related policies (Haycock-Stuart & Kean, 2013; Vaismoradi, Bondas, Salsali, Jasper, & Turunen, 2012). One of the nursing roles that are closely related to leadership and management is that of the head nurse of an Emergency Department (ED), and the present paper is devoted to its investigation.

In Australia, as well as other countries (Crossan & Shacklock, 2013), nurses are a major part of the healthcare workforce that is crucial for the community health (Duffield, Roche, Twigg, Williams, & Clarke, 2016, p. 2219). Apart from that, EDs are a significant element of modern healthcare that provides care for the injured and promotes the health of the community (Shoqirat, 2013). However, HNEDs are not just highly competent ED nurses; they also carry out managerial duties and take the role of the leader of their department. The combination of their detailed knowledge of the work of an ED nurse and the position of a manager and leader results in the ability of HNEDs to successfully manage the department and improve the performance of its nurses (Bamford, Wong, & Laschinger, 2013). In general, the role of an HNED is extremely extensive, which can result in noticeable occupational stress, but the education, training, and experience of the nurses help them to correspond to their numerous role requirements and provides HNED with the opportunity to contribute to the quality of ED care.

Role Scope

The scope of practice for a particular profession is “the full spectrum of roles, functions, responsibilities, activities and decision-making capacity that individuals within that profession are educated, competent and authorized to perform” (Nursing and Midwifery Board of Australia [NMBA], 2007, p. 1). The role of HNEDs is complex, but as healthcare managers, they have the primary purpose of ensuring the quality of care and patient safety in their department (Pegram, Grainger, Jones, & While, 2015). From the point of view of the enactment of the role of a manager, HNEDs are expected to organize and coordinate the work of their staff and perform planning and decision-making activities (Wang, Anthony, & Kuo, 2016). HNEDs also play a crucial role in enabling communication between their subordinates and superior managers; effective communication and cooperation, in turn, are very important for nursing settings (Walsh et al., 2015), including ED (Gilardi, Guglielmetti, & Pravettoni, 2013). Moreover, HNEDs are often involved in the organization of training for their unit to ensure that the knowledge of ED nurses is continually upgraded (Atakro, Ninnoni, Adatara, Gross, & Agbavor, 2016, p. 4). In certain cases, HNEDs can also be required to evaluate the performance of their staff and define the learning and organizational needs of their department (Wang et al., 2016, p. 43). As leaders, HNEDs enact their role when they work to motivate, inspire, and enable ED nurses to act and foster improvements in their department. Also, the role that nurses play from the point of view of advocacy, especially in the field of healthcare policy development and implementation, is applicable to HNEDs as nursing leaders (Haycock-Stuart & Kean, 2013).

Given the large scope of practice, the examples of HNED activities can be numerous. For instance, Zohar, Werber, Marom, Curlau, and Blondheim (2017) discuss in detail the messages that HNED can communicate to their nurses and also demonstrate that these messages can significantly affect the nurses’ behaviors. Similarly, Shirazi et al. (2015) consider nurse empowerment activities as a significant part of the HNED role. Also, workplace governance is directly connected to HNEDs since they are involved in multiple managerial and leadership-related activities as the key figures in the management of ED nurses (Wang et al., 2016).

With respect to leadership, it is noteworthy that a variety of styles and characteristics, which tend to have an influence on the effectiveness of leadership, can be adopted by HNEDs (Bamford et al., 2013; Shirazi et al., 2015; Vaismoradi et al., 2012). Also, the outcomes for the nurses can be affected by the leadership style; for instance, Laschinger, Wong, and Grau (2012) show that authentic empowering leadership helps to reduce emotional exhaustion in nurses. Finally, patient outcomes can also be affected by the leadership style; for example, Wong et al. (2013) show that transformational leadership tends to have this effect. Thus, HNEDs need to have some knowledge of the leadership and managerial tools that they can use.

The Regulation of Practice

The scope of HNEDs’ practice is rather extensive, which proves the significance of their roles while also calling for an equally extensive regulation. High-quality education, especially specialized education that specifically targets emergency nursing, is crucial for HNEDs (Atakro et al., 2016; Damkliang, Considine, Kent, & Street, 2015). Apparently, the experience is also very helpful, including professional and managerial or leadership experience; it can be regarded as an enabler that improves the quality of work of HNEDs as well as their confidence (Pegram et al., 2015, p. 325). Apart from that, there are formal requirements that HNEDs must take into account.

From the point of view of legal regulation, the practice of Australian HNED is guided by healthcare-related acts. A major act that is of significance for HNED is the Health Practitioner Regulation National Law Act (2009), which defines the general legislation for all health practitioners and includes important information on accreditation, registration, conduct, and other aspects of HNED work. Apart from that, the Act establishes the National Boards, which regulate specific health professions, and the Australian Health Practitioner Regulation Agency, which is a body that is supposed to support the Boards in a variety of ways (Health Practitioner Regulation National Law Act, 2009, pp. 83-84, 88-90). Of the Boards, the Nursing and Midwifery Board of Australia is responsible for determining standards for HNED education and practice. Also, the Health Workforce Australia can be mentioned as an organization that is busy with determining the needs and difficulties in healthcare workforce management in Australia and searching for policy-related means that can improve the situation (Buchan, Twigg, Dussault, Duffield, & Stone, 2015, pp. 164-165). Thus, the practice of HNEDs is predominantly regulated by general rather than role-specific legislation and organizations.

An Australian HNED is supposed to take into account the regulations, standards, and guidelines of the Nursing and Midwifery Board of Australia. In particular, the codes of ethics and professional conduct for the nurses of Australia that are provided by the Nursing and Midwifery Board of Australia [NMBA] (2008a; 2008b) are of importance for HNED. Apart from that, the organization establishes the standards of practice for nurses that are applicable to any area of practice, including ED (Nursing and Midwifery Board of Australia [NMBA], 2016b). These standards are continually updated to ensure the relevance of the requirements included in them (Nursing and Midwifery Board of Australia, 2016a). Finally, NMBA (2007) offers help for nurses in the form of tools that can improve practice. For example, NMBA (2007) has developed a national decision-making framework.

