Overview of Emergency Room
Emergency rooms are one of the most vital units in a hospital setup. These are the areas where clients are attended to first depending on various categories of injury severity. This unit serves as a tool used to determine whether the patient should be admitted or attended first. In this way, hospitals reduce the mortality rate and offer care in a strategic manner. Moreover, emergency rooms are the areas where grouping of patients as per disease is done. The transmission of communicable diseases, thus the chances of nosocomial conditions, is reduced. There exist certain codes worldwide that are used to effectively assist healthcare practitioners to decide who should be attended first. Hospital Emergency Codes help in delivery of prioritized care and, at the same time, reduce confusion, commotion, panic, and stress among the staffs and patients’ relatives and friends. These codes are harmonized in different countries to reduce confusion related to interpretation. Standard colors are red, blue, yellow, orange, and black. Code blue is used to represent patients requiring medical procedures such as resuscitation and immediate care.
Mostly, alarms are used that communicate emergency cases. These alarms alert the emergency team. In such cases, patients coded blue are given priority over the others. Emergency units need proper organization and arrangement that will ensure smooth flow of patients in an orderly manner. The staff should also be adequate and competent enough to reduce the number of cases where patients are delayed from receiving care. Otherwise, the mortality rate would increase, complains from clients would become more numerous, and there would be aberrant staff behavior. The staff would engage in conflicts and internal squabbling, which will decrease the productivity and quality of care (Melissa, Cohn, & Bakas, 2011). This can result to the poor flow of patients or may even lead to admitting patients to wrong wards units. Consequently, the whole hospital will fall into a quagmire with conflicts between staff members, patients, and between all stakeholders of the hospital. Finally, the hospital will crumble. Therefore, it is essential to evaluate the functionality of emergency unit and ensure that all complains received from stakeholders are addressed appropriately and without delay.
Root Causes of Complaints in the Emergency Room
Inadequate Patient Care
The quality of care given to the patient is directly related to the staff commitment level, competence, and availability of necessary equipment. Once these factors are affected, they cause an imbalance between the inflow and the outflow of patients in a unit (Melissa, Cohn, & Bakas, 2011). Commitment level is highly linked to the motivation of staffs as well as their morale in carrying out their duties. According to theory X postulated by McGregory, people dislike working. Therefore, it is up to hospital’s management to institute mechanism that will promote productivity of workers. This can be enhanced by giving monetary or nonmonetary incentives to the staffs. For instance, it has been identified that the staffs will perform better in cases where they are not overloaded, where they are allowed to offer services in areas they feel suits them, and in cases of minimal staffs conflicts. The main causes of low commitment level in this clinic have been identified to arise from low motivation, little understaffing, and unsolved organizational conflicts.
Competent staff will be in a better position to deliver quality care needed by clients. Most often, the emergency unit deals with emergency cases, where patients need immediate specialized care. Therefore, the staffs are required to act fast with minimal levels of external interventions. Patients in this unit are also extremely vulnerable to external intervention, therefore, even the slightest mistake in care delivery may lead to death within a remarkably short time. Staffs need to equip themselves with the right knowledge, skills, and experience to react to clients’ needs within the shortest time possible and, at the same time, offer the best quality care. In this case, the management has to ensure that the recruits have attained the required levels of expertize. Moreover, the staffs should have different specialties for handling cases in the emergency room. Specialist in heart problems, respiratory conditions, and other emergency cases must be available on call within the shortest time possible. Lack of specialist in the emergency room was also noted to be the cause of complaints about inadequate patient care.
Staffs may be available, highly committed, and with necessary competencies, but with inadequate equipment and supplies the quality of care will be significantly reduced. The emergency room has to be supplied with sufficient equipment and other accessories needed for providing the required care (Melissa, Cohn, & Bakas, 2011). For instance, the clinic having limited number of resuscitation trays, inadequate infection prevention barriers, drugs, and referral strategies (e.g. ambulance) has little capability to offer quality care. Therefore, clients will constantly complain about poor quality care. Interestingly, the equipment may be within the hospital, yet staffs may not be allowed to use it. This causes discomfort or waste of time since permission to use the equipment has to be obtained. In other cases, hospitals that are well equipped with high-standard machines, accessories, and equipment, have staffs that are short of required skills to operate and use the supplies. Hence, these hospitals are no different from those institutions that have no equipment.
