Reducing Congestion in Emergency Rooms Essay

A 4-Hour Door-To-Admission And 2-Hour Door-To-Discharge Time Model to Reduce Congestion in Emergency Rooms

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A 4-Hour Door-To-Admission And 2-Hour Door-To-Discharge Time Model to Reduce Congestion in Emergency Rooms

Introduction

• Change in 4-hour door-to-admission and 2-hour door-to-discharge time model

The emergency rooms are among the most congested rooms in the health centers. In this case, the patients tend to lack space for getting their medical services reduces the quality and effectiveness of the services as even the medical practitioners are overwhelmed.

The whole congestion can be attributed to the reduced patient flow within the health organizations that have the emergency rooms services. From definition, patient flow or patient throughput refers to the phenomenon through which the patients, within a given organization, move from one section to another as a sequence of getting medical care (Konnyu, Turner, Skidmore, Daniel, Forster, & Moher, 2011). The flow can be clearly indicated by a number of factors within the health care sector; the capacity of the healthcare center, the redundancies, the demand of the health services and the patient queues present for the patients.     

• Overview of the current congestion state in emergency rooms

The current state of congestion is such that the reduced patient flow within the hospitals is heightened. For instance, there has been a congestion problem in a hospital in North Kansas Emergency Department which called for a research on how the congestion can be reduced and the services run smoothly within the emergency rooms with the minimum length of stay possible within these rooms (Haybarker, 2015). Even though there has been introduction of strategic modes of improving the patient flow, such as the Real-Time Demand/Capacity Management strategies, the patients’ length of stay still remains a critical issue in the ER even though the capacity and demand have been improved substantially.

The major problem in all this is that there are deprived door-to-discharge as well as door-to-admission times within the ERs which cause the patients to pile up and stay for a long period within the emergency rooms. As a result, the length of stay is increased especially for the diagnosis of common illnesses such as pneumonia, stroke and other myocardial infraction conditions (Bernstein et al., 2008). As Bernstein et al. (2008) put it, the delayed time of services causes ineffectiveness in outcomes of patients with critical care needs as they hardly get timely initiation of therapy to contain their conditions.

 In view of the problem, it is important to develop a long term solution so as to initiate a smooth running of the ER sector. This research will propose a short term strategy that will yield long term effects in the health sector if carried out thoughtfully. Specifically, the proposal will be aimed at reducing the length of stay and thus reduce the congestion in the ER sector. consequently, a 4-hour door-to-admission and a 2-hour door-to-discharge strategy will be proposed as the mastermind approach of reducing the congestion within the emergency rooms. In other words, it is the purpose of this proposal to illustrate that the 4-hour door-to-admission and a 2-hour door-to-discharge strategy will reduce the congestion that is a common menace in the health sector especially in the emergency rooms. 

1. How 4-hour door-to-admission and 2-hour door-to-discharge time will reduce congestion in emergency rooms

Many researches such as El Sayed et al., (2015); Willoughby et al. (2010); and Haybarker, (2015) have associated a lengthy length of stay and a long door to doctor time to the increase in congestion experienced in the health care sector. Further, the congestion has been associated with the with the time taken with the transition of the patients from one care service to another whereby they end up spending more time within the emergency rooms than they could if the services were a little faster. The list goes on to entangle those awaiting admittance into and those awaiting discharge from the hospital’s emergency rooms. As the door-to-service time is high, then there results an ultimate congestion within these areas.

In as much as the departments may try to speed up the process, there is need to have a concrete framework for the mitigation of this congestion. The reduction of the 4-hour door to admission and the 2-hour door to discharge times is a key strategy to improving these conditions. This are the times set up and used all over the US in the emergency rooms of hospitals. As such, a reduction of the times would greatly reduce the length of stay of the patients within these rooms (Haybarker, 2015). 

The reduced times strategy will work based on the rationale that long times of waiting at the ER are the major causes of impaired patient throughput. The strategy will work if for instance, there is an implementation of a rapid admission and discharge system policy. The rapid admission system will work if the admitting personnel, upon deciding the need for the patient’s admittance, prompts for the writing of a basic admission order which dictates on the type of bed the patient needs so that the patient can be admitted prior to being attended to by the admitting service. In other words, the patient is given a bed and the admitting service come later to complete the admission procedure.