NMBA’s (2008b) Code of Professional Conduct contains ten principles that require safe, competent, respectful, standardized, legal, and ethical conduct. The Code of Ethics of NMBA (2008a) includes eight requirements that also promote ethical, impartial, culturally sensitive, and responsible care. The seven standards of NMBA (2016b) demand that registered nurses make their practice legally immaculate, evidence-based, planned, safe, high-quality, and culturally sensitive; nurses are also supposed to ensure their own safety and ability to provide care. Apart from that, Australian nurses are required to develop meaningful relationships with their patients and peers. Finally, the standards demand comprehensive assessments and the evaluation of outcomes, which should be used to improve practice. All these requirements are applicable to HNEDs.

To sum up, NMBA (2008b; 2016b) offers comprehensive but generalized requirements, which can indeed regulate the practice of HNEDs. From the two codes and the standards, it can be concluded that the Board demands evidence-based and patient-centered care. As a result, the values of safety, competency, respect, and ethical practice appear to be central to the role of HNED.

Role Benefits and Outcomes

HNEDs are very important for the improvement of the outcomes of care (Wang et al., 2016). A systematic review by Jennings, Clifford, Fox, O’Connell, and Gardner (2015) demonstrates that while the relationship between the performance of ED nurses and the cost efficiency of care cannot be detected, their work improves the quality of healthcare as well as the time of waiting, and, ultimately, the satisfaction of the clients. Apart from that, HNEDs have great clinical leadership potential, which helps them to improve the experiences of their subordinates and organize their units, improving their efficiency (Bamford et al., 2013).

As nurse leaders, HNEDs can facilitate and improve care through their capacity to develop the environment and atmosphere of safe care and the ability to integrate the activities of various healthcare providers (Vaismoradi et al., 2012). Zohar et al. (2017) show that the modification of head nurse messages can significantly improve the safety culture of their departments, leading to statistically relevant positive changes in safety and time climate as well as patient care. Naturally, these changes result in positive outcomes for patients and nurses.

Advocacy-related outcomes also seem to be of importance for patients, communities, and HNEDs themselves (Haycock-Stuart & Kean, 2013). However, Shoqirat (2013) points out that while ED nurses are being encouraged to contribute to community health promotion, the majority of them do not actually report being involved in the process or seeking to do so. In other words, while the role of HNEDs seems to require advocacy-related activities, it is not typically regarded as a primary or even significant aim.

In general, the outcomes of the role and related benefits are predominantly of use for patients as well as HNEDs’ subordinates. It is noteworthy that the stress of ED work can be significantly modified by successful managerial interventions (Adriaenssens, De Gucht, & Maes, 2013). Given the fact that HNEDs tend to be well-acquainted with the needs of ED nurses, they seem to be particularly capable of improving their experiences (Bamford et al., 2013). All these factors prove the significance of the role of HNEDs once again.

Role Experiences and Development Needs

The experiences of HNEDs are likely to vary across countries, but certain aspects of the role seem to be reported by nurses from various settings (Buchan et al., 2015; Crossan & Shacklock, 2013). For example, Atakro et al. (2016) report that in Ghana, ED nurses tend to experience understaffing, insufficient or ineffective training in certain areas of knowledge that they need to fulfill their role, and the lack of necessary resources (pp. 1, 4). The authors explain the issues by the lack of institutions that can offer quality emergency training to professionals in Africa. However, Pegram et al. (2015) survey nurses of the UK and discover that they also report training issues (their own and those of other staff members), resources shortage, and understaffing (pp. 318-319). The latter is classified as a particularly significant contributor to occupational stress by the respondents of the study by Pegram et al. (2015).

Understaffing is also characteristic of Australia, and it has been shown to decrease nurses’ ability to provide quality care (Duffield et al., 2016). Oostveen, Mathijssen, and Vermeulen (2015) point out that understaffing is an issue for the Netherlands as well, and they suggest that the key reason for the issue in developed countries is the rising demand for healthcare, which can be connected, among other things, to the aging population. It also apparently results in nurses being overworked (Kaddourah, Khalidi, Abu-Shaheen, & Al-Tannir, 2013). Oostveen et al. (2015) also point out that understaffing can be related to the lack of proper communication between managers and nurses where nurses’ opinions are overlooked. In this respect, the role HNEDs appears to become crucial as well since it is theoretically capable of improving communication between ED nurses and senior managers (Wang et al., 2016).

As a result, it appears that the mentioned issues are universal, even though the reasons for their existence may differ for countries with different levels of development, and they tend to result in a decreased quality of care. It is noteworthy that at least two of the mentioned issues seem to be acknowledged by the Australian government, including the Department of Health (2015). This fact can be supported by the governmental initiative “More doctors and nurses for Emergency Departments,” which was developed to improve the education of ED specialists in Australia to boost their numbers and quality of training (Department of Health, 2015, p. 51).

Concerning other experiences, ED nurses report the emotional strain and stress, which result from the specifics of the patients’ injuries, and the communication with the families of patients, which can lead to negative or positive situations (Atakro et al., 2016). There is also the possibility of the lack of support from subordinates, peers, or senior managers as well as the excessive pressure that results from the expectations of the surrounding people (Ericsson & Augustinsson, 2015; Pegram et al., 2015; Wang et al., 2016). Similarly, unsupportive environments can be an issue (Bamford et al., 2013). Moreover, nursing experiences are not isolated from global events; for example, the recent economic recession has resulted in difficulties with payments and employment (Buchan et al., 2015). Given the fact that HNEDs are often involved in staffing, scheduling, and training, these events are likely to result in multiple negative experiences for them, including personal and department-related ones.