Poor Emergency Room Management
Quality management is highly determined by the qualification and flexibility of management teams. Every institution has to be guided by a strategic plan, vision, mission, and goals that must be achieved within a specified time. Failure to set guiding objectives reduces the drive for result-oriented activities, which are replaced by routine work. Management involves recruitment of employees, overseeing institution's daily running, and caring for the welfare of the staff among others. A common observation in several institutions is that failure of the management team immensely decreases the level of employees’ output. The management team has to accommodate technological and environmental changes among other changes affecting the institution (Melissa Cohn & Bakas, 2011). Therefore, lack of flexibility will promote resistance to change, hence lack of improvement. Accommodating differences in ideas, culture, and behavior is an imperative duty of the management team. Factors such as corruption, discrimination, conflicts, and poor problem solving strategies are some of the causes of poor management. These factors were also identified in this clinic.
Long Wait Times
Most of the time, emergency rooms function under the principle of triaging. Patients are attended depending on the severity of their condition. Critically ill patients are prioritized over those, who have minor or less life threatening conditions at a given time. The triaging is done frequently depending on the progress of the condition. The increase of waiting time can be associated with understaffed unit, increased number of patients, limited space, or poor supply of required equipment. Understaffing or insufficient number of healthcare professionals on call will increase the time patients will have to wait for services. In case of a disaster or when the hospital is located in the place where there are numerous patients, quality of service delivery tends to be low. Long waiting hours cause patients to develop mistrust towards the staff. This also increases dissatisfaction with the level of services since patients, their relatives, and significant others consider this as a lack of concern and inhuman attitude. Therefore, this leads to patients’ turnout in such hospitals/clinics. Despite the fact that staff may be busy, it is the role of management to ensure that patients are attended in the shortest time possible. These factors were the main causes of delays in patient care delivery (Mitchell, 2012; Committee of the Health Team, 2007).
Failure to Attend to Patients
When staff-to-patients ratio is destabilized, the option that the hospital has to choose to save patient’s life is to refer him/her to another healthcare institution. Lack of space can be attributed to either increased number of patients seeking services in the facility or to poor admission strategy. In some hospitals, especially profit making institutions, admission of the patient is recommended since it helps the hospital to generate income through admission charges. In other cases, patients who are not supposed to be in the emergency room are retained due to poor prognosis evaluation strategies. It was determined that the clinic had inadequate number of staffs with necessary skills to attend to patients. The admission strategy also proved to be defective in that many patients hospitalized had to be placed in wards and not in the emergency room. Moreover, scheduling was poorly done in that there was poor expertise distribution (Griffey & Bohan, 2006). Another problem identified in the clinic that contributed to the issue of patient being chased away was the unavailability of staffs since there were no staff quotas around the clinic. In cases of emergency, the staffs were out of reach making it difficult to attend to patients in time.
In conclusion, the main problems identified as the cause problems concerning service delivery included the following: inadequate staffs, poorly motivated workers, corrupt management teams, accumulated internal wrangles among the staffs, lack of staff quotas, absence of the strategic plan, and shortage of facilities.
Strategy to Overcome the Challenges
The issue of staffing has to be seriously considered by the hospital. Inadequacy of staffing can be solved by involving part-time employees or locums in cases of severe need for additional employees. The staffs have to be well motivated through giving them days-off and ensuring that their achievements are realized. Moreover, scheduling should involve mixed skilled staffs at any given period. The recruiting process should be based on the needed skills, experiences, and knowledge to fill in the vacancies identified. To reduce instances of long waiting hours and chasing away patients, the clinic should hire staff residing in a nearby locality. This move will ensure that employees will respond immediately when they are signaled (Committee of Health, 2007).
