Level Of Agitation In ED

Level Of Agitation In Emergency Department
Objectives: The primary purpose of this study was to determine the level of agitation that
psychiatric patients exhibit upon arrival to the emergency department. The secondary purpose was
to determine whether the level of agitation changed over time depending upon whether the patient
was restrained or unrestrained. Method: An observational study enrolling a convenience sample of
100 patients presenting with a psychiatric complaint was planned, in order to obtain 50 chemically
and/or physically restrained and 50 unrestrained patients. The study was performed in summer 2004
in a community, inner–city, level 1 emergency department with 45,000 visits per year. The level of
patient agitation was measured using the Agitated Behavior Scale (ABS) and
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Emergency Department Bottleneck
Emergency Department Bottleneck Proposal
Joyan Thomas
University of Phoenix Online
OPS/HC 571
Patience McGee
March 7, 2011
Emergency Department Bottleneck Proposal
Introduction
Most hospitals experience the affects of the unexpected, ambiguity and uncertainty, and as a result,
face challenges with quality. Middletown Hospital is a 200–bed general not–for–profit hospital. The
hospital has a 20–bed Emergency Department (ED). It averages 100 patients per day. The CEO of
the hospital has been receiving numerous complaints about long waits for care and poor service and
has charged the Six Sigma team to analyze the root cause of the bottleneck (University of Phoenix,
2011 Course Syllabus). This paper analyses the root cause ... Show more content on Helpwriting.net
...
Using time–motion studies will give the team a complete assessment of the patient flow from
registration to dismissal from the emergency room. Time–motion studies will involve a step–by–
step measurement of the length of time the patient spends in each phase of the process. Examining
the cycle times over several days can identify the time bottlenecks are occurring in the patient flow
process and at what stage. The goal of capacity planning is to ensure that patients move along the
shortest and least costly path by avoiding as many delays as possible (Rechel, Wright, Barlow, &
McKee, 2010). Using capacity planning will systematically guide the team through analysis of the
demand and availability of resources. Scheduling and controlling techniques With the six sigma
authority in place, the first recommendation is to change the scheduling pattern of the shifts. By
doing so they can put more doctors and nurses on the shift that falls from 6:00 to 9:00 p.m. where
the overloading of patients comes into the emergency room. When this is done, it will have adequate
assistance to help with the high volume of patients coming into the emergency room during the 6:00
to 9:00 p.m. hours. If more doctors and nurses are on that shift, more patients will be seen and taken
care of at a faster time and the turnaround rate will be more than suffice.

The

The Emergency Department At Saint Vincent 's Medical Center
Introduction Every day in the United States there are 136.3 million people that visit the emergency
department (CDC, 2015). To put this number into perspective that is 44.5 people per 100 persons
(CDC, 2015). 11.9% of these visits result in hospital admission leaving 88.1% of visits to be
discharged home with or without caregiver assistance or to another healthcare facility (CDC, 2015).
While high numbers of patients being discharged is desirable, it is important to consider that "In one
out of every 30 discharges things get missed. [For example] patients [are] sent home who didn't
know how to use their insulin or they got the wrong prescription" (Maguire, 2011). Another
important statistic to recognize is that "Ninety million Americans have difficulty understanding their
own medical care" (McCarthy et al., 2012). Similar adverse events and misunderstandings of
medical care have been occurring in the emergency department at Saint Vincent's Medical Center in
Bridgeport, Connecticut–a 60–bed emergency department with a fast–track zone that is classified as
a level one trauma center. The nurse manager of the emergency department at Saint Vincent's stated
that many patients were not being adequately educated during discharge. She placed most of the
blame on the nurses as it is the nurse's responsibility to be educating and providing all patients with
clear and concise discharge instructions. As of right now, most emergency departments do not have
discharge instructions that

My Life After A Volunteer At The Emergency Department
I was never fully able to wrap my mind around how one discovers their vocation in life. It was not
until last summer that I was able to uncover my passion. My novel discovery would take place
during, one of the most scorching months of August I ever recall experiencing. It would be during
this amplifying heat that I would conclude to go to Mercy Hospital and become a volunteer at the
Emergency Department. This day would not only come to symbolize an inflection point in my life
due to the fact that I had recently emigrated from Spain, but a realization of my calling in life.
As if it was yesterday, I remember I had to wake up punctually that day. My father, a draconian man
in his fifties, would have to drop off my mother first at her office, and afterward, come back home
to pick me up. Weak sunbeams shone through the blinds of my dusty window, taking with them a
sweltering tangibility that would congest my silent room. I suddenly got up, breathing heavy as if
the flaming spears of the sun had pierced my lungs.
Soon after I dashed to take an encouraging shower. Promptly, I put on a red polished polo with
hospital miniature logo. I added blue cargo pants, which I thought would fit better for the unknown
tasks waiting for me at the hospital. Since the first moment I exited the bed, my mind had generated
persistent feelings of inquietude. With the smell of brand new clothes still hovering in the air, I
believed myself to possess a health professional when my juvenile figure

The Emergency Department For Healthcare Organizations
The Emergency Department for most healthcare organizations has been referred to by many as the
gateway to the entire hospital. This is largely in part due to the observation that the Emergency
Department is often the most frequently visited department of the acute care hospital that many
patients will ever receive care from (Falcone, 2013). The Emergency Departments function by its
design is to fulfill a healthcare organizations obligation of providing care during episodes of acute,
severe injuries or illnesses. This function at times can be one that requires a unique workflow to be
present within the department. Adding to the required tasks needed to fulfill this obligation, is also a
large patient population who utilizes the emergency departments resources for non–acute and/or
chronic medical conditions that are best classified as non–emergent in nature. Nonetheless, the
Emergency Departments of healthcare organizations who are participant's in Medicare and
Medicaid, must balance the allocation and utilization of their resources to accommodate both these
acute and non–acute patients within the guidelines that have been set forth by the Center for
Medicare and Medicaid Services or CMS. In addition to this requirement, other regulations such as
the Emergency Medical Treatment and Active Labor Act (EMTALA) stipulate that under certain
pre–defined "medical conditions", Emergency Departments are required to provide a standard of
care which can include ensuring that an