The study by Pegram et al. (2015) also reports the possibility of positive experiences of manager nurses, which includes the feeling of being valued and accepted by coworkers (p. 325). It is apparent, however, that the investigation of negative experiences seems to prevail among the works that have been included in the current literature review. Still, the review cannot be regarded as perfectly representative, and the observation can be explained by the fact that the negative experiences of nurses are typically related to issues that require solutions. The cited works either attempt to point out the issues or search for their solutions, which are vitally important activities.

Educational and Job Satisfaction Needs

With respect to the needs of HNEDs, education and job satisfaction can be mentioned. Atakro et al. (2016) regard training at work as the most appropriate solution for the issue of insufficient training. Similarly, Damkliang et al. (2015) discuss educational interventions that can be applied to working ED nurses. Morphet, Kent, Plummer, and Considine (2016) also demonstrate that ED nurses can and should continue their education after graduation, and show that Australian nurses have multiple educational opportunities, many of which are provided by healthcare organizations. However, the availability of educational resources may vary for territories. Since communication skills are crucial for HNED (Gilardi et al., 2013; Wang et al., 2016), relevant training can also be regarded as a need. Also, Paganini et al. (2016) point out the significance of disaster preparedness for ED, including its nurses.

Job satisfaction is another important need for HNEDs as well as other nurses. This aspect of nurses’ work depends on multiple factors, including payment and other forms of recognition, schedule and other conditions of the work, relationships in the department and with other managers, and the availability of career and professional growth options (Crossan & Shacklock, 2013; Pegram et al., 2015). Apart from that, job satisfaction is affected by the negative experiences discussed above and the occupational stress considered below. Thus, the mechanisms of improving job satisfaction for HNEDs seem to be apparent.

Role Strengths and Weaknesses

When compared to other nurses, HNEDs have more autonomy and a greater opportunity to make a difference, which is rarely a possibility for regular nurses (Kaddourah et al., 2013; Oostveen et al., 2015). This feature of the role can be regarded as a significant strength, which can be used to achieve the desired outcomes at the level of ED or the community. However, the present analysis seems to indicate that current researchers are predominantly interested in the topic of issues that are related to the role. This observation can be explained by the fact that the studies are apparently aimed at resolving these issues, but the resulting report may seem to be rather one-sided as a result. Still, the present study allows to state that occupational stress is a complex and significant weakness of the role of HNEDs.

Occupational Stress

The role of an HNED is naturally correlated with specific occupational stress (Atakro et al., 2016; Pegram et al., 2015). Yuwanich, Sandmark, and Akhavan (2016) state that the problem mostly originates from the unpredictability of ED events as well as their stressfulness, which is also pointed out by Atakro et al. (2016). Yuwanich et al. (2016) suggest that ED can be a more stressful environment than some of the other nursing settings. The complexity of the work, which increases with new developments in the field of healthcare, is also a significant stressor (Ericsson & Augustinsson, 2015). The increasing workload (which is correlated with understaffing) can lead to job dissatisfaction and stress as well (Bamford et al., 2013).

Stress is a definite weakness in the role that is correlated with health issues (Yuwanich et al., 2016). While the specific outcomes of stress vary depending on personal and organizational characteristics, stress tends to reduce job satisfaction while contributing to emotional burnout (Admi & Eilon-Moshe, 2016; Adriaenssens et al., 2013). It follows from this fact that the issue is capable of undermining HNEDs’ health, thus making it difficult for them to carry out their practice: the quality of care tends to depend on nurses’ well-being (Admi & Eilon-Moshe, 2016). Yuwanich et al. (2016) show that nurses tend to search for ways to manage their stress with relative success; Adriaenssens et al. (2013) also point out that managerial interventions can be of use if they are aimed at improving the organizational predictors of stress. Here, it is noteworthy that HNEDs can be regarded as nurse managers, which implies that they may be required to introduce such interventions or advocate for them on their own. As a result, while the issue of occupational stress is acute, the solutions to it are available to HNEDs.

The Challenge of Development, Implementation, and Evaluation

According to Bryant-Lukosius et al. (2016), there exists a significant knowledge gap in the topic of the development and assessment of nursing roles. The authors view the determination of the methods of development and assessment as a significant step towards the improvement of the management of the roles (which is not limited to standards but also includes various educational and organizational initiative and related funding and so on) (Bryant-Lukosius et al., 2016, p. 205). The authors demonstrate that multiple frameworks for the development and evaluation of the nurse role’s goals and objectives exist, including the Participatory Evidence-Informed Patient-Centred Process, which the authors promote for its qualities, including its evidence-based nature and the focus on the patient. The present study also demonstrates that NMBA (2016b) has developed a framework of standards, even though it can be regarded as very general. In fact, the suggestion of Bryant-Lukosius et al. (2016) about the lack of relevant research seems to coincide with the finding of the current literature review, which indicates that the topic of the role of HNEDs may be rather underrepresented in modern studies. As a result, it can be suggested that the development, implementation, and evaluation of the role is not only challenging; it also requires additional investigation. The present paper can be regarded as an attempt to summarise relevant knowledge, but additional research is clearly required for a deeper understanding of the role of HNEDs.

Conclusion

The present analysis suggests that the topic of the role of HNED is relatively underrepresented in recent literature. However, it is possible to supplement the few articles on this role with those of the roles of ED nurses and head nurses to achieve the following conclusions. First of all, the significance of the role of HNED is difficult to overestimate, and the scope of practice of HNED is most impressive. Basically, HNED is responsible for management and leadership in an ED, which can be exemplified by a vast number of activities that include but are not limited to planning, decision-making, coordinating, motivating, and advocating. The role of HNED can result in positive outcomes for patients and HNEDs’ co-workers; apart from that, the role presupposes active involvement in policy-making, which can be beneficial for HNEDs themselves.