Massive overhaul of the management team should be enforced and vacancies should be filled on a competitive basis. Those running for any post in the management team must present strategies on how they will help develop the clinic. Their objectives (manifesto) must be presented to and evaluated by the stakeholders so that they could take such position. This will reduce cases of discrimination, corruption, and under-performance of the management team. Consequently, the emergency room will be under considerable management. The management should involve affected stakeholders in the decision making process and two-way communication should be encouraged.
With goal oriented emergency room management, supplies that are required in the emergency room (resuscitation equipment, infection prevention facilities, etc.) strategic plan guiding the operation of the clinic, problem solving mechanism, and appropriate conflict resolution mechanism will be readily available. Consequently, complains will be addressed and operation of the clinic will be boosted to a level that will satisfy the clients. The main problem that should be solved is poor management of the unit (Committee of Health, 2007; Griffey & Bohan, 2006).
Good Samaritan Law
Good Samaritan law refers to laws based on kindness that make people help others. These laws do not apply to cases of revenue generating rescue missions. The Good Samaritan law protects well-wishers in cases of mistakes that lead to adverse outcomes concerning the victim (Texas Medical Association, 2012). These laws are meant to reduce fears of being sued that make people hesitate about helping others that may need immediate care. Many countries approve these laws to protect healthcare professionals from litigation that may result from haste intervention meant to safe the patient. However, the jurisdiction of laws does not extend to professional dues in institutions.
Emergency room patients need immediate attention and intervention. Delays will only exacerbate the poor prognosis of patient’s condition. In the hospital/clinic setup, the health care professional will have to conduct investigation and document procedures and interventions. This process may be time consuming, thus threatening the life of the victim. Specific procedures have to be followed for legal purposes to ensure that professionals are protected. Therefore, even when the professional is willing to help the patients immediately, certain procedures have to be followed to avoid being sued. This happens because the Good Samaritan Law does not protect them. The fear of being sued holds them back from giving the urgent care needed (Deguerre, 2004).
Prioritizing Emergency Levels
The priority of patient care delivery must be guided by the need to save client's life in all possible ways. In many cases, trauma patients are severely injured as most of them loose a lot of body fluid through bleeding (Griffey & Bohan, 2006). Therefore, the first priority should be given to this group. The hospital should provide necessary facilities and skilled personnel to handle these cases. Once patients are stabilized, they are then transferred to the intermediate. The basic level is also vital emergency care. This level is involved in giving first aid services as the specialist analyses the condition of the patient. The moment the patient comes in, the first aid group should be in a position to receive the client and provide resuscitation intervention. The intermediate care will be provided after the patient receives first aid and resuscitation care. Then the patient will be admitted for consistent monitoring and investigation to evaluate the prognosis. Long-term plans for the patient are formulated and implemented at this level. Transfer of the patient will involve discharging patient home or referral to a higher level of admission to proceed with their diagnosis. To reduce congestion, commotion, and confusion among the staffs, patients, and relatives there should be a strategized flow of patients (Committee of Health Team, 2007).
Effective treatment starts with understanding patient’s requirements and formulating a plan aimed at meeting client’s needs in a prioritized manner. Physiologically, adults differ from children. The procedure of care delivery to an adult is different from the one to a child. For instance, the consent is given by different individuals in these two cases. The staff should be prepared to handle patients of different ages and offer necessary care to them. However, once patients have been stabilized, they should be referred to the specialist for further care (Griffey & Bohan, 2006).
Children, minors, and incompetent minors should be accompanied by a close relative if not a parent/guardian to provide consent for treatment. This will ensure that there is an agreement between healthcare providers and patient’s representative. Adults and emancipated minors will be required to give their own consent in cases they are able to do so (conscious). People who refuse to provide consent will have to sign a form showing that they declined treatment and gave reasons as to why they declined the treatment. However, adequate informing of patient to help him/her understand the importance of treatment must be done before the patient officially rejects treatment. This form (Against Medical Advise) will ensure that the patient is fully responsible of his/her choice (Wagner, 2012).