Emergency Department Models of Care
Emergency Department Models of Care July 2012 NSW MINISTRY OF HEALTH 73 Miller
Street NORTH SYDNEY NSW 2060 Tel. (02) 9391 9000 Fax. (02) 9391 9101 TTY. (02) 9391 9900
www.health.nsw.gov.au This work is copyright. It may be reproduced in whole or in part for study
or training purposes subject to the inclusion of an acknowledgement of the source. It may not be
reproduced for commercial usage or sale. Reproduction for purposes other than those indicated
above requires written permission from the NSW Ministry of Health. © NSW Ministry of Health
2012 SHPN (HSPI) 120204 Further copies of this document can be downloaded from the NSW
Health website www.health.nsw.gov.au or Emergency Care Institute NSW website
www.ecinsw.com.au August 2012 ... Show more content on Helpwriting.net ...
Created to support this document is a self–assessment tool for each Emergency Model of Care. The
purpose of the tool is to allow Local Health Districts to assess if a MOC is appropriate for their ED
or if an implemented MOC is functioning to its utmost potential. The tool is intended to be used at
an ED level in a collaborative approach with all key stakeholders. The Self–Assessment tool rates
the effectiveness of each model. Results of the self–assessment are then linked to responses based
on the key principles described for each MOC. A robust evaluation of each model can be used to
generate an action plan for an ED to improve the functioning of current Models of Care being used,
or to consider the implementation of new models. Assess the current Models of Care in their
Emergency Departments using the given criteria It is recognised that not all of the Models of
Emergency Care are applicable for all NSW Emergency Departments. Decisions to implement them
will be made based on the staff, patient presentations and space available in the ED to operate each
model. Assess the potential to introduce models to their hospitals that may improve patient care and
flow, the patient experience and clinical outcomes ■ PAGE 2 NSW HEALTH Models of Emergency
Care The demands placed on Emergency Departments are obvious, as are the needs for the

Emergency Department Chief Compliant Data Entry Screen
Screen 1. Emergency Department Chief Compliant Data Entry Screen.
1. What is the purpose for the screen?
The chief compliant screen will allow clinicians to enter patient's reasons for visiting the emergency
department. The chief complaint data entry screen will be to obtain information from patient such as
symptoms, duration of symptoms, and what major problem they are experiencing as a result of
symptoms. The chief compliant data entry screen does not deals with obtaining information about
chronic illness or history of family disease. Rather, the data entry screen will enable clinicians to
prioritized treatment intervention based on severity of patient's condition. Furthermore, the data
capture in the chief complaint entry screen can be ... Show more content on Helpwriting.net ...
The data element will be highly instrumental when it comes to treatment regiments, and ordering
diagnostic test to further gain insights to medical concerns. The data element in chief compliant
screen can be used to prioritized patients treatment; patient with less severity can be identified at the
time of computation and classified for treatment priorities.
3. Why is the type of data entry appropriate for the data element?
The free text data and check box entry will appropriate for the purpose of obtaining chief complaint
from patients in sense that only human intelligence can prioritized and determine what the chief
complaint of patients really are, The free text data entry will allow clinicians to input narrative detail
about the patient's medical concerns, and due to the fact that complicated details are more easier to
describe through imputed texts. Furthermore, free text data entry will capture robust information
about patient's medical condition and can be used to support and improve quality of care. Check box
data can be used to gauge the severity of symptoms that will include duration of onset of symptoms,
pain scale measurement. Also, patient's age group, and race/ethnicity can used the check box data
entry tool.
4. How did you design data quality into the screen?
The design for data quality for the chief medical compliant screen

Emergency Department Practicum
During my practicum in the emergency department, I utilised my interpersonal, negotiation and
conflict resolution skills to de–escalate a situation during a busy shift. When asking the patient how
I could help her, the patient became verbally aggressive. Expressing displeasure with her nursing
care, a lack of communication, the long wait time for medical treatment and not being offered food
and drink. I let the patient express her issues, maintaining eye contact, actively listening with an
open posture so the patient would know, I was listening. In a calm voice, I assured the patient I
would enquire about her test results from a staff nurse and the doctor, then come back to her shortly.
Firstly, I talked to the patient's nurse, advised

Emergency Department Crowding
Abstract
America has expanded so much over the last decades. People are living longer due to advancements
in technology. However, the down side to this circumstance is over populated areas in the U.S. The
impact is tremendously felt in the health care settings of hospitals. Hospitals are having a difficult
time accommodating patients. Hospital department leaders, are responsible for management
performance in their hospital, there are several reasons why emergency department crowding should
be at the head of the hospital improvement efforts. The purpose of this paper is to address those
issue.
Medical Care Delivery System
The United States health care system is currently in need of an overhaul. The U.S health care
hospitals are having a ... Show more content on Helpwriting.net ...
In order to fix the situation if a bed is not available patients could be treated in the hall depending on
the problem at hand. Unfortunately, the down side is for women requiring an examination she will
have to wait until a room is available. Likewise, some hospitals are handling patients more speedily
by using a team method approach. Resulting, in a patient being seen by a doctor, nurse and
registration nurse immediately. Due to the fact that, he or she can order needed tests and procedures
as well as quickly treat patients if necessary (Marte, 2013). Majority of the hospitals today are
advertising their wait times on a website. Hoping to allure people to their facility and not their
competitors. In doing so by lowering the emergency room wait times. All in the effect of a pay–for–
performance system established by the Affordable Care Act. Medicare disbursements to hospitals
are somewhat based on patient fulfillment ("E R Wait Time," "n.d.").
Another area that needs correction is the way information is shared between healthcare
professionals. Years ago a patient's files were paper notes that were actually stored on the premises
of a physician. In the recent year's patient's information from hospitals, doctors' offices, and medical
centers store health information electronically ("Kids Health from Nemours,"

The Federal Emergency Management Agency ( Fema ) Of The...
One dominant agency is the Federal Emergency Management Agency (FEMA) of the United States
Department of Homeland Security. FEMA was created on 1979 by the late President Jimmy Carter
that signed the executive order to support the citizens and first responders to ensure that as a nation,
people work together to build, sustain and improve our capability to prepare for, protect against,
respond to, recover from and mitigate all hazards. Another program called National Earthquake
Hazards Reduction Program (NEHRP) was developed to lead the federal government's effort to
reduce the fatalities, injuries, and property losses caused by earthquakes. This program was
established in 1977 to coordinate their complementary activities with FEMA, the ... Show more
content on Helpwriting.net ...
Preparedness Programs As mentioned earlier children is one of many vulnerable group of people
when an earthquake occur. They do not concern themselves with training and conducting safety
drills compared to adults who wants to and needs to prepare for such disasters. Children are more
interested in making friends, playing with friends, learning, and, of course, having fun at home and
school. Most of the time, children are at school doing what they need to do, which is to learn from
what the school has to offer. They do not fully understand that they may be separated from their
family, loss their parents or brothers and sisters, and experience a horrific destruction of seeing
severely injured people or even dead bodies. This is something that should not happen and
experience by child. It will be extremely difficult and traumatizing for that child if they do
experience it. However, there are many programs that are developed to mitigate such experience
from a child. In California, there are school programs that will help prepare the children for the
disaster. Not just that, the program are placed to help them gain knowledge on the mechanism of
natural disaster, to be specific an earthquake disaster. The California Governor's Office of
Emergency Service (Cal OES) (2008), developed a program that