Given the significance of the role, the regulations that are related to it and the educational and training needs of HNEDs are particularly important; also, their job satisfaction is known to affect their productivity in a positive way. The strengths of the role include its increased autonomy, which is rather rare for a nursing role; however, the issues and challenges seem to receive more attention from researchers. Possibly, the focus on issues can be explained by the fact that their elimination is crucial for the success of HNED role enactment. The key weakness of the role is the immense occupational stress which is caused by multiple contributing issues; the stress can be reduced by HNED or specific managerial interventions. The definition, evaluation, and development of the role also seem to be challenging, in particular, because of the relative lack of research on the topic. To sum up, the role of HNED is an extensive subject that requires further investigation with the aim of informing the actions of HNEDs and improving their performance.

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Abstract

Due to the fact that the trend of the growth of emergency situations, the issue of enhancement of the preparation for the prevention and elimination of emergency situations remains. It is also very important to point out the fact this issue is undoubtedly relevant nowadays. The study reveals the shortage of Emergency and Disaster Department at Health Authority Abu Dhabi and the need to improve the emergency preparedness by means of manpower, staff training, and innovative equipment. The research results suggest some appropriate solutions of the problem including the system of employees training and changes in the organizational structure of the regulator.

Investigation and Problem

Emergency situations are getting more and more widespread in today’s society. The fact that one of the characteristic features of our time is the frequent occurrence of emergencies cannot be contested. In connection with this, the interest to the study of emergencies in the modern world is steadily growing. The research is related to previous researches done in the area under study that arise the question of the emergency staff preparation.

In particular, one might note “Emergency medicine in the United Arab Emirates” by Fares et al., 2014, or “Emergency medicine in Dubai, UAE” by Partridge Abbo, and Virk, 2009. In addition, as a result of recent events at Yaman, UAE needs to be prepared for emergency cases, and the Health Authority Abu Dhabi Capabilities’ mission is to provide the appropriate preparedness.

Statement of the Problem

Nowadays, one might note the shortage of professional doctors, the latest medical equipment, and innovative operational centres. In this regard, it seems necessary to address a problem of lack of the Emergency and Disaster Department at Health Authority Abu Dhabi (HAAD) Capabilities and the necessity to improve the preparedness of emergency by means of enhancing manpower, equipment, and training.

Purpose

The purpose of the paper is to express the relevance of the chosen theme demonstrating some current data and suggesting a set of suitable measures that might be taken into account in order to improve the situation. In other words, the paper is aimed at in-depth analysis of the current state of Emergency and Disaster Department at Health Authority and revealing adequate measures that would enhance the preparedness of emergencies from the medical perspective.

I believe that the above purpose would improve the current situation as prepared professionals orientate in the specific emergency situation better, they estimate it more accurately anticipating its development. In its turn, it makes the emergence of difficulties apparent and helps to exclude plenty of unexpected circumstances. Prepared doctors are less nervous, worried, operates quietly, allow fewer mistakes, and they do not create additional difficulties.

Arrangement and Approach of Study

The conducted investigation consists of five phases each of each is thoroughly considered and possesses a special role. First of all, I would like to present the proposal of the research including the target audience, methodology, and other aspects that would express the topicality of the problem. Second, I would consider the HR related organizational analysis based on credible sources indicating key points of the theme. Finally, I would provide the reader with the thought-out discussion of the research findings along with limited and justifiable concluding remarks. The research paper was chosen as the investigation format. In addition, the research is initiated in the framework of Emergency and Disaster Department at Health Authority Abu Dhabi Capabilities.

Project Proposal and Planning

Target Audience

Speaking of the target audience, it is important to emphasize that the research results might be interesting and helpful for a range of readers from an average reader to scientist with a degree. However, the general purpose of the paper is to provide the useful and comprehensible information for Health Authority Abu Dhabi authorities. Additionally, the research might be used for perspective investigations.

Methodology of Research

The literature overview was chosen as a methodology of the research as it is an indispensable part of the investigation. It is significant for determining the main areas of the research as well as for the implementation of the research process. The literature review would describe what has been done within the subject before, in particular, concepts, approaches of different authors, the current state of the problem, and a range of unsolved problems in the chosen field. Therefore, the literature review is chosen to designate the selected issue. Besides, it contributes to the explanation of the necessity of the study.

Corporate Description

The Organization’s Activities

The organization under analysis is the Emergency and Disaster Department at Health Authority Abu Dhabi Capabilities. Its activity includes emergency patient’s treatment, transfer to the morgue section if required, and other operations.

Strategic Management

According to the Health Authority Abu Dhabi, its mission vision consists in healthier population procuring better access to health care services and constantly improving services quality (HAAD, n.d.a). What is more, its strategic objectives suppose the workforce attraction and training, emergency preparedness, wellness along with disease prevention, and other objectives. As for the business strategy, it is expressed improving medical outcomes and public health. The functional strategy comprises inspect and control for quality, filling critical gaps in capacity and insurance coverage, and being prepared for emergencies. HAAD’s top management role is to ensure the quality and preparedness of the provided services.

Current Projects Undertaking

Presently, the Emergency and Disaster Department at Health Authority Abu Dhabi Capabilities has two sections, which are the operation section and mortuary section.

Research Result and Data Analysis (HR related Organizational Analysis)

The following part of the paper examines HR related organizational analysis based on the literature overview. In their, “Emergency medicine in the United Arab Emirates” article, authors point out the main features of emergency medicine in the UAE as well as the challenges it has to face. For instance, they claim that there is the lack of training of the staff. The majority of states of the United Arab Emirates use the following classification of employee: education, training, and experience.

