Introduction
Code blue –emergent care is a practice aimed at giving immediate help to patients possessing acute health conditions considered to have the capacity to threaten their life. The concern for this procedure arose in the 2006 due to of lack of emergency care systems and due increased issues facing orthopedists taking calls in the U.S. (Canale, 2013, p.212). During that year, there was a huge increase in the number of patients visiting the emergency departments.
This increase was accompanied by a decrease in the number of emergency departments within health clinics (Canale, 2013, p.213). This resulted to poor and inappropriate emergency care being given to patients together with heavy pressures being laid on orthopedists serve as surgeons and who take calls. Cognition of these challenges have truncated into establishment of code blue-emergent care department at the clinic where I work as the chief operating officer, responsible for a 15-bed Emergency Room (ER).
A year later after the establishment of the emergency department, there has been “a number of complaints received by the chief officer regarding inadequate patient care, poor ER management, long wait times, and patients being sent away because of lack of space, staff, or physicians unable to provide appropriate care” (O’Connell, Johnson, Stallmeyer, & Cokingtin, 2007, p. 163). This paper aims at identifying the main causes of problems in the emergency room of the clinic, establishing a strategic plan to deal with the problems in the emergency room and justifying how the law about the Good Samaritan will affect patients’ treatment in the emergency room.
The paper also aims at looking at the different levels of emergency services and analyzing them to make sure that they are prioritized in the strategic plan and laying out a plan to handle adults, emancipated minors, or incompetent adults in the new ER organization.
Diagnosis of the Causes of problems in the Emergency Room
There are various causes of problems in the ER at my clinic. They include inadequate funds, inappropriate behavior of attendants or patients, congestion in the emergency room, language barrier and lack of a backup plan to respond to emergencies.
Funds required to buy the emergency room facilities is insufficient. This creates challenges for the department to provide modern emergency care facilities at the clinic. This challenge encompasses one of the major threat preventing patients from gaining good health services in the emergency room. This is a significant cause of alarm requiring immediate attention by the chief operating officer of the ER.
Poor management of the emergency room’s human resource results to ineffectiveness of the staff to cater for the needs of patients visiting the emergency room at the clinic. Consequently, patients have to wait for long hours in the waiting before they are attended. Others even leave unattended. There has been also an increasing incidence of rude and humiliating patients and or attendants in the emergency room. Consequently, cases of violence articulated to poor management in the emergency room have been reported. Based on the analysis of the impacts of this undue behavior, the chief operating officer finds out that the behavior has negative effect towards the employees in terms of their productivity coupled with their effectiveness.
Congestion is yet another enormous challenge for the clinic’s ER. The clinic has 5-seater emergency room. This means, if more than five patients are allowed into the ER waiting bay, overcrowding results. The chief operating officer has identified that overcrowding is due to lack of space in the Emergency room. Hence, many patients are sent away to avoid overload of patients in the emergency room. Since the goal of the clinic is to attend as many persons in need of emergency care services as possible, the chief operating officer finds overcrowding as incredible challenges that require immediate solution.
Communication is one of the necessities required in the emergency room. In any health facility, people from different ethnic groups walk in the emergency room (Chmiel & Huber, 2011, p.12). At the clinic, most of the patients or even the attendants speak their native language. This is a major cause of communication barrier. Recognition of this problem implies that there should be a plan to enhance communication between the patients and staff. A plan to respond to emergencies is yet another critical issue that the clinic should attend to in order to improve and manage extra patients in times of emergencies for instance suicidal attacks, accidents and natural disasters.
In my clinic’s ER, patients are forced to wait due to lack of an emergency backup plan to deal with their issues. Staff behaving in an undue manner toward patients and their relatives is a big concern to the chief operating officer. This calls for rules and guidelines to mobilize the staff to act professionally. Such rules must be properly established and documented for the all staff to see. Emergency Medicines for use in the emergency room need also being adequate.
Strategic plan to deal with the problems in the emergency room
Realization of all the discussed root causes of the problems encountered at the clinic’s ER, it is crucial for the chief officer to develop a strategic plan to deal with the problems in the ER. They include improved communication between the patients and staff, implementation of guidelines to discourage bad behavior among patients and staff, reduction of congestion by managing the number of visits in the emergency room, and use of a 24-hour rule to guide the orthopedists.
Tracking funds allocated to the department to avoid their misappropriation and poor management in the ER is part of this package. It is crucial to initiate measures to respond to emergencies. I also find it important to recruit qualified staff. This is an effort to increase the number of staff in order to reduce wait time of a patient in the waiting room. However, the mechanism of recruitment will be based on calculations of the service rates and arrival rates of the patients seeking emergency services at the clinic. This is important since emergency clinic handles people who in their conditions is hard to turn off.
Communication is a vital element to take into consideration when formulating a working plan that would help multicultural interaction of all persons interacting with the facility whether patients or their relatives. To proactively address this problem, the acceptable language at the facility is English. Establishing a standard language is anticipated to incredibly aid in breaking language barrier at the facility. Indeed, improved communication between the patient and staff will help reduce misunderstanding in the emergency room. There will be no language barrier, as this plan will discourage staff or patients from speaking in their native language.
