Medicine and Health Sciences Commons^™

The Impact Of Health Insurance Coverage On Short-Term And Long-Term Readmissions To The Emergency Department For Pediatric Patients With Asthma: A Retrospective Regression Analysis, Micheline Plantada

MUSC Theses and Dissertations

Inadequate health insurance coverage may hinder the management of asthma in children in recurrent emergency department (ED) visits in comparison to children with health care insurance. Children with asthma who do not have health insurance are at risk of not having access to primary care physicians. They may live in poorer communities, where they are more likely to encounter higher concentrations of asthma-inducing agents or factors contributing to increased healthcare utilization, resulting in increased expenditures and reduced patient outcomes.

Impact Of A Discharge Bundle On Boarding Hours In Acute Care Hospitals, Monica L. Herrera, Sharon L. Blackerby

Doctor of Nursing Practice (DNP) Scholarly Projects

The national epidemic of boarding hours in the emergency departments prompted the implementation of a discharge bundle in an acute care hospital. This bundle included an ADT nurse, discharge orders written prior to 11AM, and EVS shifting employee hours. Initial findings indicated a reduction in boarding time by 126 minutes.

Hospital Characteristics Impact On Left Without Being Seen, Anthony Roberts

MUSC Theses and Dissertations

Emergency Department (ED) care is provided to patients for urgent and life-threatening emergencies. Inefficiency and overcrowding of ED continues to be a problem for the U.S. Health systems threaten the ability to provide care for the most vulnerable patients. The inefficiency of ED and hospital throughput creates challenges in being able to provide timely and effective care for ED patients. Prolonged ED wait times can be related to the availability of ED and hospital beds, inefficiencies in the emergency department, staffing, and other factors. Timely and effective care is important to providing high-quality care and decreases the risk of serious …

Emergency Department Patient Navigator Post Chest Pain Diagnosis Discharge, Nancy Simoes

Seton Hall University Dissertations and Theses (ETDs)

Abstract The most common complaint seen in the Emergency Department, along with abdominal pain, is nonspecific chest pain. Often, these complaints cause prolonged lengths of stay in the ED, followed by hospital admissions and subsequent readmissions for various reasons. When thinking about these various reasons, the question for prevention of readmission comes to mind. What could we do as a department to keep patients from continuously using the Emergency Department as a primary point of care instead of outpatient facilities when necessary? Project Aim: The purpose of this quality improvement project was to initiate the need for a patient navigator …

Sepsis Inservice And Video At An Urban Hospital In California, Angela T. Ho

Master's Projects and Capstones

The emergency department at an urban hospital in California was performing below institutional goals related to sepsis protocols over the past few months. This intervention was targeted at nurses and was composed of a PowerPoint in-service on compliance to SEP-1 protocols and follow-along video on using the correct sepsis order set and documentation in the electronic health record (EHR). Goals included increased compliance to the SEP-1 protocol and documentation, (2) reduced time between the onset of symptoms, recognition, and intervention, (3) decline in sepsis rates and mortality rates, and (4) lower cost of care. Data was collected from the EHR …

Factors Affecting Emergency Department Mental Health Visits, Logan Daul

Honors Thesis

Research has shown that current quantities of emergency department visits for mental health and substance use are increasing at a startling rate. These increases are acknowledged in quantitative studies and some important information can be gathered from qualitative studies however determining specific causes for these emergent visits are difficult. The purpose of this study is to derive findings from statistical analyses focusing on quantities of emergency department visits for mental health and substance use disorders. Comparisons will be drawn at the state level between the per capita quantity of emergency department visits and poverty rate, climate, psychiatric healthcare infrastructure, urban …

Nurse-Driven Protocols For Abdominal Pain In The Emergency Department, Chris Schmidt

Student Scholarly Projects

Practice Problem: Emergency department (ED) crowding hinders the opportunity to deliver safe, quality care to abdominal pain patients and detrimentally affects clinical outcomes. Leadership of a rural community ED recognized a comparable issue by introducing a nurse-driven protocol (NDP) to reduce patient length of stay (LOS) and the rate of patients who leave the department prior to physician evaluation.