At the same time, the “HAAD classifies ambulances into those providing basic life support (BLS / Type 2) or advanced life support (ALS / Type 3)” (Fares et al., 2014a, p. 3). Thus, one might note the shortage of the professional training. The knowledge gained by staff in institutions is rapidly becoming obsolete increasing their need for a substantial renovation. Therefore, today, for the successful work, specialists should be aware well enough to understand the special and the common areas. Unfortunately, “even within the medical community, many doctors do not understand the importance of emergency medicine and giving this branch more recognition is an important step forward” (Bell & Rizvi, 2014b, para. 2).

The lack of the required skills leads not only to the inefficient operation but also to the reduction of the job satisfaction. “The shortage of emergency medicine-trained, board-certified consultants in the UAE has a negative impact on the quality of emergency medicine training. They have little to no available time for teaching and research” (Fares et al., 2014a, p. 6). Consequently, the systematic training of employees could reveal their full capabilities. Training is designed to prepare staff to the correct solution of a wide range of tasks and provide a high level of work efficiency. In addition, organizational changes become difficult to implement without timely training.

In order to achieve its organizational strategies, HAAD’s HR management periodically revises rating criteria in appraisal forms and processes. Moreover, the organization offers special training programs aimed at emotional integrity and enhancement of communicative skills of employees. As a result, it improves relationships between colleagues and patients. Besides, HAAD exerts every effort to remain attractive on labour market including the competitive salary, appropriate working environment, and remunerations.

Taking into account the above, it is possible to examine the effectiveness of techniques of performance appraisal. Accomplishing organizational objectives is ensured by means of encouragement strategy. Corporate HR management provides expertise, creates programs and practices, and manages timely and effectively. Moreover, the organization focuses on constant improvement of working conditions. It motivates employees to work harder and achieve high results.

Among challenges faced by the emergency medicine, there are working conditions of the personnel. Emergency staff provides emergency medical assistance to patients in different conditions. Nevertheless, advances in the development of medical equipment and means of communication have expanded the capabilities of these workers in the resuscitation and stabilization way in the emergency department (Trivedy, Hall, & Parfitt, 2010).

Increased opportunities of ambulance workers do not completely meet current requirements as they are now faced with increased risks in the performance of their duties. In particular, challenges facing them should be overcome quickly and often in poorly equipped facilities with limited access to the patient. The working environment might suddenly and uncontrollably become threatening in the biological, physical, and chemical aspects.

The dynamic and rapidly changing situation increase the risk of the medical staff. It is important to take into account health risks of medical rescue services personnel in the development of strategies to reduce this risk and prevent injuries during operations. The work of ambulance workers occurring in the uncontrolled and unequipped environment as well as responsibility for making major decisions with inadequate equipment and limited time often leads to occupational stress.

Errors and malfunctions, job dissatisfaction, and loss of the sense of patient care that might arise as a result of occupational stress, are a danger both for workers and for society to some extent. In order to mitigate the devastating effects of the nervous system associated with emergency cases, some techniques for stress relief should be applied.

It is also very important to stress the fact that authors argue the emergency equipment. Precisely speaking, there is a need to have the latest equipment in terms of communication between stakeholders. While the current one is TETRA, there is a necessity to have more innovative equipment that would help to trace the bed equipment in the regulator, etc. Moreover, the regulator organization plays a significant part in the emergency medicine effectiveness.

According to Fares et al. (2014b), it should be centralized. The centralized system of the regulator organization means the majority of departments integrated together in one body, but located, usually, on different floors or parts of the building. As a rule, in this type of organization, there is a single building rendered for technical facilities, catering department, outpatient, and autopsy department.

In its turn, new equipment would increase the speed of processing the material and expand the range of the researches. For example, automated analyzers ensure more accurate results excluding the human factor. It means that the analysis would be received in the regulator lab, and after conducting research within few days automatically head back. Such a system would not only increase the speed and improve the quality of the research, but also eliminate the need for paperwork and errors. What is more, such an organization would provide free communication between staff and patients’ transportation to the required location.

Discussion and Research Analysis

Research Findings

It goes without saying that there is a need to prepare for action in emergencies as it is the potential danger that might occur anytime. However, the nature of the emergency is that the awareness of this need comes already after the emergency actually happened. Usually, the need to prepare for is not regarded as urgent before the accident. The lack of Emergency and Disaster Department at Health Authority Abu Dhabi Capabilities leads to accidents and emergencies.

However, it is especially significant to emphasize that in a case like this one, the awareness of the need of the preparedness to emergencies and invest in their creation gives organizations the knowledge, experience, and resources enabling safe operation and performance requirements of morality and law and increasing the likelihood that doctors would cope with emergency situations in a timely manner. In addition, the total loss increases due to the lack of efficiency of methods to limit and eliminate emergencies.

For the organization of an effective system ensuring the preparedness for emergencies, it is necessary to realize its importance, consider the project, and support its creation. Consequently, the following purposes should be achieved:

• Awareness of the need to provide appropriate measures, planning, and support;
• Definition of long-term goals and objectives;
• Ensuring financial support to purchase the necessary medical equipment;
• Adequate staff training;
• Provision of the necessary organizational resources.

Based on the initiated research, a system of measures could improve the preparedness in emergencies. The proposed system that allows achieving the state of emergency preparedness focuses on an integrated approach to the prevention of such situations and the ability to cope with them in the case they appear. The system includes the following aspects:

• Organizational objectives and their implementation (a priority role and the need to prepare for action in an emergency);
• Risk management (identification, assessment, and mitigation of the potential dangers and risks);
• Definition of measures to cope with the unexpected situation or accident;
• Provide the necessary space, equipment, and materials;
• Training methods of detection, control, and warning about the accident;
• Evaluation and improvement of the entire system through regular inspections and tests;
• Periodic re-evaluation of risk factors and testing the effectiveness of the system (HAAD, n.d.b).