The Emergency Department At St. Agnes Hospital Essay
As a medical scribe in the Emergency Department at St. Agnes Hospital, I constantly work in a fast
paced environment and learn something new everyday. Some days are good days. Some days go
badly. My third day of training as a medical scribe was a bad day. Eight hours into my shift
alongside my assigned physician, Dr. David Hale, we had already seen a myriad of symptoms and
ailments from nearly twenty patients. Suddenly, an urgent overhead page called out, "Code Heart
Emergency Department Room 5." Dr. Hale sprinted to Room 5 with me rushing to keep up. The
space was filled, shoulder–to–shoulder, with emergency medical services (EMS) and several nurses.
I squeezed my way through the gathered crowd. A paltry three days of training left me simply
awestruck amongst so much activity.
Our patient had arrived by ambulance complaining of dyspnea. The patient was already in
cardiopulmonary arrest and receiving cardiopulmonary resuscitation (CPR) from EMS. The doctor
had the team switch over to LUCAS CPR. Unfortunately, after thirty minutes the patient still had no
return of respiration. The doctor made the call to administer tissue plasminogen activator, which was
followed by LUCAS CPR. During the last periodic check, the patient had spontaneous respiration
and progressively became more alert and awake. Although the whole event lasted just 45 minutes, it
felt like several hours. The stress, tension, and unease in the room were palpable. I clearly recall
standing wide–eyed in Room 5

The Role Of Emergency Department Physiotherapists And The...
History
Physiotherapists were first able to serve as primary contact providers in Australia in 1976 with the
lifting of the Australian Physiotherapy Association's ethical principle stating "It is unethical for a
member to act in a professional capacity except on referral by a registered medical or dental
practitioner". [1, pg 217] Although the change met much debate, the United Kingdom followed suit
in 1978. [1] This legislation had yet to pass in all 50 American states, the District of Columbia, and
the US Virgin Islands until July 1, 2014. [2]
Primary contact physiotherapists first arrived in emergency departments in the United Kingdom,
with the role quickly expanding to Australia. [3, 4] The profession has continued to expand and
evolve to better service in Emergency Departments. [3, 5, 4] Many studies have been performed
regarding the roles of Emergency Department physiotherapists in both Australia and the United
Kingdom, the data of which will be reviewed. However, with the implementation running behind in
the United States, there are few studies pertaining to physiotherapists in American Emergency
Departments.
Definition
Physiotherapists in the ED are identified by many different titles both in the United Kingdom and
Australia. In the United Kingdom they may go by Emergency Department Physiotherapy
Practitioners (EDPPs) [6], Extended Scope Physiotherapist (ESP) [7], or A&E Physiotherapy
Practitioners [8]. In Australia physiotherapists may hold the title of Emergency

Emergency Department Ratios
Soleimanpour et. al (2011) explained that patient satisfaction is an essential component in the
Emergency Department (ED) because it is the entrance for patients to receive their initial treatments.
The most important and single possible cause for ED patients' flow problem is the availability of
inpatients beds (Peck et. al, 2012). The American College of Emergency Physicians (ACEP) (2011)
explained that the primary cause of ED overcrowding is boarding; which was defined as holding
patients in the ED after the admission had been completed due to unavailability of inpatient beds.
Lutheran Medical Center faced this problem and in his paper will discuss analysis of the problem,
determination of possible quality lapses, identification of performance measures, designing and
evaluation of the interventions and reporting of the results. The quality improvement tool which
would be used to analyze the problem is the Root–Cause Analysis (RCA), which is a ''post hoc"
process to evaluate a problem after its occurrence (Lighter, 2011). RCA ... Show more content on
Helpwriting.net ...
The structure involves the infrastructure that is needed to deliver medical care such as medical
equipment, staff, information system, workplace, culture and physical structure (Lighter, 2011). The
process involves the essential procedures and steps to provide healthcare services to customers and
this include finance, service utilization, compliance and customer satisfaction with care (Lighter,
2011). The outcome measures assess the process effectiveness, which includes two types: business
and clinical outcomes (Lighter, 2011). Examples of business outcomes are insurance billings return
and customer satisfaction with food services (Lighter, 2011). Clinical outcome measures are specific
to the clinical condition being measured which should meet the usual healthcare needs and goals of
the patients' population where it is used (Lighter,

Emergency Department Journal
While working in the emergency department for my clinical this week I could see the staff members
that help in the emergency department. There are RNs, EMTs that have different certifications like
BLS or ALS, a nurse practitioner, and doctors. In the emergency department, they have staff
members from different parts of the hospital to assess the patients. Radiology comes down to get X–
rays on the patients for a closer look at their heart. The patients who come into the ER with
shortness of air, chest pains, numbness in the extremities and dizziness with signs of fatigue are
ordered an X–ray. The lab can come to draw the patient's blood or the nurse will draw up the
patient's blood and then send it to the lab. More patients come in with chest pains or shortness of air
while in the ER, ... Show more content on Helpwriting.net ...
The ER has a variety of patients come through the department, but everything depends on the
severity of the condition to whom is seen first. Patients with chest pains will be seen first rather than
a patient with a stuffy nose. When the patient first walks into the facility they are greeted by the
nurse at the window. The nurse then will call them in and do an assessment which is the triage part
of the ED. Triage is the first person you see when you enter and the one who set you up in a room.
Triage assesses the severity of the patient and they decide along with the facility's policy who
should be seen first. When the patient has been assigned a room a nurse then will enter and assess
the patient's condition with a more focused assessment. The nurse then will hook the patient up to
the blood pressure machine with the O2 monitor. Then the nurse will take a temperature to include
the assessment of

Alternatives For Overcrowding Emergency Departments
ALTERNATIVES FOR OVERCROWDING EMERGENCY DEPARTMENTS
Meeting the Challenge and Filling the Gaps in America's Healthcare System
Executive Summary: Many visits to the Emergency Department are made for non–emergent needs.
This causes congestion in the healthcare system and makes it harder for those who truly need
emergent medical attention receive the care they need. Aging populations, under or non–insured
patients, Medicaid expansions, and Psychiatric/Behavioral Health problems directly impact
overcrowding in the Emergency Department. Providing alternative facilities and services, and
utilizing Community Paramedicine programs will alleviate the strain overcrowding Emergency
Departments face on a regular basis.
Introduction: Overcrowding in ... Show more content on Helpwriting.net ...
Federal Mandates: Annual visits to the Emergency Department in the United States grew by 40%
between 1998 and 2013 while the number of hospitals with an Emergency Department available
declined by 14% (Newhook, 2014). Emergency Medicine is the only specialty within the "House of
Medicine" that carries mandates from the federal government to provide care to anyone who
requests it. One such federal mandate is The Emergency Medical Treatment and Active Labor Act
(EMTALA). The EMTALA requires hospitals and ambulance services to provide care and treatment
to anyone needing or requesting it, regardless of their ability to pay, legal status, and citizenship
(Barish, Mcgauly, & Arnold, 2012). A survey conducted by the American Hospital Association
(2010) revealed that more than half of America's urban hospital emergency departments were at or
over capacity 130 out of 168 hours in a given week. The surveyed showed non–emergent visits
tripled the emergent visits.
Behavioral Health: Instance of Psychiatric/Behavioral Health Problems have significantly increased
over the last few decades. While many of the causes are unknown, Behavioral problems negatively
impact overcrowding in the emergency department. David Judge (2013) reports Mental Health
related ED visits have increased 75% between 2002– 2014. The issues is not the fact there is an

