How Could the Wait Time in the Emergency Center Be Decreased Research Paper

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Wait Time in the Emergency Center Can Be Decreased

How Could the Wait Time in the Emergency Center be Decreased?

This paper discusses how long wait times and overcrowding can be reduced in emergency centers as a way of improving healthcare quality for all patients.

Physicians working in emergency departments are dedicated to offering high quality emergency care, as fast as possible, to all the patients brought into the emergency center. However, long wait times and crowding hamper patient safety. The ever increasing emergency patient numbers, coupled with critical shortages in the entire system of emergency medical care, play a role in limiting patients' access to emergency care on a timely manner. Patients with the need to see physicians in 1 to 15 minutes get attended to in 37 minutes, a figure twice the expected timeframe. The long wait times and crowding in emergency departments have been attributed to patients not being seen on a first-come, first-served basis, with regards to how triage works as a triage nurse assesses incoming patients to determine the ones with the most severe injuries or critical illnesses to see the physician first (although a patient might not look critically ill on the outside, it does not mean their condition does not need immediate care) (Siciliani et al., 2013).

The fact that diagnosis takes a long time also brings about long wait times in ED. Blood analysis, tests, imaging studies like CT scans and medical treatment do take time, hence increased wait times. Boarding is another cause of crowding and longer wait times because patients admitted in the emergency room have to wait for a patient to be discharged for them to access an inpatient bed. Although emergency physicians are available 24/7, specialist physicians can cause delays and longer wait times when they are not available to attend to new patients in the ED, probably when attending to other patients. This can result in patient referrals to other hospitals where they can receive the specialized care they need. Insufficient emergency departments due to closure, disasters and the fact that most patients visit EDs in the evenings and over weekends when most of the medical staff are off duty, are also attributed to long wait times and overcrowding in emergency departments. As a result of such delays, patients experience pain for longer as they do not get diagnosed and treated on time; this negatively affect patient outcomes in terms of timely healthcare provision. Shortage of nurses, physicians and inpatient beds, the availability of few EDs and the fact that the uninsured patients also need to receive care, are some factors that have been stressing emergency departments (Mcnew, 2014).

Solution to the Problem

There are effective low-cost solutions that can help overcome crowding and long wait times in emergency departments. For instance, health facilities need to reduce the duration within which patients are boarded or held in the emergency center before they can access inpatient beds. Admitted patients need to be discharged within reasonable time so that those in ED that need admission can be moved out of ER to inpatient areas. Boarding is evenly spread if hospitals ensure free movement of patients between the emergency center and inpatient departments; this relieves all the departments from stress that comes with overcrowding and delays. Inpatient beds can be made available by coordinating all patient discharges to take place before midday every single day, creating enough room for patients streaming in from the emergency department, especially in the evenings and over the weekends. The uneven influx of elective patients, which usually occur at the start of every week, should also be spread to ensure that inpatient units do not exceed their maximum capacity. This can be attained through the coordination scheduling of surgical cases and those of elective patients. A database can be created to store both inpatient and emergency center patient data, giving both departments access to the system. The emergency department can check free inpatient beds through the database and assign patients in ER that need admission. The inpatient department can also update the system as patients get discharged and admitted, enabling free flow of patients between the two departments. When hospitals adopt the three mechanisms and build a relevant database, they can improve patient care by reducing wait times and overcrowding in emergency centers, which in turn lead to overcrowded inpatient beds (Chan, 2010).

Description of the Data Needed to Answer the Question

The data needed to answer this question entails information on patients that visit the emergency center and inpatient data. There is a need to study a hospital's inpatient data with regards to patient admissions and discharge.

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The data on patients visiting the emergency center will help determine whether the hospital experiences long wait times in the emergency department and overcrowding of inpatient beds as a result (Chan, 2010). This data will be extracted and used to create the new centralized database system for the health facility.

Specific Instructions on How the Data Should Be Collected

The data will be downloaded from the inpatient and emergency center systems accordingly. Backend data extraction by the use of SQL Server management studio and queries will be deployed for data collection purposes. SSMS offers an Export Wizard task that can be used to extract data from the existing systems used in the inpatient department and emergency center. It offers the options of choosing from a range of data source and destination types, tables from which to copy data or particular queries for data extraction and even the ability to save the extracted data as an SSIS package. The data will be exported from SQL Server databases through the 'Export Wizard' to an Excel spreadsheet file. The following process will be used to extract data from the two systems (Brimhall, 2012):

1. Click on Microsoft SQL Server Program and select SQL Server Management Studio to launch the SSMS program.

2. Connect to the Database Engine through the prompt to make a connection.

3. The specific database (inpatient or emergency department database system) can be accessed under the SSMS Object Explorer.

4. Right click the chosen database under the 'Object Explorer' window and select 'Tasks'.

5. Launch the 'Export Wizard' by selecting 'Export Data' in the context menu that comes up.

6. Click 'Next' to go through the 'Export Wizard' step-by-step.

7. Choose a data source; the selections will be done automatically because the database from where the data is to be extracted was already chosen in the initial steps.

8. Click 'Next' to choose a destination; select 'Microsoft Excel' as the destination of exported data.

9. Specify the Table Copy or Query; select the first option to copy data from at least one table or view. It is also possible to use the query option as desired, instead of the former.

10. Click 'Next' to select source tables and views; the 'Preview' button can allow view of the first 100 rows of data in the selected table. Edit Mappings enable view and editing of tables that have been sourced from the source to destination of data. If none exists, a table can be created under the same window. If the 'Query' option was selected earlier, the statement can also be edited under the same window.

11. Click 'Ok' then 'Next' to save and execute the SSMS package; select the 'Execute' and 'Save' check boxes to do this.

12. Under the 'Save SSIS Package' window, the spaces shall have been automatically filled.

13. Click 'Next' to complete the export wizard.

14. Review the summary of selected options and click on 'Finish' to execute the 'SSIS Package'.

15. Open the Excel spreadsheet file to view the exported data.

16. The procedure is repeated until all the data needed to create the new database for the two departments (or the whole institution) is successfully collected from the existing stand-alone databases (Brimhall, 2012).

During the data extraction and transfer process to the new database, accuracy and integrity must be upheld to ensure the information is in its rightful form. The data can be backed up in an alternative location, in addition to being verified for accuracy and integrity. It is advisable to do data extraction on the facility's backup systems to avoid any interruptions with the ongoing system functionality and use.

How to Maintain Data Integrity and Accuracy

Data integrity ensures that the collected inpatient and emergency center data is accurate, valid and consistent, without any alterations. Integrity will be imposed on the data during database creation and authenticated through continual validation and error checking routines. Data is kept free from modification, corruption and unauthorized disclosure to ascertain its accuracy and integrity, rendering it reliable and auditable. Other measures of maintaining data integrity and accuracy include: input validation to eliminate incorrect data entry; data backup in alternative locations; access controls to manage user privileges with regards to data access; data verification to ascertain accuracy; data encryption; and data validation to ensure no corruption during extraction and transmission (Hernandez, 2013).

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