As a matter of fact, another important issue that should be taken into account is the assessment of risk factors. Analysis of risk factors allows identifying factors that are typical for a particular emergency. On this basis, the risk factors assessed in comparison with known criteria determine the degree of acceptable risk. In the case the risk is high, it is necessary to determine measures to be done to reduce it (for instance, to reduce the likelihood of an emergency, to decrease its effects, to eliminate all or, at least, part of factors).

As a result, the plan to reduce the identified risk factors should be developed and implemented. Similarly, on the same basis, the action plan in case of emergency should allow taking the most effective measures in the case of its occurrence. Identification and analysis of risk factors predict the perspective scenario of this or that situation development with high accuracy. Therefore, it would be possible to determine suitable actions necessary in each case.

Finally, the research explores the centralized organization of the regulator emphasizing that it is the best way of the regulator body organization. It guarantees effective communication and medical processes. Personally, I agree with the research analysis. Indeed, it would be better if all the departments would be united in the one body. In my point of view, it would eliminate the lack of the Emergency and Disaster Department at Health Authority Abu Dhabi.

Contribution of this Project

The research presents a systematic description of what actually is happening to emergency medicine department and staff. In my opinion, the research has made a significant contribution to the study of emergency situations in the HAAD regulator. The study reveals the lack of effectiveness of employees work in the Emergency and Disaster Department at Health Authority Abu Dhabi and proposes measures for the improvement of the situation.

Limitations

I consider that there are some factors that might impinge upon student’s research. For instance, the obsolescence of the information chosen for the analysis or some current events. However, I find that thee was no external factors that influenced my research.

Recommendations for Further Development within the Organization

Thus, the study could be utilized in further investigations. For example, it gives the perspective of the research in other medical institutions of the United Arab Emirates or in any other narrower specialty related to emergencies.

Conclusion and Lessons Learned

In conclusion, it should be stressed that the aim of this paper was to evaluate the lack of Emergency and Disaster Department at Health Authority Abu Dhabi Capabilities and to identify the areas of emergency preparedness requiring improvement. During the study, it was stated that there are some weak points need to be improved. Among them, one might mention the shortage of professional doctors, obsolete equipment, and inappropriate regulator organization. Consequently, the following measures should be taken correspondingly: adequate staff training, innovative equipment installation, and structural reorganization of the regulator.

Emergency situations are often viewed as unforeseen ones. However, in the modern era of advanced technology and communication systems, few events could be called really unexpected and very few of the accident unprecedented. Newspapers, hazard warning, accident statistics, technical reports – all that reliable data gives images of what could be waiting for. Nevertheless, methods for preventing and eliminating emergencies based only on past experience does not always guarantee the same level of their solution.

A good reinforcement of the regulator is personnel training concerning some risk factors and necessary actions. Deficiencies in staff training often determine the difference between the emergency patients’ recovery and causalties. Therefore, the staff training is the mechanism that determines the effectiveness of the HAAD regulator work and developed activities resulting in the healthier population. The emergency preparedness is ensured by the integration of all the necessary elements including the proper staff training, the high-quality special equipment, and regular examinations of the efficiency of undertaken actions.

Speaking of the procedural design flaws, the thing worth turning one’s attention to is the shortage of illustrative material such as tables, diagrams, drawings, statistic material. Perhaps, it would be better if the study included some proved data or statistics organized in tables. However, I find that it is a strong point of the research that I referred to several reliable sources. Thus, the analysis of the can be proved. It could not be easily argued and denied, as there is evidence of it being taken from credible sources. As a result, the information presented in the research appears to be accurate and trustworthy.

Consequently, one may conclude that the goal stated in the research proposal was achieved because the useful and comprehensible information was provided.

References

Bell, J., & Rizvi, A. (2014). “Lack of specialists is great challenge to emergency medicine, say UAE doctors”. The National. Web.

Fares, S., Femino, M., Sayah, A., Weiner, D. L., Yim, E. S., Douthwright, S.,… Ciottone, G. (2014b). Health care system hazard vulnerability analysis: An assessment of all public hospitals in Abu Dhabi. Disasters, 38(2), 420-433.

Fares, S., Irfan, F. B., Corder, R. F., Abdulla Al Marzouqi, M., Hasan Al Zaabi, A., Idrees, M., & Abbo, M. (2014a). “Emergency medicine in the United Arab Emirates”. International Journal of Emergency Medicine, 7(4), 1-8.

HAAD. (n.d.a) About HAAD. Web.

HAAD. (n.d.b) Abu Dhabi Healthcare Strategic Plan. Web.

Trivedy, C., Hall., & Parfitt, A. (2010). Mastering Emergency Medicine: A Practical Guide. London: Hodder Arnold.

Demographics

The patient is a 32-years-old male. He was admitted to Emergency Room (ER) 2 weeks ago. The patient was referred to the hospital by a general practitioner (GP).

Presenting Complaint

The patient was in good condition and did not have any critical healthcare issues before he got injured. He appeared in the ER because he had his finger amputated accidentally. It happened to him when he started splitting firewood. He cut his hand accidentally, injured his thumb finger, and amputated his index finger so that there was a necessity to consult a doctor. His case got worse over the course of time until he received the needed care.

History of Presenting Complaint

The patient claimed that he noticed the problem immediately and it got worse before he received treatment. He suffered from severe (10) pain in his hand until it was released with painkillers. The patient wanted his finger to be put in its place but was afraid that it would not be possible. He also thought that he could have had some infection in the wound.

Past Medical/Surgical History

In 2015, the patient had surgery, which dealt with his knee replacement. In addition to that, he had cleft palate surgery. What is more, the patient had 3 surgeries performed on the eye. Still, none of them have any relation to the current case and problems with his finger. The patient has no history of current and inactive medical conditions.

Drug History

The patient is taking painkillers to reduce the pain because of his injury: Bi Morphine is used to relieve pain 3 times a day and paracetamol is used 4 times a day (1000 mg).