Emergency Department Bottleneck Proposal Essay example
Emergency Department Bottleneck Proposal Middletown Hospital is a 200–bed, not–for–profit–
general hospital that has an emergency department with 20 emergency beds. The emergency
department handles on an average 100 patients per day. The hospital's CEO has authorized the Six
Sigma Team (SST) to address complaints received from patients seeking treatment between 6:00
p.m. and 10:00 p.m. The complaints are centered on waiting times and poor service. During this
time the data indicates that approximately 70% of the department's admissions occur (University of
Phoenix, 2009, Course Syllabus). To address these complaints and improve performance of the
emergency department the Six Sigma Team must understand process improvement proposals. ...
Show more content on Helpwriting.net ...
Data collection can be subdivided into three categories with service type, department, and floor.
This collection of data is valuable tool that managers need to have in order to understand the flow of
business within each department. With the collection of data it will allow managers to calculate the
volumes of patients during specific times. The SST will require data collected from all computers
used to monitor access to the admission system. Additional data will have specific times at which
the patient reported to various stations of treatment, and when the patient was discharged. A
multivariate trend forecasting method will be more appropriate in this setting; the use of multiple
variables about the item being forecasted allows seasons and cycles to be combined with other
variables and improve forecast accuracy (Langabeer, 2008). This will give operation managers
better forecasting abilities as they will be able to see trends. Finally, the SST will need to analyze
the amount of resources or assets available to serve demand (Langabeer, 2008). Quantitative data
needed to measure capacity will include: the number of available beds and treatment rooms, the
number of key providers and other staff available at each point of care between 6:00 p.m. and 10:00
p.m., and availability of key medical technologies and equipment. Examples of key medical
equipment are diagnostic imaging, X–ray and laboratory equipment.
Methods to Analyze
The first step in analyzing the

Research Paper Hca/530 Emergency Department
Emergency Department
David W. Banson
Stratford University
HCA 530
May 5, 2015
Dr. Zelalem Atlee
Emergency Department
Introduction
Any patient brought into the Emergency Department, is first signed in at ED receptionist desk and
triaged by a triage nurse, prioritized and brought to patient room by a charged nurse either by
wheelchair or stretcher or walking by the patient depending on patient's illness. A nurse is assigned
to the patient. Emergency Doctor comes in and if the patient illness is life threatening it is stabilized
and the Doctor orders test such as blood work and x–ray if necessary to be conducted. Based on the
test result the patient is either discharged or admitted. Certain times the emergency department is
filled with a lot of patient that there is no place to sit and patients keep coming in and creating ...
When overcrowding occurs, patients are placed in the hallway waiting for room to be transferred to.
Any time overcrowding occurs most ambulances divert away from the closest hospital to the
patients and in this situation hospitals lose a lot of revenue. Data published in the US Department of
Health and Human Services (HHS) in 2004 report national hospital ambulatory medical care survey
on ED summary depicted that ED in United State are approaching a boiling point in terms of
increasing patient demand and shrinking bed capacity, Levin et al (Fall,2006). According to the
Institute of Healthcare Improvement, a recent survey conducted by the American College of
Emergency physician of about 200 hospital administrators, majority pointed at overcrowding as
their major constraint and about 60% said overcrowding in their facility forces the diversion of
patients with urgent need

Emergency Department Nurses
Introduction
Title: Relationship between occupational violence, burnout and intention to leave in emergency
department nurses in Western Australia
The motivation for this research direction and area of investigation stemmed from my personal
experiences as a final year nursing student in a busy emergency department in a metropolitan
hospital in Western Australia. Anecdotally and personal observation–wise, the level of stress,
disillusionment and discontentment amongst the staff in a busy and demanding environment where
violence or threat of violence was experienced or witnessed on a daily basis was significantly higher
when compared with earlier practicum experiences in other departments. This served as an
inspiration to further investigate the extent of occupational ... Show more content on
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The approach for this particular research was adapted from the dissertation project of Christensson
(2014) to increase knowledge of the relationship between emergency department violence, burnout
experienced by the nurses and eventual motivation to quit. I endeavour to explore the relationship
between these elements in the context of Western Australian emergency department as the social and
cultural demographics, the profile of acute presentations, the advent of alcohol and drug cases that
are a significant cause of workplace violence and level of security and deterrence to violence vary
from the place of abovementioned research in New Jersey, United States of America to the state of
Western Australia. Research has identified burnout and high attrition rate as a result of workplace
violence, but there is a dearth of studies that have delved deeper into the interconnectedness of these
elements specific to a Western Australia context. The purpose of this proposal is to fill this gap in
the

The Effect Of Fast Track System On Emergency Department...
Introduction In this paper I will discuss efficacy of fast track system in emergency department
across Ontario, that will influence patient satisfaction, and also identifies practices that can be used
in the Emergency Department. It also provides ways of promising strategies to help Emergency
Departments address patient satisfaction issues more effectively. Each hospital can identify critical
issues and processes and choose strategies to support local needs. By introducing the fast–track
process in a hospital, it caters for the patients who have critical conditions and can be attended to
within a very short period. It ends up reducing the extensive waiting time in the emergency room
and improves the flow of the patients who come through ... Show more content on Helpwriting.net
...
The fast track system can be employed at various stages to check for potential outcomes and other
implementations in the healthcare industry. On the operation stage, the system can be used to
analyze the various outcomes of patient flow study. At the strategic stage, fast–track system can be
used to monitor the financial gains of an organization and evaluate its commercial health. On the
national stage, it can be used to observe the government programs that address the reduction of wait
time for the patients in the ED's. At the operational stage, it aims to present a concrete analysis of an
ED that exists within a fast track system. Introducing the fast track system was meant to reduce the
wait times in the ED (Yoon, 2003). Reducing the time would allow the increase of the numbers of
patients who come in, get treated, and discharged. It ends up increasing the efficiency and
effectiveness of the ED. Increasing the effectiveness and its capacity makes it possible for more
patients to be examined and treated because there is more time in the system. For example, at the
Grand River Hospital, there are several initiatives that are already in place that are targeting to
reduce the staying duration of the patient in the ED. These initiatives include having nurse
practitioners in the emergency department, having a specific fast–track area, emergency medical
rules that permit nurses to start on

Stress in the Emergency Department
Stress, Burnout, and Compassion Fatigue in the Emergency Department Background
Nursing is a field that many enter with the intention of helping and providing care to those with
mental, physical, emotional, and spiritual needs (Lombardo & Eyre, 2011). Many consider nursing
as their calling; yet have not prepared themselves for the emotional and physical implications that
come from having interpersonal relationships with families and patients. As nurses care for the ill,
traumatized, and vulnerable patients in their charge, they inadvertently expose themselves to the
pain, suffering, and trauma that their patients are experiencing on a regular basis.
When the continued stress of this field is not dealt with, one can become a victim of the
overwhelming need that surrounds them, which can result in burnout or compassion fatigue. This
not only effects ones physical and emotional health, but also results in decreased productivity and
job satisfaction, as well as increasing job turnover rate (Lombardo & Eyre, 2011; Boyle, 2011). This
concept is predominantly true of those working in the Emergency Department, and is actually where
the context of compassion fatigue was first noted approximately two decades ago, but is also seen
across the spectrum of health care providers in all areas (Boyle, 2011).
This topic will be discussed further in the words following, as well as an exploration of ways to
overcome compassion fatigue in the workplace.
Definition of Terms
In order to