A similar scenario goes for the discharge practices in which case the nurse notifies the discharge services of a list of patients that intend to discharged at a given specific time of the day so. The discharge services personnel then work on the patients’ discharge process and documentation hours prior to the discharge. In so doing, the patients are not piled up during the admittance or the discharge process within the ER section.  

• Advantages for this newly proposed model
• Increased revenues as the problems such as ambulance diversions associated with overcrowded ERs will be reduced.
• Increased patient throughput.
• Enhanced image and reputation for the organization.
• Improved healthcare quality.
• Offers a long term solution against congestion.
• Increases capacity without expansion.
• Limitations of the newly proposed model
• Requires large capital inputs in terms of increased assets such as IP beds.
• May lead to an increase in indirect costs such as laundry.
• Financial Forecast of the new model

Assuming that there will be a need for increasing the number of IP beds in the hospital by say 8 beds (@ $595/ piece), total cost = 595*8 = $4,760; increase the hours of work for ER physician extenders personnel by say 2 hours ($27.81/hour), total= 2*27.81*24 workers = $ 1,334.88 per day; and increase the number of equipment used in the admission and the discharge units by two equipment for each unit (@ $395/piece), total= 4*395 = $1,580.

On the other hand, the hospital will reap of the benefits of reduced ambulance divergence which will greatly increase its revenues. For instance, if the hospital has 2 patients in a day coming on the ambulance but is able to attend to both of them without diverging them to another hospital (after reduced overcrowding), then the hospital will earn a revenue of $2,400 per patient which totals to $4,800 for the two patients per day. Additionally, if the time of admittance and that of discharge were reduced by 1 hour each, then there is a chance of clearing two beds in two hours for discharge. This would create an extra bed for admission of new patients. If a single admission is worth $600 per day, then the hospital will be able to make an extra revenue of $600 per patient per day, for the extra bed. If the hospital admits half as many patients as it discharges, and it discharges around 20patients per day, then it will make an extra revenue of $6,000 per day for ten admitted patients who would otherwise not be admitted in presence of overcrowding. Consequently, there will be an extra revenue of $(4,800 + 6000) = $10,800 per day just due from reducing of patient overcrowding.

The whole model of reduced admission and discharge times will require a starting capital of $6,340 for the additional equipment and the beds needed which marks the short term cost for the new model. In addition to the money necessary to pay for the added work time enough to sustain the workers for at least 4 months summing up to $160,185.6 with each month having 30 days which marks the long term costs for the organization. The total starting capital is therefore $166,525.6.

Comparing this with the revenue for the same period of time (four months) resulting from the reduced times of the model, the revenues would be $10800*120 days = $1,296,000 total revenues. It is clear that the revenues greatly outdo the costs on the short term period of four months. In this case, the monetary benefits outweigh the monetary costs for the model and this will result to a great value of return on investment given by: [(1,296,000-166,525.6)/166,525.6] *100% = 67.8%.   

Conclusion

In conclusion, the ROI for the whole new model is logically high which means it can be easy to implement and has many benefits as compared to the costs. The overall operation of the hospital will be improved as the patient throughput will be enhanced. 

References

Bernstein, S., Aronsky, D., Duseja, R., Handel, D., Hwang, U., McCarthy, M. (2008). The effects of emergency department crowding on clinically oriented outcomes. Academic Emergency Medicine, 16(1), 1–10. doi:10.1111/j.15532712.2008.00295.x

El Sayed, M., El-Eid, G., Saliba, M., Jabbour, R., & Hitti, E. (2015). Improving Emergency Department Door to Doctor Time and Process Reliability. Medicine, 94(42), e1679. http://dx.doi.org/10.1097/md.0000000000001679

Haybarker, B. (2015). Reducing Emergency Department Length of Stay by System Change (PhD.). Walden University.

Konnyu, K., Turner, L., Skidmore, B., Daniel, R., Forster, A., & Moher, D. (2011). What input and output variables have been used in models of patient flow in acute care hospital settings? Ottawa Hospital Research Institute, 1-20. Retrieved from http://www.ohri.ca/kta/docs/KTA-Patient-Flow-Evidence-Summary.pdf

Willoughby, K., Chan, B., & Strenger, M. (2010). Achieving wait time reduction in the emergency department. Leadership In Health Services, 23(4), 304-319. http://dx.doi.org/10.1108/17511871011079010

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