Intravenous therapy is used to keep his blood pressure up as he has atrial fibrillation and his heart rhythm is irregular.

The patient has no allergies. No side-effects are noticed.

He has all obligatory vaccinations, including Flu, Td/Tdap, MMR, and Chickenpox (CDC 2016).

Family History

No diseases run in the family. Both parents are alive and have only age-related health issues, such as high blood pressure and farsightedness.

Social History

He has never smoked, drunk alcohol, or taking drugs.

The patient is a farmer so that he works outside the home a lot. He did not travel much and was at home recently. He has a dog.

The patient is divorced and has two male children, but he lives alone in a large one-story house. Being independent, he is able to take care of himself, walk and drive without any assistance.

Review of systems

• Gastroenterology: no mouth ulcers, indigestion, nausea, vomiting, diarrhea, abdominal pain, constipation, or bleeding.
• Genitourinary: no problems with passing urine.
• Rheumatology: no weakness, stiffness, and joint pain. Swelling, pain, and limited mobility due to the injury but it is getting better.
• Skin: no rash, lumps, itch, or hair changes.

Brief Summary of the Case

A 32-years-old male was admitted to the ER 2 weeks ago. He is a farmer with a work injury (finger amputation). Before the accident, he had several surgeries but was in a normal general condition. Now he is receiving painkillers and intravenous therapy.

Reflection/Discussion

I from this case that it is easier to treat a patient and reach positive outcomes if one did not have related health issues in the past. I also got to know that treatment with painkillers may be the best option in case of amputation.

On the wards, I noticed that the patient lacks his family’s attention and support. I believe that nurses and other members of the medical staff should be more attentive to him.

After the report, my views changed and I started to pay more attention, not to the problem that the patient has but to him as an individual.

Reference List

CDC 2016, 2016 recommended immunizations for adults: by age, Web.

Emergency Department (ED) is a unit of a hospital that provides various types of emergency care, including reporting, response, field care, etc. One of the most common problems of emergency departments is staff burnout due to highly increasing stress levels, understaffing, and inappropriate scheduling. Specific policies that promote work-life balance, employee benefits, and provide support for staff’s mental health can improve the situation.

Systems Theory

The department chosen for the analysis is Emergency Department in an XYZ hospital. The department’s input includes staff, patients, family members, supplies and equipment necessary for procedures, funding and grants, information about the type of injury/condition, patient feedback, and healthcare environment. The throughput includes various ED services, such as detection, reporting, response, field care, transit care, unit care, including specific services, e.g., burn, trauma, and stroke care and poison control.

The output includes patient volumes, data on the type of injury and care delivered (trauma-critical, urgent care), time of stay, any issues related to admission and discharge of patients, treatment time, and patient volumes (Meyer & O’Brien-Pallas, 2010). Cycles of events include expenditures and revenues, staff accreditation, programs focused on improvement of care effectiveness, coaching, workshops, etc. Negative feedback includes metrics related to organizational and staff performance, treatment efficiency, the impact of human error on care, etc.

Identified Problem

The problem identified by the author is staff burnout, which can lead to further problems with mental health, e.g., acute stress, depression, and anxiety. Some causes of burnout might be “unpredictable workload, frequent disruptions to circadian rhythms, and caring for high acuity and high complexity patients” (Lu, Dresden, McCloskey, Branzetti, & Gisondi, 2015, p. 998). Staff burnout directly relates to the inflow of energy in the unit, resulting in disruption of care, worsened nursing condition, and less effective treatment and care; all these factors adversely influence inputs. Burnout is also related to the mental and physical health of the staff since it can lead to emotional exhaustion, potential bullying, nonsupportive working relationships, etc. (Laschinger & Grau, 2012).

Desired Outcome

The desired outcome of a proposed intervention would be decreased burnout, reduction in stress levels and turnover rates, improved working conditions and relationships, suitable scheduling, and lack of too extensive workload.

To facilitate the outcomes, the hospital will need to provide better life-work balance to staff by introducing the following policies:

1. Understaffing cannot be addressed by increasing employees’ workload if they are unwilling to accept it.
2. The work environment should be designed and structured in a way that does not interfere with the working process and is not potentially dangerous to staff and/or patients.
3. Appropriate scheduling is provided to all staff and does not require them to undergo major changes in private life to adapt to those.
4. Provide mental health support for employees in a specific center, where a counseling psychologist will be available to them during the working process.
5. Launch a program that will directly relate to staff training and include cognitive behavioral interventions (e.g., relaxation training, cognitive restructuring) (Morse, Salyers, Rollins, Monroe-DeVita, & Pfahler, 2012).

Relevant Standards

The standards of practice for emergency nurses include the ability to collect comprehensive data, determine the diagnosis, identify the outcomes of a treatment plan, develop and implement the treatment plan, coordinate care delivery, promote health, consult patients and other professionals about the plan, use procedures, referrals, therapies in accordance with legal regulations, and evaluate progress (AMN Healthcare, 2014).

Burnout can interfere with the ability of nurses to provide comprehensive care, as well as coordinate it. Lack of motivation, stress, and inability to use complex decision-making can result in different mistakes, which will undermine the nursing standards of practice. Policies targeting work environment, relationships, and scheduling will improve teamwork, procedure implementation, and care delivery, also reducing the level of stress experienced by employees.

Resolution Application

The proposed resolution can improve organizational culture by teaching the staff how to address negative aspects and challenges in a non-toxic way, e.g. instead of bullying or substance use they can use active coping, self-control, or problem-solving (Guveli et al., 2015). Furthermore, additional coaching and workshops will positively influence teamwork, resulting in decreased number of misunderstandings among staff.

Resolved issues in teamwork will also improve patient care and satisfaction, thus aligning with the hospital’s mission to provide quality care, care for safety and health of patients, ensure their satisfaction, and promote healthy habits and behavior to them. Monitoring the psychological well-being of employees and addressing any issues as early as possible will positively affect climate at the working place. Moreover, it will also decrease employees’ willingness to engage in unhealthy behaviors to reduce stress levels (i.e., drinking, smoking, absenteeism).