Emergency Department Overcrowding
Today, overcrowding affects the viability of emergency departments across this county (Derlet,
2002). Emergency department overcrowding refers to an excess of patients in the treatment areas
exceeding ED capacity. According to the Joint Commission on Accreditation of Healthcare
Organizations (JCAHO), over one half of all sentinel event cases of morbidity and mortality
resulting from delays in treatment occur in hospital emergency departments. Emergency department
overcrowding has been cited as a contributing factor in 31% of these sentinel event cases. (Trzeciak
& Rivers, 2003). Consequently, overcrowding affects persons who suffer an unexpected severe
illness or injury requiring time sensitive emergency treatment. Therefore, patients must ... Show
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Several surveys among health practitioners and nurses have revealed satisfactory usage results. The
respondents stated the system was simple to use, reduced the subjectivity of the triage decision and
was more accurate than other triage systems (Singer, Infante, Oppenheimer, West & Siegel, 2012).
The rapid identification of patients that need immediate attention is one of the benefits of the
emergency severity index. The system focuses on the fast and accurate sorting of patients in cases
where there is shortage of adequate resources for treatment of emergency patients. The emergency
severity index (ESI) uses a five level categorization process that is used to rapidly sort emergency
patients into five groups that are based on clinically meaningful differences and projected resource
needs available. Another positive outcome of the emergency severity index is the improved flow of
patients through the emergency department as patients categorized as level one and two can be
immediately taken to the treatment area for rapid evaluation and treatment. Patients determined by
the triage nurse to be lower acuity can safely wait to be attended to after the higher acuity level
patients are cared for. There are other benefits of the system that include determination of the
patients who do not need to be seen in the main

Reducing Primary Care Utilization Of The Emergency Department
Reducing Primary Care Utilization of the Emergency Department
Mary Urbina
Florida Atlantic University
Dr. Granger
GEB 6217
Communication Skills for Business Professionals
November 30, 2014 Table of Contents
Executive Summary 3
Introduction 3
Recommendation: Hiring a Patient Navigator 4
Supporting Reasons for Recommendation 4
Preventing Increased Costs and Patient Dissatisfaction 5
Preventing Patients from Developing Serious Health Problems 7
Assisting Patients New to the Affordable Care Act 8
Counterargument and Rebuttal 9
Conclusion 10
Reference List 12
Executive Summary Patients are using the Emergency Department for medical issues which could
be better addressed by a visit to a primary care physician. A recent report ... Show more content on
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Introduction The Hospital is an advanced tertiary medical center located in Palm Beach County,
Florida. Recently, the Hospital has seen a growing trend towards higher utilization of the
Emergency Department by patients who routinely go the Emergency Department for their primary
healthcare needs. Patients are going to the Emergency Department for non–emergent reasons
because they have not developed a relationship with a primary care doctor ("ED Navigators," 2014).
There is major concern that patients are not connecting with a primary care provider and they are
not accessing the appropriate level of care for their medical needs. The Hospital faces a negative
financial impact and decrease in the quality of patient care because patients continue to routinely
use the Emergency Department for their primary healthcare needs. This report recommends the
hiring of a Patient Navigator. The Patient Navigator will assist patients that use the Emergency
Department for non–emergent reasons to connect with a primary care provider. This report includes
the recommendation for solving this problem, the supporting reasons for the recommendation, the
counterargument and rebuttal, and a concluding section. In addition, this report examines the

negative impacts of primary care utilization of the Emergency Department, the advantages of
connecting patients with a primary care

Emergency Department Essay
Aiding Throughput by Adding Advanced Practice Providers to Saint Joseph's Emergency
Department
Cavan Quam
California State University, Stanislaus
Introduction
Emergency departments (EDs) across the country are inundated with too many patients based upon
staffing and resources (Sun et al., 2013). This is a problem, as overcrowding in the ED has been
shown to increase the likelihood of multiple negative outcomes. Patients who go to overcrowded
EDs experience a higher likelihood of mortality, have a longer length of stay in the hospital, and
incur higher costs (Sun et al., 2013). While the problem of overcrowding is a multifaceted one, one
contributing factor is that low acuity patients go to EDs because they lack access to primary ... Show
more content on Helpwriting.net ...
Approach – Urgent Care in ED Model Since overcrowded EDs must provide care to patients across
the acuity spectrum, it is imperative that the appropriate level of care is delivered as often as
possible. In other words, a physician does not need to perform assessments on a patient who can be
managed by a nurse practitioner (NP) or a physician assistant (PA). Similarly, a high acuity patient
should not be relegated to a longer time to assessment because the ED physicians are assigned to too
many patients already. In order to appropriately match patients with the level of care required, EDs
must increase NP and PA staffing to treat those who seek primary care and urgent care treatment at
the ED.
Urgent care models utilize multiple NPs and PAs. The reason being is these providers can deliver
the care at the level the patient requires. It has been shown that utilizing NPs in the ED can result is
lower acuity patients being seen and discharged faster, as well as helping overcrowding in the ED
overall (Burlingame & Simpson, 2009). In concert with an effective front–end and ambulance triage
model, NPs and other advanced practice providers can lessen the burden on ED physicians.
Importantly, nurse practitioners and other advanced providers contribute to throughput in the ED
even if they are not the final provider signing off on the patient's discharge. Rapid access to NPs and
PAs

The Emergency Department ( Ed )
Background Length of stay in the Emergency Department (ED) is one important aspect of
healthcare that can affect patient satisfaction as well as the number of patients that can be seen by a
physician in a day. Length of stay (LOS) is measured as the time a person spends at the ED between
arrival and departure (1). A longer LOS will not only affect patient satisfaction negatively by
creating unnecessary frustrations, but can also cause ED overcrowding, leading to poor patient care
(2). The number of ED visits in the U.S. i.s approximately 129.8 million in 2010 and is continuing
to rise (10). The issue of ED overcrowding has gained national attention due to many problems,
such as a decrease in hospital bed availability (3), an increase in hospital mortality, and an increase
in the number of patients leaving the ED before being seen by a physician (4). It has then become
increasingly evident that in order to improve patient care and ED flow, it is necessary to examine
factors associated with longer LOS in the ED. The purpose of this study is to examine specifically
the patient population that presents to the emergency department with suicidal ideation (SI), due to
the lack of literature regarding the topic of LOS in patients with suicidal ideation. Considering how
vulnerable suicidal patients are, it is even more crucial to provide prompt and timely care to them,
and find ways to reduce their LOS in the ED. SI is defined as unusual thoughts or desire to end one's
life, which

