Strategies and solutions to alleviate access block and overcrowding in emergency departments

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The major goal of this article is to provide evidence-based remedies that hospitals and emergency departments can implement to ease the worry of access block, which has been identified as underlying in the growing public health burden of overcrowding. The study employs a literature-based analytic method, with the primary goal of discovering techniques from existing knowledge and contextualizing them to the Hong Kong setting. The data extraction and synthesis noted that holding units, political actions, early discharge, as well as improving patient flow as critical strategies for addressing access block. Expanding primary care facilities, improving issues pertaining to emergency nurse practice were evidence-based means of addressing overcrowding in the E.R.

The article is critical in the exploration as it explores both the negative public health implications of ED overcrowding as well as solutions to addressing the challenge. The centrality on the two areas is an international focus of all health systems, an aspect that justifies the need for the study. Despite being congruent with the universal ideals, the study exhibits serious methodical concerns which arise from the systematic review. While it is one of the cheapest approaches of carrying out transnational studies, the paradigm calls for addressing inconsistencies that can affect interpretations. However, the study fails in the standardization by including studies from the U.K, the U.S, and Australia, where access block is perceived differently. By making an assumption that access block is the underlying factor in the ED overcrowding, the article also ignores a widely-accepted concept that increased attendance, overutilization, as well as deficiencies in staffing also contributes to the problem.

While it has emerged as a leading cause of preventable deaths and complications, the article concludes that overcrowding can be addressing by replicating existing solutions in the literature. The thematic coverage will be critical in the exploration, where justifying the existence of overcrowding, its negative implications, as well as proposing research-based solutions will be the primary explorations.

DeFlitch, C., Geeting, G., & Paz, H. (2015). Reinventing Emergency Department Flow via Healthcare Delivery Science. HERD: Health Environments Research & Design Journal, 8(3), 105-115.

The study is a discussion of a computer model, which is driven by the need to address overcrowding because of its implications on access and quality of care. The case study is dictated by the fact that despite experiencing overcrowding, which can be resolved by physical investments such as reducing patients’ volume and expanding ED facilities, the approaches are unattainable because of the limited space in urban settings as well as increase patients expectations. The study works on the assumption that computer models can be used to improve efficiency and patients capacity handling as the case of industries, thus increase staff and patient flow. The model utilizes staff input and operational data as well as flow in staff and patient numbers to identify bottlenecks in the system. The system employs the ideas to design a simulated model, which aims at improving patient-directed queuing and caregiving. The model was tested and confirmed to improve efficiency concepts such as waiting times, patient experience, as well as reducing incidents of leaving ED without receiving seeing the doctor.

While the findings are mostly hypothetical, the article highlights the potential of technology in breaking overcrowding-patient safety nexus. However, there is a need for more trials to address real-life practice issues as well as human interactional elements, which the study does not cover.

The article concludes that practical application of the model can be used to address inefficiencies that are associated with overcrowding. The exploration will be fundamental in the exploration, where technological adoption is one of the proposed solutions to overcrowding and its associated issues.

Uscher-Pines, L., Pines, J., Kellermann, A., Gillen, E., & Mehrotra, A. (2013). Deciding to visit the emergency department for non-urgent conditions: a systematic review of the literature. The American journal of managed care, 19(1), 47.

The article is exploring personal-level factors that are fundamental in shaping the decision to visit ED among cases considered non-urgent. An underlying focus on the topic is that non-urgent conditions have contributed to not only the growing financial burden of overutilization of ED services and unnecessary examination and treatment but also overcrowding that contributes to poor patient-provider relationship that increases the probability of adverse outcomes. The study adopts a systematic review of the studies conducted in the United States after 1990, where the inclusion criteria majors on sieving out factors associated with unnecessary ED visits. The articles were independently appraised by L.U.P and E.G, where 26 were picked for content analysis. The study found out that race, gender, and income were some of the underlying factors in the overutilization of urgent care, where African Americans, women, and economically disadvantaged groups reported the high likelihood of visiting E.D even if the condition was not life threatening. Similarly, medical cover and social support contributed to the concern of moral hazard, with poor health status and previous experience with the healthcare system also playing a fundamental role. Other contributing aspects were cultural perception, perceived severity, convenience, access, health beliefs, and cost.

The article offers one of the most epigrammatic discussions on the subject by exploring underlying factors in the overcrowding. The significance is exemplified by quality controls, where despite utilizing systemic review, it employs independent evaluators and uses studies from the United States only to address inconsistencies that can arise from the transnational studies. Nevertheless, the use of meta-analysis still poses methodical concerns such as conflict with findings of primary studies, heterogeneity shortfalls, as well as selection bias.

While it recognizes that overcrowding will remain a source of socioeconomic burden in coming years, the article concludes that comprehensive explorations will be key to containing the problem. The article will be relevant in the project, where addressing the inconsistencies in the causes of overcrowding is the major area of focus.

Wong, A., Combellick, J., Wispelwey, B., Squires, A., & Gang, M. (2016). The Patient Care Paradox: An Interprofessional Qualitative Study of Agitated Patient Care in the Emergency Department. Academic Emergency Medicine.

The article is discussing a phenomenological study, where lived experiences of emergency medicine physicians, ED nurse practitioners, hospital police officers, and patient care technicians was assessed at a New York City hospital. The underlying motivation in the exploration is a growing body of evidence, where ED has been categorized as a high-risk environment. It has emerged as not only a contributor of mortality and morbidity aspects but also criminological issues such as violence. A growing number of cases report that patients are perpetrating violence against providers, which highlight the spillover impacts of overcrowding if not addressed. It raises security issues not only from a healthcare perspective but also criminological one following agitation and negative patient experience. The study corrected data in a uniprofessional group focus as well as in-depth interviews. The study found out that overcrowding does not only pose safety threats but also domino health challenges. Similarly, the qualitative exploration notes that inter-professional collaboration has the potential to neutralize the effects of the problem. However, systemic and environmental solutions also have a critical role in the solution.

The article is the only primary-based study, and thus offers unique and irreplaceable arguments in developing the project. It's phenomenological approach makes its inclusion to the resources more exciting. Nevertheless, its positivist approach is a major shortcoming, as it raised critical reliability issues because of concern of fabricating views as part of protecting the profession.

The study concludes that overcrowding in the ED is a multi-dimensional and complex issue, which should be addressed in a four-tier approach (Individual, inter-professional, environmental, and systemic levels). The study will be critical in developing arguments of the study as well as solutions to the overcrowding. Its primary data-driven strategy will induce new ideas, including contemporary aspects such as overcrowding as a criminological concern in hospital settings.

May 17, 2023

Health Education



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Hospital Public Health Study

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