Advanced Health Services Management and Research

Quality Healthcare in Emergency Rooms 

Background information

In the recent past, the essentiality of providing quality patients oriented services in healthcare has been given prominence in the United States and other developed countries. Many departments in healthcare have evolved due to innovation and evolution in the field, enabling the overall field to provide essential primary and advanced care. The emergency department (ED) is one of the most significant components of the entire healthcare delivery system and the broader social safety net system. In the emergency rooms, qualitative evaluation of patients’ experience is increasingly recognized as an essential part of healthcare assessment (Paavilainen et al. 2009). Measuring patients experience with healthcare performance in different countries has helped medical researchers propose preferable service models for the emergency department. The Organization for Economic Cooperation and Development (OECD). Analyzes the significance of national and international research on patients understanding, and diligently emphasizes cross-nations comparative study using the regulated instrument to test the quality of services provided in the emergency rooms. The emergency department not only provides emergency services but also plays a vital role in public health by providing regular healthcare services to patients irrespective of their ability to pay for the services. Compared to the past years, when emergency departments were meant only for providing critical emergency services, evolution in the medical field has expanded the role of the emergency department. The department has become flexible for regular patients to seek care service in the ED when they are unavailable in community healthcare.

The traditional measurement of quality care in healthcare emergency department is based on logistics and financial parameters. However, this has changed over time, as the experience and satisfaction of patients in the emergency rooms (ER) is taking over a measure of quality (Welch, 2010). This is because these parameters are able to assess the quality of patients’ interaction with ER staff, their estimated waiting durations, and the general organization of the environment in the ED. Most researches of patients experience in the ER involve quantitative surveys or interviews which focus on judgment and narratives of patients after their visits in the ED. Qualitative studies have often been used to complement the quantitative results. For instance, an interview with 40 patients resulted in 25 negative results, ten positive and five neutral. Patients’ experience was perceived to have been shaped by their interaction with ER staff, waiting time, and the quality of care provided. The results from this interview showed three important facts about patients’ participation: (1) recognition and having aspects of contact with ER staff, (2) involvement in the care process, and (3) having a chance to provide essential information and establishing a rapport with healthcare providers. Although such researches have revealed that patients’ satisfaction is directly related to care, providers, interpersonal skills, there is still much that is not known about patients’ experience in the ERs.

Quality care services offered in the ER has critical significance. The quality of the service in ED is best measured through its ability to meet patients’ expectations. The consensus of quality care is referred to as “The care medical practitioners would desire to receive in case they are admitted.” ER’s quality measure involves information that describes an element of medical care that has significance to one or more patients. Some patients’ conditions require priority, while other conditions run counter to each other. Various stakeholders in the ED describe quality depending on their role in the department. For instance, decreasing waiting durations is a vital consideration for patients, healthcare organization, and visiting family members while it is of little significance to the payer (Welch, 2010).

On the other hand, unnecessary diagnostic tests and costly care is of important concern to payers while it holds little direct influence on the patient. However, a win-win situation is experienced when by all parties when patients receive accurate medical care. The framework for measuring quality in ED has often been divided into structures, processes, and results. Structure refers to facilities and equipment available in the Ed before patients visit which includes the staff, procedures and clinical guidelines in addition to the general layout of the department as a strategy for oversight in the compliance with the value of care. Process aspects involve accessible and dynamic measures that are usually referred to as the focus of quality improvement. The resulting aspect refers to the aftermath of emergency care, which mostly includes quality of life, morbidity, and mortality rates.

The United States is presumably one of the countries with the most sophisticated technology in healthcare. Emergency departments are viewed to be among the best in terms of quality care services. However, patients visiting the ED are not always satisfied with the value of services provided. Welch (2010) says that there is a need for more focus to be put on the specific needs of patients without urgent needs, who comprise a significant portion of all patients who attend ED. Different factors influence quality care in the ED. Today, healthcare institutions are faced with various challenges which affect the quality of care provided in the ED. Rising cost, staff losing efficiency, and restriction of facilities are vital aspects to quality care. In the ER, patients expect to be treated immediately and with quality measures. However, this has not been met as the problems affect the entire medical field. In the ER, the time factor is essential as a single second may be decisive for death, healthy life, or severe disability for a patient (Welch, 2010). In a creased waiting time in ER has in the past resulted to adverse condition of patients and sometimes death. As a result, patients have lost confidence with the value of care provided by ED of some medical institutions. Research holds that upgrading the value of services in ED can play an essential role in timely diagnosis and treatment of patients’ specific problem, which would, in turn, improve their perception of quality care in the ED.

Purpose of the Study 

Various studies have been conducted in the past to investigate the value of healthcare services provided by medical institutions in different states. Most of these studies have generalized care service offered in the entire field. As a result, there have been gaps in the research conducted in the emergency department (Agborsangava et al. 2013). Some of the studies are not well documented, and the statement of their problem has been termed as too general. This department holds critical aspects in the medical field, and therefore, critical research methodology needs to be conducted to establish the value of care provided and the level of satisfaction of patients who visit emergency rooms. The state of Alaska uses independent practice model for medical practitioners. In this model, physicians are allowed to use the best judgment in providing care to the patients. Limited monitoring of medical practitioners has led to varied reports about the value of care service provided to patients in the ED. Therefore, the purpose of this study is to examine the quality of healthcare provided by the emergency department in the state of Alaska from a patient’s perspective which will lead to an intervention model to be used in improving care services in the ER.