Emergency Department Crowding Essay
This article addresses the nationwide problem of crowding in the emergency department. Crowding
in the emergency department creates delays in care and has been proven to be most prevalent in
urban and teaching hospitals across the country. The authors infer that since the institution of the
Emergency Medical Treatment and Active Labor Act (EMTALA) in 1986, record numbers of
individuals seeking care through the emergency department has skyrocketed. Patients either use the
emergency department as the first line of care or the last line of care. According to the study,
uninsured members of society are most likely to utilize the emergency department for care versus
their "sicker" insured counterparts. A survey conducted in 2010 by the American

Emergency Department : Improving Quality Care Outcome
Emergency Department Promptness By Improving Quality Care Outcome
Nwakaego Ugorji
Charles R. Drew University Mervyn M. Dymally School of Nursing
Introduction
About 50 million Americans do not have health insurance and, the emergency department seems to
be the only way to get adequate health care. Doctors there see all patients who arrive, regardless of
their health insurance status (Lobachova L, Brown DF, Sinclair J, Chang Y, Thielker KZ, Nagurney
JT. 2014). The quantity of emergency departments is diminishing. In 1991 there were about 2,500
departments in urban and suburban areas, now there are about 1,800 (Lobachova L, Brown DF,
Sinclair J, Chang Y, Thielker KZ, Nagurney JT 2014). Even though additional staffing would help,
there 's a primary problem of too many patients being directed into too few emergency departments
and are not able to receive quality care that is demanded.
Patient gratification is a significant measure of emergency department quality of care. Little is
identified about the providers ' ability to evaluate the patients' satisfaction. Patients want to be
provided with an estimated wait time. The wait time provides them with baseline information about
what they can expect.
Literature Review
The systematic method was used for the literature review, which provided a clear tactic to locate
applicable articles related to the subject area. The primary sources of articles are from electronic
databases that include PubMed,

Violence Against Nurses in the Emergency Department
Violence Against Nurses in the Emergency Department
Kimberly L. Kirk Professional Nursing Practice of the Baccalaureate Nurse
August 8, 2014
Violence against Nurses in the Emergency Department
According to the National Institute for Occupational Safety and Health, workplace violence is
defined as "an act of aggression directed toward persons at work or on duty, ranging from offensive
or threatening language to homicide" (Wolf, Delao & Perhats, 2014, p.305). Workplace violence
(WPV) can include verbal, physical, and emotional abuse, or any type of threatening behavior that
can cause physical or emotional harm. According to the Emergency Nurse's Association Position
Statement (2010), "workplace violence is a ... Show more content on Helpwriting.net ...
Despite the lack of reporting, it is clear that emergency department nurses are frequently victims of
violence perpetrated by patients and visitors (Gates et al., 2012, p. 203). Prosecution to the full
extent of the law is necessary to decrease the perception that violence against nurses is acceptable.
Greater support from public officials and management is necessary to combat this growing problem,
with the institution of specific policies and procedures. Movement toward a nonviolent workplace
will result in higher nurse satisfaction and retention. To effectively establish and address the issue,
more research, support from hospital management, and stronger legislation is necessary.
References
Violence in the Emergency Care Setting. (2010, January 1). Retrieved , from
http://www.ena.org/about/position/position/Pages/Default.aspx
Gates, D., Gillespie, G., Smith, C., Rode, J., Kowalenko, T., & Smith, B. Using action research to
plan a violence prevention program for emergency department. (2011). Journal of Emergency
Nursing, 37, 32–39.
Gillespie, G., Gates, D., Mentzel, T., Al–Natour, A., & Kowalenko, T. Evaluation of a
Comprehensive ED Violence Prevention Program. (2013). Journal of Emergency Nursing, 39, 376–
383.
Pich, J, Hazelton, M., Sundin, D., & Kable, A. Patient–related Violence Against Emergency
Department Nurses. (2010). Nursing & Health Sciences, 12, 268–274.
Wolf, L., Delao, A., & Perhats, C. Nothing Changes,

Use Of Electronic Medical Records From Emergency...
Background
Most emergency care is delivered in Emergency Departments (ED), there were over 129 million ED
visits in the United States in 2010, and some of the most common reasons patients visit the ED is for
abdominal pain, chest pain, fever, headache and back pain (Mutter & Clancy, 2014). Doctors and the
other healthcare providers in the ED use electronic medical records (EMRs), rapid blood/urine
testing, and diagnostic procedures such as; X–ray, CT scan, MRI to decide if a patient requires
inpatient or outpatient care (Free et al., 2013). They also use other tools such as; telemetry, bedside
sonography, point of care tests, and clinical decision aids for quick decision (Free et al., 2013). The
ED physician's new mHealth technologies may allow more patients to receive the care at home that
was once only accessible in hospital (Manojlovich et al., 2015), and on that way they don't need to
go to ED for minor illness. mHealth is transforming the way people with chronic illness are
retrieving and evaluating information and communicating with their primary physician or other
health professionals (Free et al., 2013). Mobile technology can be utilized to remind patients to take
their medication at proper times, and it can assist patients record their health symptoms and send
them to his/her primary physicians and specialists electronically as needed (Manojlovich et al.,
2015). Instead of waiting for patients to understand that they have any abnormalities and visit their
doctor,

Emergency Department Boarding
Emergency Department boarding of psychiatric patients continues to be a major problem for
hospitals. Due to the lack of inpatient psych beds, interventions and alternatives have been installed
by affected hospitals to alleviate crowding. Also, in–state level policies and increase funding for
mental health to ease this problem is also in effect. Not only that these systems in place ease the stay
of mentally–ill patients, but also the remaining of its population. Since wait times for psychiatric
beds to be ready for intake takes from more than a few hours to sometimes months, emergency
departments are left in an indeterminate state. A research about the overcrowding of the EDs of
Pennsylvania reported that, "A total of 81% of EDs reported ... Show more content on
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A stand–alone emergency department specializes in dealing with psychiatric patients is a proven
way to deviate psychiatric boarding in the regular ED. According to a study on the effect of having a
dedicated psychiatric emergency service published in Western Journal of Emergency Medicine,
"transferring patients from general hospital EDs to a regional psychiatric emergency service reduced
the length of boarding times for patients awaiting psychiatric care by over 80% versus comparable
state ED averages" (Zeller, Calma, & Stone, 2014). Not only will the emergency departments
benefit from this study, but also inpatient psychiatric