PICOT: The PICOT question that guided this project was: For adult patients in an emergency department, how does a nurse-driven protocol for abdominal pain compared to no protocol use affect the LOS and left without being seen (LWBS) rate over 10 …

Early Information Access To Alleviate Emergency Department Congestion, Anjee Gorkhali

Theses and Dissertations in Business Administration

Alleviating Emergency Department (ED) congestion results in shorter hospital stay which not only reduces the cost of medical procedure but also increase the hospital performance. Length of patient stay is used to determine the hospital performance. Organization Information Processing (OIPT) Theory is used to explain the impact of information access and availability on the information processing need and ability of a hospital. Technical devices such as RFID that works as “Auto Identification tags” is suggested to increase the information availability as well as the information processing capability of the hospitals. This study suggests that the OIPT needs to be further …

An Integrated Model Of Palliative Care In The Emergency Department To Improve Referrals, Jennifer L. Schlatter

Doctoral Projects

Introduction: The emergency department plays a critical role in the trajectory of in-hospital patient care. The Center to Advance Palliative Care (CAPC) along with the American College of Emergency Physicians (AECP) recommend early referral to palliative care for patients with life limiting illnesses that present to the emergency department. Research demonstrates that early palliative care consultations result in patient directed goals of care, improved symptom management, decreased length of stay, and reduced direct costs for inpatient hospitalizations.

Objectives: The goal of this project was to implement evidence-based recommendations for early palliative care referrals in an adult emergency department to improve …

Improving Patient Handover From The Pediatric Emergency Department To The Pediatric Intensive Care Unit, Kathryn Devinney

Doctoral Projects

Patient safety can be at risk during registered nurse handover, particularly when transitioning between high risk areas. According to The Joint Commission (2017), a standardized transition process should be implemented during patient handover. The purpose of this paper was to evaluate the effect of a standardized process with a cognitive aid on handover between a pediatric emergency department and an intensive care unit. Objectives of the project were to decrease conversion time in the emergency department, increase standardized process utilization, and improve patient outcomes, registered nurse perception and satisfaction, and patient proxy satisfaction. This evidence-based quality improvement project took place …

A Pilot Of Emergency Department-Initiated Buprenorphine For Opioid Withdrawal And Opioid Use Disorder: A Quality Improvement Project, Jason Lucey

DNP Scholarly Projects

Background: Emergency department (ED) visits for opioid related visits have increased dramatically during the opioid epidemic. Buprenorphine is an evidence-based therapy for treating opioid use disorder (OUD) and withdrawal. Unfortunately, lack of access to pharmacotherapy for OUD, including buprenorphine, remains a challenge. Research supports ED-initiated buprenorphine as a practical, cost-effective strategy which engages patients in treatment better than non-pharmacologic alternatives.

Purpose: The aims of this improvement project were to 1) develop a pilot process in an ED for providing buprenorphine to patients in opioid withdrawal or for OUD; 2) recruit and train a cohort of ED staff on the process; …

Preventing Emergency Department Overutilization For Florida’S Seasonal Resident Population, Amanda Garcia

DNP Scholarly Projects

Background/Local Problem: Seasonal migration of elderly patients to Lee County, Florida result in overcrowding and prolonged wait times in emergency departments. Many of these seasonal residents dissociate the management of their chronic health conditions with a local provider, therefore utilizing the emergency department for non-urgent needs. Purpose: The Seasonal Resident Navigator Program was intended to enhance the coordination of primary care services for elderly seasonal residents by establishing appointments with local primary care providers (PCP) in order to reduce the overutilization of emergency services and improve patient throughput. Methods: A residency and provider assessment tool was incorporated into the Healthpark …

Analyzing The Effectiviness Of A Prescription Drug Monitoring Program Targeting At-Risk Opioid Abuse Patients, Treadway Childs