Research Question 

The research question of this study was formulated based on qualitative measures investigated in the emergency department of various health institutions across the state of Alaska, and critically analyzing past results documented in various scholarly articles that have conducted research on Electronic Health Records (EHR) and quality of care in the emergency rooms for nurses and ER (emergency room physicians).

RQ1: How can EHR help provide quality care in the emergency room?

EHR stores and outlay patients in medical history electronically. This program is maintained by healthcare providers. The data contained in electronic health records may involve all of the vital information essential to a patient under a specific care provider including, medical problem, medical history, and progress note. The information contained in this program is automated to streamline the workflow of clinicians (Handel, & Hackman, 2010). The objective of this study is to demonstrate how electronic health records can be used to improve the quality of service provided in the emergency department of health institutions in Alaska. Overcrowding in the ER in many medical institutions has become a state issue. Prolonged durations of stay in ERs have been associated with a low level of patients’ satisfaction. To overcome this problem, medical practitioners can install better methods to dispense efficient care. According to Handel, & Hackman (2010) EHR program can be one of the strategies to enhance workflow in the ER, thus improving efficiency, particularly in easing the duration of documenting patients’ information. The EHR system has the ability to record patients’ information by their flow in the emergency room. Since time factor is critical in the ERs, fast retrieval of patients previous data in the ER would help clinicians provide quality services within a short duration. This would also help reduce overcrowding that is caused by the slow physical tracing of patients information.

In addition to the efficient provision of patient’s information, EHR can be utilized by medics to infer the latest medical knowledge, reminders, or other information that facilitate sound decisions by health professions in the ER. A previous study analyzed the impact of EHR use by clinicians in making decisions (Handel et al., 2011). The results showed that the program could facilitate medical efficiency in the ER through enhanced decision-making strategies. The results showed also showed that the program could effectively sort patients by utilizing limited information that would be of both economic and clinical importance. Handel et al., (2011) argues that the quality of care in the ER is considerably impacted by clinicians’ decision, especially in critical conditions life-saving decisions are essential in the ER. EHR facilitates exposure of information related to a particular course of action that can help emergency caregivers’ to confidently make timely and applicable decisions to save a life.

RQ2: How can the state improve the quality of services offered by nurses and physicians in the ER?

Previous research has shown that physicians and nurses in the emergency department are not only required in sufficient number but also composed of highly skilled personnel. The State of Alaska has been faced with an insufficient number of medics in the emergency department. To address the issue of shortage, many healthcare institutions have been forced to employ personnel with insufficient knowledge to operate in the emergency department. This has resulted in a problem of quality in care provision in ER (Li et al., 2013). The objective of this study is to assess the measures state of Alaska can put in place in order to improve the quality of care provided by nurses and physicians in the ER. The introduction of nurse practitioners (NPs) in many states has helped facilitate operations in various departments of the medical field. NPs have sufficient knowledge of handling the critical problem in healthcare. Their involvement in the ER can significantly contribute to efficiency services of patient management in the department. This is particularly essential in relieving waiting duration through the help of electronic health records. According to Li et al. (2013), NPs can help to reduce sub-acute workload for physicians who would enable the latter to cater for advanced health problems which require their expertise. Due to their advanced knowledge than registered nurses, NPs in addition to complementing physicians in providing emergency care, they can also make the ED a one-stop facility which would address particular health issues which would be unavailable in the primary care units.

In addition to employing NPs to operate in complementing physicians and registered nurses, the state government has the mandate to install the latest technology to enhance immediate response care for patients in the ER. This emerging trend in healthcare facilitated by EHR can be of significant use in the ED. The automated response equipment can help healthcare providers in the ER monitor patients status in an around the clock system upon their admission. This system would enable patients in the ER report how they are feeling and receive adequate treatment in case of a problem. The EHR enabled system has the capability of directly communicating to caregivers forty-eight hours about completing a shift. This can help the effective transition of shifts by clinicians as the whole data about patients in the ER is readily accessible to all practitioners authorized to use the system. Besides providing essential information, the system can only be accessible to care givers in the ER, which would help in keeping patient information confidential.

Significance of the Study 

The study on quality healthcare services in emergency departments is not only essential for the population in the state of Alaska but also addresses essential elements necessary for implementation in the United States’ medical industry. This research will enable emergency departments to develop cautious measures that would help increase patients’ satisfaction and clinicians credibility in providing services. This study is of particular importance to medical scholars who wish to research emergency department.