Economics of an Urgent Care Center in a Market of...
Economics of an Urgent Care Center in a Market of Emergency Departments
One of the contributors to the rising cost of Healthcare can be attributed to the over use of
emergency departments (EDs) for non–emergency needs. In the greater Capitol/First/Beacon Hill
area there are three major hospitals (Virginia Mason, Harborview, and Swedish) with emergency
rooms and no urgent care centers with the exception of Group Health which is restricted to Group
Health insurance members.
The question I asked myself is, "Why does Group Health have urgent care for their insurance plan
members and the major hospitals in Seattle do not."
Urgent vs. Emergency Care
A study by the CDC showed that approximately 70 % of emergency department visits can be ...
This will reduce the demand for ED visits and the ratio of patients with insurance to offset the cost
of uncompensated care. With a decrease in demand we should see a decrease in the cost of
emergency room visits as more patients get their non–emergency care at urgent care centers. The
new healthcare reform will eventually reduce the burden on hospitals and insurance companies by
providing the means for everyone to have healthcare and increase the ratio of insured patients
seeking treatment.
Urgent Care Economics
Unlike an emergency department, urgent care centers do not charge facility fees. Insurance
companies and patients are only charged for services rendered. Urgent care centers provide a high
level of non–emergency care at a similar cost as it would to visit a doctor's office which is about
1/10th of the cost of an emergency room visit. This includes minor procedures such as lacerations
that need sutures, minor burns, casting of fractures, reduction of dislocated joints, and on the job
injuries.
Urgent care centers are for–profit and are not required to provide indigent care, but do not have the
tax benefits of a not–for–profit hospital.
The quality of care in an urgent care center is just a good in an emergency department for non–
emergency care. The differentiating factor is follow–up care. Most emergency department
physicians do not see their patients for follow–up care and only 2/3 of the patients will follow

Emergency Department Staffing
In a hospital, the Emergency Department is the most crucial area (Girija & Bhat, 2013). With many
challenges, the Emergency Department must operate efficiently in an effort to deliver quality care in
a timely manner while meeting the patient demand based on volume size (Richard & Jarvis, 2016).
If there is an unbalanced match with the patient demand with the Emergency Department capacity
and staffing to deliver care within a timely manner, it can reflect on the patient flow and can create
crowding and long throughput times (Richard & Jarvis, 2016). As a result, it can lead to poor quality
of care and patient outcomes (Richard & Jarvis, 2016). On the other hand, the shortest throughput
time while operating efficiently with the needed staffing can lead to good patient satisfaction and
better outcomes (Richard & Jarvis, 2016). ... Show more content on Helpwriting.net ...
With this goal, Thomas Jefferson University Hospital created a fast track team consisting of a nurse
practitioner, nurse, and a tech for signage at the entrance to reduce throughput time (McHugh, Van
Dyke, McClelland & Moss, October 2012). However, this takes way staffing in the Emergency
Department treatment area that can help to reduce additional excessive throughput time.
To improve the Emergency Department patient flow with having sufficient staffing without the
signage fast track team, I will reduce the throughput time, even more using process measurements
of a predictive model, sensitive analysis, and lean six sigma improvement process as follows:
With a Predictive Model, data will be obtained from the electronic health record system for a two–
year period to analysis throughput time based on the day and time of arrival to the time discharged.
Otles, McLay & Patterson, October

Emergency Department Nurse
In this article it talked about how to become an emergency nurse. the article talks about what roles
emergency department nurses have and the different things that the nurses may experience. Also,the
article talked about the amount of responsibility and expectations that are piled on the emergency
department nurses on a daily basis.
The medical professionals attending the patients have to chose the difference between life and death.
As an emergency department nurse you have the iron in the fire to work as a segment in a
significant medical team in an undertaking to assist patients facing devastating injuries also
unexpected serious illnesses.
https://www.ausmed.com/articles/how–to–handle–difficult–patients/

Abusing Emergency Department
One of the main issues in today's society is the usage of the emergency department. For many
individuals, the emergency department is used as a day to day health care facility instead of the
urgent care that it should be. But then again, what is the emergency department and how is it being
used? It is a section in the hospital where patients come to be seen whether it is for critical and/or
non–critical reasons.
According to the National Institute for Reform, its mission is "to provide trauma and emergency
services for people in imminent danger of losing their life or suffering permanent damage to their
health". It is in fact open 24 hours, 7 days a week. This gives more "accessibility for those who have
hectic working schedules" (RW Foundation, ... Show more content on Helpwriting.net ...
Medical providers have the ability during these non–emergency visits to provide patients with other
resources to further expand the learning process of future ailments. It also can provide patients with
appropriate follow–up care plans (Wei, Camargo June, 2000).
In conclusion, we can see that emergency departments are not used for what they have been
intended for. They are now being abused for the most minor issues, including that of preventive
care. In order for us to help reduce costs, we must learn to use the emergency department for serious
and critical issues. One major way we can help reduce costs and unnecessary visits is by educating
one another on visiting our local medical facilities when having the most minor issues. This will not
only help costs but it will give faster results when visiting the hospital overall.
References:
"Emergency Medical Treatment & Labor Act (EMTALA)." Centers for Medicare & Medicaid
Services. Centers for Medicare & Medicaid Services, 23 Mar. 2012. .
Johnson Foundation, Robert Wood. "Reducing Inappropriate Emergency Department Use." RWJF.
Robert Wood Johnson Foundation, 1 Sept. 2013.

Emergency Management Operation Of Emergency Department
Emergency management Operation
Emergency management operation deals with executive functions that create the framework for
managing the community disaster response and recovery plans. It requires proactive,
comprehensive, progressive, risk–driven, integrated, collaborative, coordinated, flexible, and
professional approaches (Principles of Emergency Management, 2007, p.4). City emergency
department is responsible for handling all the emergency response in the city. The department has to
put together necessary emergency actions such as mitigation and prevention, preparedness,
response, and recovery that will help to protect lives and properties during disaster emergencies.
This presentation will outline and describes the National Incident ... Show more content on
Helpwriting.net ...
For instance, disaster causes serious damages to our critical infrastructures such as roads, bridges,
facilities, even lives and properties ((Suryanto, & Kuncoro, 2012). Plans of action, to deal with
unexpected occurrence of incidents are part of emergency management. These actions are also part
of the National Preparedness goal for the "whole community–individuals, families, communities,
the private and nonprofit sectors, faith–based organizations, and state, local, tribal, territorial, insular
area and Federal governments to prepare for all types of emergencies" (Federal Emergency
Management Agency, n. d). It includes five mission areas of such as preventing, protecting against,
mitigating, responding to, and recover from incidents of national significance (Federal Emergency
Management Agency, n. d). Cities and business shall have an emergency plan or incident
management system that will help in the management of resources during incidents (Federal
Emergency Management Agency, n. d). The National Incident Management System (NIMS)
provides guidelines on how the city and community emergency plans will integrate to the national
plan for effective nationwide response and recovery. But NIMS also, specified that local
jurisdictions will retain command, control, and authority over response activities in their
jurisdictional areas during incident response (U.S. Department of Homeland Security 2008).
The National Incident Management