Public Administration ETDs

The effectiveness of a prescription drug monitoring program in coordination with a prescription opioid recidivism program was examined at a semi-rural community hospital. Patients were identified by a multi-disciplinary committee to be at-risk for opioid misuse or abuse, and were denied prescription opioids. Patients were considered eligible for the program if they had over 12 emergency department visits in the previous 12 months, or 6 visits in the previous 6 months, depending on how long the hospital had records on a patient. Patients who were placed in the prescription opioid recidivism program could not receive opioids at this hospital. The …

Implementation Of A Standardized Handoff During Transition Of Care From The Emergency Department To The Intensive Care Unit, Melinda Abbring

Evidence-Based Practice Project Reports

Patient safety and nursing communication are crucial to the nursing handoff during transition of care from the emergency department (ED) to the intensive care unit (ICU). The Institute of Medicine published To Err is Human: Building a Safer Health System (1999) and Crossing the Quality Chasm (2001) highlighting ED handoffs as a safety measure. In 2006, the Joint Commission recognized handoffs with the National Patient Safety Goal 2E. The purpose of this evidence-based practice project was to determine if implementation of a standardized handoff would improve nursing communication and patient safety during transition of care from the ED to the …

Improving Nursing Attitudes Toward Suicide Prevention In The Emergency Department: The Implementation Of An Adolescent Suicide Risk Screening Tool, Julie A. Simpson

Evidence-Based Practice Project Reports

The Center for Disease Control ranked suicide as the second leading cause of death for American adolescents (2015). This crisis of adolescent suicide warrants evaluation and improvement of current suicide prevention practices. The Emergency Department (ED) offers 24-hour services and may be the only organized healthcare for utilized by some individuals. Nurses are the front-line provider of care in the ED and this role offers opportunity to identify an adolescent with increased suicide risk. The purpose of this EBP project is to evaluate nursing attitudes toward suicide prevention by implementing the best practice screening tool for adolescent suicide risk assessment. …

Evaluating The Impact Of Integrated Care On Service Utilization In Serious Mental Illness, Heidi C. Waters

Walden Dissertations and Doctoral Studies

Serious mental illness (SMI) affects 5% of the United States population and is associated with increased morbidity and mortality. Use of high-cost healthcare services is common, including hospitalizations and emergency department (ED) visits. Integrating behavioral and physical healthcare may improve care for consumers with SMI, but prior research findings have been mixed. This quantitative retrospective cohort study addressed the impact of integrated care on physical health and ambulatory care sensitive (ACS) utilization via a program evaluation of an integrated health clinic (IHC) at a community mental health center (CMHC). The research questions assessed whether there was a predictive relationship between …

A Test Of The Behavioral Model Of Health Services Use On Non-Emergent Emergency Department Use, Moira Crosby Mcmanus

Health Services Research Dissertations

Even though emergency departments (EDs) were created to treat trauma and emergent cases, there has been an increase in emergency department (ED) utilization for non-emergent reasons over the past half of a century. As non-emergent utilization grows as a result of the ED becoming a prevalent substitute for primary care, overcrowding of the ED and increased wait times will continue. Additionally, unnecessary cost to both the ED and the patient will be incurred. Previous research has examined and determined various reasons and risk factors driving non-emergent ED use, among them the influence of living location and the number of non-emergent …

Dynamic Queue Management For Hospital Emergency Room Services, Kar Way Tan

Dissertations and Theses Collection (Open Access)

The emergency room (ER) – or emergency department (ED) – is often seen as a place with long waiting times and a lack of doctors to serve the patients. However, it is one of the most important departments in a hospital, and must efficiently serve patients with critical medical needs. In the existing literature, addressing the issue of long waiting times in an ED often takes the form of single-faceted queue-management strategies that are either from a demand perspective or from a supply perspective. From the demand perspective, there is work on queue design such as priority queues, or queue …