With a significant number of inpatient population coming from ERs, ensuring quality healthcare in the emergency department will help improve patients flow in the ED. This study will facilitate improvement, such as the use of a real-time locating system (RTLS) in the ED, which will impact on the value of the services provided. RTLS benefits the ER in the following ways. Firstly, it improves the admission and discharge of patients in transparency and real-time location. Use of tags for location transmission to patients, staff, and essential facilities in the ER enables administrators to monitor workflow and patients progress in real time (Boulos, & Berry, 2012). This facilitates in attending patients by caregivers and preventing delays that can result in inconveniences in the ER. RTLS also enables clinicians to locate real-time admission of patients through generating a map containing the latter’s medical information. Secondly, RTLS enables to optimize service delivery continually. In case of delays in the ER, administrators in RTLS analyzes the real time of occurrence thus enabling the department administration to act proactively by placing necessary equipment, staff and other necessities that may solve the problem. According to Boulos, & Berry, (2012), a constant flow of work is achieved through inter-department communication. The collaboration of ED with another department in access of RTLS also allows acceleration of activities that were once delayed due to poor communication. Lastly, RTLS plays an important role to improve patients’ satisfaction in the ER. One of the most significant roles of ED about patients is to keep family members up-to-date about their member’s progress which is an attributed to having an impact on patient’s experience and satisfaction (Boulos, & Berry, 2012). Installation of computers in the visitors’ area in the ED gives an opportunity for visiting person to have limited access to the ER real-time map. RTLS enables sharing the real-time status of patients, which helps the visitors plan when to see their patient. In addition to improving the image of ED, it also helps to save time wasted in the waiting area.

This study will also encourage hospital administrators in the overall US medical industry act accordingly to the problem that has been influencing slow admission in the hospitals today. Nearly half of the delays experienced in patients’ admission in the emergency rooms results from unscheduled admissions. It is evident that office-based clinicians have been sending patients who would have been admitted in regular care to ERs (Cardoso et al., 2011). Due to evolvement in the medical industries, ED staff performs primary care roles which require complex diagnostic that cannot be efficiently handled by regular medical practitioners. These staff also serves in the primary care department to accelerate patients’ attendance (Schuur, & Venkatesh, 2012). Such evolvement shows that clinicians in the ED impact most of the main decisions concerning patients’ admission in the US. Since hospital admissions dictate for a considerable portion of hospital revenue, ED clinicians influence major healthcare costs as inpatient medical care amount to more than thirty percent of the nations spending on healthcare. Some of the patients who seek care from the ER do so due to lack of alternative rather than convenience. Therefore, efforts to reduce non-urgent emergency room admission would help focus on ensuring efficient primary care access, which will play a significant role in decongesting ER with patients who can be treated by the office-based physicians.

Modern medical care calls for interdependent and collaborative efforts by all healthcare departments in a bid to provide sufficient and efficient care to the patients. Literature in this study would be essential in showing the necessities of collaboration between emergency department medical personnel and other departments. Ways to ensure this interconnection may be through information technology, effective coordination of care management, and better collaborative strategies (Boudreaux et al., 2009). Research shows that broader use of these and other innovation practices can generate more savings through ensuring patients access to improved primary care services without necessities of ER admissions. This would greatly help to save cost incurred through needless hospital admissions in addition to the cost of unnecessary testing.

References

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Boudreaux, E. D., Allen, M. H., Claassen, C., Currier, G. W., Bertman, L., Glick, R., ... & Camargo Jr, C. A. (2009). The psychiatric emergency research collaboration-01: methods and results. General hospital psychiatry, 31(6), 515-522.

Boulos, M. N. K., & Berry, G. (2012). Real-time locating systems (RTLS) in healthcare: a condensed primer. International journal of health geographics, 11(1), 25.

Cardoso, L. T., Grion, C. M., Matsuo, T., Anami, E. H., Kauss, I. A., Seko, L., & Bonametti, A. M. (2011). Impact of delayed admission to intensive care units on mortality of critically ill patients: a cohort study. Critical care, 15(1), R28.

Handel, D. A., & Hackman, J. L. (2010). Implementing electronic health records in the emergency department. The Journal of emergency medicine, 38(2), 257-263.

Handel, D. A., Wears, R. L., Nathanson, L. A., & Pines, J. M. (2011). Using information technology to improve the quality and safety of emergency care. Academic emergency medicine, 18(6), e45-e51.

Li, J., Westbrook, J., Callen, J., Georgiou, A., & Braithwaite, J. (2013). The impact of nurse practitioners on care delivery in the emergency department: a multiple perspectives qualitative study. BMC health services research, 13(1), 356.

Paavilainen, E., Salminen ‐ Tuomaala, M., Kurikka, S., & Paussu, P. (2009). Experiences of counselling in the emergency department during the waiting period: importance of family participation. Journal of clinical nursing, 18(15), 2217-2224.

Schuur, J. D., & Venkatesh, A. K. (2012). The growing role of emergency departments in hospital admissions. New England Journal of Medicine, 367(5), 391-393.

Welch, S. J. (2010). Twenty years of patient satisfaction research applied to the emergency department: a qualitative review. American Journal of Medical Quality, 25(1), 64-72.