Summary

Professionals working in EDs need to understand the impact of burnout on their care and possible outcomes of it. The facility can address the problem via rescheduling, decreasing understaffing, providing psychological support, observing psychological well-being of employees, redesigning work environment, and ensuring proper work-life balance for employees. If all these policies are implemented, the facility will be able to provide more efficient and quality care.

References

AMN Healthcare. (2014). Professional nursing practice: An update. Web.

Guveli, H., Anuk, D., Oflaz, S., Guveli, M. E., Yildirim, N. K., Ozkan, M., & Ozkan, S. (2015). Oncology staff: Burnout, job satisfaction and coping with stress. Psycho‐Oncology, 24(8), 926-931.

Laschinger, H. K. S., & Grau, A. L. (2012). The influence of personal dispositional factors and organizational resources on workplace violence, burnout, and health outcomes in new graduate nurses: A cross-sectional study. International Journal of Nursing Studies, 49(3), 282-291.

Lu, D. W., Dresden, S., McCloskey, C., Branzetti, J., & Gisondi, M. A. (2015). Impact of burnout on self-reported patient care among emergency physicians. Western Journal of Emergency Medicine, 16(7), 996-1001.

Meyer, R. M., & O’Brien‐Pallas, L. L. (2010). Nursing services delivery theory: An open system approach. Journal of Advanced Nursing, 66(12), 2828-2838.

Morse, G., Salyers, M. P., Rollins, A. L., Monroe-DeVita, M., & Pfahler, C. (2012). Burnout in mental health services: A review of the problem and its remediation. Administration and Policy in Mental Health and Mental Health Services Research, 39(5), 341-352.

• Course: NUR 000/The Nursing ER training program.
• Place: Emergency Department and Training Department.
• Duration (Time): Three months.
• Educational Level: For new nurses in the emergency department.

Course Overview

The course is intended for new nurses, who will be operating in the emergency department. Students will be taught domains connected to the evaluation of patients in the emergency department settings and prioritization of care (Bryant & Knight, 2011). Educational activities will center on such topics as cardiac and pulmonary emergencies in adult patients (Bennett, 2013). The course will have both theoretical and clinical underpinnings, and students will need to exhibit a range of clinical competencies.

Course Objectives

Students will be able to:

• Design and implement nursing strategies adequate for emergency department patients;
• Deliver multidisciplinary care and exhibit skills unique for emergency department nursing;
• Assess the pathophysiology of the condition that brought the client to the emergency department;
• Appraise existing issues in clinical practice and determine the implications for the nurse’s practice;
• At the end of the course, students should possess knowledge of conceptual models and strategies needed for effective functioning in the emergency department settings.

Course Requirements

The course will consist of a series of educational sessions, which will include lectures, tutorials, and written assignments. Students are required to participate actively in all practical activities and discussions. At any point, students may seek additional clarification as applied to emergency evaluation.

Course Outline

Summary of the learning activities:

• Emergency nursing – general overview;
  • Symptoms and complaints;
• Evaluation and care;
  • Taking a patient’s history;
  • Assessment (Talley & O’Connor, 2014);
• Respiratory physiology;
• Care;
  • Oxygen therapy;
  • Airway management;
  • Assisted ventilation;
• Respiratory failure and emergencies;
• Acute coronary syndromes (Wesley, 2012);
  • Conditions from ischemia to infarction;
  • Managing emergency situations;
• Myocardial infarction;
  • Patient complaints, symptoms, management (Wesley, 2012);
• Hypo- and hyperthermia;
• Current tendencies and the latest research;
  • Implications for practice.

Teaching Strategies

Students will be exposed to a variety of educational activities ranging from lectures and tutorials to review sessions and group debates. Students are expected to take part in all sessions (80% attendance is required). Learners will be provided with required readings for independent studying at home. Their knowledge will be tested during the course exam at the end of the semester and during lectures and discussions. All educational activities will be supported by audio-visual aids and handout materials.

Attendance and Participation

Students are expected to take part in all educational activities and be present during all class lectures and planned discussions. Negligence to meet the attendance requirement may result in class failure. Learners are responsible for studying topics they have missed independently by reviewing handouts and educational materials.

Course Evaluation Strategies

The final grade depends on student engagement with lectures and group discussions. It will be determined based on the completion of an essay (35%), delivery of presentation (30%), and final examination (35%) (See Table 1). If the student fails to meet the attendance requirement (80% attendance is required) for no objective reason, they will need to retake the course.

Evaluation Methods

Table 1. Student Evaluation Criteria.

Presentation requirements are as follows:

• Student presentations should have a relevant introduction (15%) into the topic and specify the purpose clearly;
• Narration should be logical and points made should be interconnected (15%);
• Learners need to support their claims or general ideas with visual aids to ease the process of understanding for the audience (10%);
• The speaker should stick to a formal style, keep proper eye contact with the audience, and address any queries that may arise (10%);
• The presentation should incorporate findings from the latest research (20%);
• The speech should end with a summary of points made and general conclusions on the issue (10%).

References

Bennett, D. H. (2013). Bennett’s cardiac arrhythmias: Practical notes on interpretation and treatment (8th ed.). Hoboken, NJ: John Wiley & Sons.

Bryant, B., & Knight, K. (2011). Pharmacology for health professionals (3rd ed.). Sydney, Australia: Elsevier.

Talley, N. J., & O’Connor, S. (2014). Clinical examination: A systematic guide to physical diagnosis (7th ed.). Sydney, Australia: Elsevier.

Wesley, K. (2012). Huszar’s basic dysrhythmias and acute coronary syndromes: Interpretation and management (4th ed.). St. Louis, MO: Elsevier.