The Emergency Department And Its Effects On Health Care...
"Just go to the ER" Redirecting Consumers from Costly Choices in Health Care Access
Patricia Crosby
USCB
NURS B401
March 14, 2015 "Just go to the ER" Redirecting Consumers from Costly Choices in Health Care
Access
Introduction
Since the development of the EMTALAAct in 1986, any individual which presents to the
emergency department, must be accessed and triaged by qualified medical personnel.
(www.cms.gov) Individuals are aware that if they present to the emergency department, regardless if
it is for just a tooth ache or a major illness like a heart attack, they will have to be treated. "This
mandate does not extend to private physician offices, however, which creates an incentive for those
without the means to pay for care to ... Show more content on Helpwriting.net ...
(Mann, 2014, p.2) These strategies include: broadening access to primary care services; focus on
individuals who frequently utilize the emergency department (super–utilizers); and targeting the
needs of individuals with behavioral health problems. (Mann, 2014, pp 2–4) Many resources and
processes have been implemented in order to help decrease inappropriate emergency department
visits. This paper is going to demonstrate some resources and processes that are in place to help
individuals obtain health care at the appropriate health care setting.
Body When focusing on the Centers for Medicare and Medicaid Systems strategies for improvement
with unnecessary emergency room visits, a major key area is accessibility to health care at the
appropriate health care setting. For many years, there has been the perception that the emergency
department is the only place for someone who is uninsured or underinsured can go to receive the
needed and appropriate health care, and in some situations that may be the case. (Rhodes et al, 2013,
p.394) Due to the decreases in reimbursements for the publicly funded, more and more physicians
are opting out to treating these patients, thus leading to an increase in emergency department
utilization. According to a study conducted by Rhodes, Bisgaier, Lawson, Soglen, Krug, and
Haitsma, this is becoming a greater concern for the

Evaluation Of The Emergency Department
The inpatient unit that I will focus on for my final project the unit is the emergency department
(ED). I am focusing on this department because it is the first interaction that we have with the
patients, the healthcare providers have to be able to think and act on the spot. The reason that I am
choosing to focus on this unit is because it is the starting pathway for most patient that enters the
hospital. This unit have a major effect on patient's experience and outcome of care. The result of
their experience determines their overall satisfaction with the care and potential recommendations
that they give to their friends and family members. Throughout their stay in the ED, I can see that
they are plenty of room for improvements, since it ... Show more content on Helpwriting.net ...
The emergency room also encounters with a variety of illnesses. The emergency room is an open
unit where the beds are separated by curtains, with a few private rooms for patients that are on
isolations and precautions.
On average there will be about 20 individuals in the waiting room needing our services with a wait
time of about two to three hours. On a busy night there is about forty to fifty individuals with a wait
time of about six to seven hours. There are numerous challenges that an emergency staff is faced
with, those challenges range from the personnel in triage being put in a detective role overseeing all
from the critical patients to security issues. The staff having to keep a close eye on the patients
because at any time a stable or unstable patient could crash and we will then have taken in account
our surrounding, staying focus in a loud environment. Making sure we have enough security staff
the list of potential challenges in an emergency room is endless.
A redefine mission and vision statement for the emergency room that would embrace quality
management, improve on the productivity, find a balance in the supply chain management. Improve
on delivering quality and efficient care in order to reduce the 30–day patient re–admittance to the
facility. To show exemplary leadership as a manager and by doing so it reflects on everyone.
The metrics that I propose for delivery of patient care is having

A Report On The Emergency Department
S (situation): Hi, my name Kelsey and I am a nurse in the emergency department. I am calling about
Shannon O'Reilly's most recent laboratory results.
B (background): Ms. O'Reilly is 24 years old who came to the emergency in a DKA crisis earlier
this morning and has been DM1 since she was 3 years old.
A (assessment): Ms. O'Reilly's vital signs are temperature of 37.5 C, pulse of 112, blood pressure of
102/52, and respirations of 24. Her respirations are still deep but have a regular rhythm. She has a
CBS of 8.1 and regular insulin running as per orders. The lab work shows uncompensated metabolic
acidosis with no hypoxia. Ms. O'Reilly's neurological status has improved with a GSC of 13. Her
dehydration is being treated with NS containing 40mEQ KCL/L running at 200ml/hr and potassium
levels maintained at 4.
R (recommendation): Do you want to continue with the current care plan continued with frequent
CBS and potassium monitoring?
Describe your rationale for the recommendations made. Shannon's glucose levels are still high
(above 6.1 mmol/L) thus still needs the insulin drip (Robbins et al., 2010). Administration of insulin
and efforts made to correct metabolic acidosis forces potassium into the cells causing hypokalemia
(Bopp, 2010). Thus, even though the potassium is within therapeutic levels (3.5–5 mmol/L) there is
a high chance that Shannon may experience hypokalemia and the administration of NS with
potassium is necessary (Bopp, 2010).
More Clinical Reasoning:

Blood Culture Contamination Rates In The Emergency...
Blood Culture Contamination Rates in the Emergency Department:
Issues and Resolutions for Improvement Blood culture (BC) contamination is a common, yet
preventable problem for emergency departments (EDs) across the country (Self et al., 2014).
Erlanger Hospital's ED is no different and being the region's only Level 1 Trauma Center, it is called
to an excellent standard of practice. BC testing is a routinely applied intervention used to diagnose
infections in symptomatic patients who arrive at the ED (Denno & Gannon, 2013). BCs are essential
as they help identify accurate pathogens and provide targeted antibiotic therapy (Denno & Gannon,
2013). They are often viewed as the standard for diagnosing illnesses such as septicemia and other
... Show more content on Helpwriting.net ...
She also responded that to be in compliance with Joint Commission guidelines Erlanger is required
to adhere to a strict standard of practice ensuring the safest and most competent care of patients. A
second question was asked: "Have causative issues been identified for the increased rates of BC
contamination in the ED?" She responded stating that BC contamination is an ongoing issue and
while many ideas have been presented, a single factor cannot be narrowed down specifically. A third
question was posed: "What is involved in an official change process at Erlanger and is the staff
allowed to have input on change processes needed in the ED?" Her response was that staff is
encouraged input and there is formal chain of command that they must go through. First, staff must
present their issues to their Charge Nurse who is then responsible to relay the information to the ED
Manager or herself. Issues warranting a need for change are then brought before an internal review
committee. A fourth question was presented: "Does upper management support change processes
backed by evidence–based practice (EBP)?" She responded that all upper management are
supportive of change processes when backed with proper research and statistics which warrant a
change in the department. Finally, a fifth question was asked: "What are the current protocols for
BC collection

Police Department : Call For An Emergency
Nyta Vath
Flavia Ruzi
English 1A
12 November 2014
Police Department: Call for an Emergency The University of California, Riverside, is known for its
high crime rate. We constantly get notices and emergency warnings about robberies and
kidnappings. As students, we walk in fear at night. Whether we live on campus or near campus, the
chances of being mugged or sexually assaulted is always a possibility. When a person is afraid, his
or her movements are limited. Thus, the existence of a police department on campus can help
expand those limitations as it provides protection.
The presence of a police department allows students to feel safe. The UCR police department
(UCRPD) is located toward the beginning of campus housing. Similar to any other building on
campus, the building's interior can be seen through clear glass. Located near PARKING LOT 24,
surrounded by lively green grass, the building is painted white. At the top, a sign read in capital
letters, "POLICE." The sign is identical to any other police stations on television. Then, at the door,
printed in bold and capitalized letters on normal printing paper, a sign read, "THE DOOR WILL
AUTOMATICALLY CLOSE." Everything seemed to be in signs as no one was available to instruct
people.
Inside the building, there was a silence and emptiness that I did not expect. After watching Cops and
21 Jump Street, I expected the building to be filled with police officers and detainees, noises and
disturbances. However, no one was at the

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