Dealing with communication barrier will enhance patient satisfaction and patient treatment in the ER. In fact, the problems of rudeness and disrespect are akin to the challenges of failure to enact appropriate rules spelling the code of ethics to which all the staff should subscribe. For this reason I plan to ensure that all staff proactively recognize and understand that persons seeking emergency services from the clinic’s ER are the reason why they are employed.
Consequently, they will be required to give unconditional respect to the patients and their relatives. Where non-compliance is experienced, strict rules and actions will be taken to guide the staff. Such actions include but not limited to dismissal from work, compulsory non-paid leave, and or any other action deemed appropriate to discourage repeat of such behaviors.
To help reduce congestion in the ER, management of the number of visits to the ER is important. One of the ways of doing this is by implementing 24-hour policy in the approach treatment and service accessibility. However, implementing such a strategy calls for recognition that staff members normally get fatigued when they work for excessive number of hours without rest. Consequently, a plan to reduce the number of patients’ working hours in the ER is necessary to avoid overcrowding and long wait times of the patient in the waiting room. This is done by embracing the needs to take into consideration of a mechanism of ensuring that staff gets adequate rest.
Using this guideline in the implementation of the 24 hours service provision routine at the clinic’s ER call for implementation of three eight hours shift. In fact, scholars have identified poor client service provider relations as being instigated by work fatigue (O’Connell, Johnson, Stallmeyer & Cokingtin, 2007).
Another strategy for dealing with the challenges of overcrowding is by ensuring that patients’ arrival rates are regulated. This is crucial for consideration especially by considering the facility has a bed capacity limited to 15. Such a regulation can be enhanced through provision of short message automated line through which the patients can get fast information about the availability of the bed space before deciding to seek emergency services from the facility, latter to be turned down. In the case of an emergency that needs response does not necessarily need admission to the facility, other ways for handling influx of patients into health facility needs to be put in place (Clark, Field & Koontz, 2008). Measures to respond to emergencies by having backup medicines and extra resources to cater for emergencies is one the important strategy towards realization of this endeavor.
In case of misappropriation of funds allocated to the department, tracking will be done to avoid loss of funds. This is perhaps necessary on consideration of the fact that the proposal to hire more staff would also mean increased expenditure.
Efficiency and effectiveness in the utilization of the funds allocated to the department encompasses one of the mechanisms of enhancing accountability of the ER. Without accountability, it becomes hard to convince the clinics’ board to allocate more funds to the ER. Being unaccountable is an immense challenge to the emergency care department in the endeavor to realize its plan for hiring more staff. Even though service provision in the emergency care unit may be argued as being driven by concerns of Good Samaritan, good remuneration of the service providers is vital.
Justification of how the law on the Good Samaritan will affect patients’ treatment in the emergency room
Good Samaritans are people who offer personal assistance to those who are unfortunate. Persons volunteering to help do it with compassion and out of their own will. In legal terms, Good Samaritan refers to people who offer help in the occurrence of an emergency to injured people without compulsion (Rolfsen, 2007). Some states provide immunity to person who offer help to persons who have been injured. In other states, the person giving such aid is liable and subject to actions of torts of negligence. The emergency unit may be argued as acting from the paradigms of Good Samaritan. Nevertheless, the law on Good Samaritan has the capacity to impact the manner in which the staff of my facility works.
Although, Good Samaritan may provide first aid to an injured person, it is considered acts of negligence failing to call for assistance. In the event that an individual is unconscious and is unable to respond and or talk, a Good Samaritan may help that person (Rolfsen, 2007, p.225). Nevertheless, if the person reacts and/or is cognizant, then the unpaid helper should get consent from the party before attempting to offer any aid. This is necessary to evade any legal proceeding that may be brought against the Good Samaritan if in the process of giving aid the injured person suffers further injuries (Rolfsen, 2007, p.227).
However, in case of the operations of the emergency unit, it is arguable that the place from which a Good Samaritan may seek help while still attempting to give aid is from qualified and competent medical personnel. Such personnel are found at my clinic’s ER. Hence, the only legal consideration in the applicability of the law on Good Samaritan at the clinic is in matters of consent where a procedure that may cost the life of patient is necessary to free the patient from danger.
Although, Good Samaritans are offered immunity in some states, in case the Good Samaritan worsens the injured person’s health condition in the process of offering help, persons considered competent and qualified to offer such help are not provided with such immunities. As O’Connell, Johnson, Stallmeyer, and Cokingtin (2007, p. 162) argue, “If a Good Samaritan commits a mistake while offering medical procedure in the case of an emergency, the person should not be held liable for the damages in court”. This immunity is granted under the Good Samaritan law, which requires two conditions to be met. The first condition is that help offered must be given at the emergency scene. Secondly, the law will not compensate or reward the volunteer if the volunteer requires compensation or rewarding.
Unfortunately, the staff at the ER is paid whether they get patients to attend to or not. Consequently, applicability of the second condition fails in case of the emergency facility I am in charge of. The Good Samaritan law will affect treatment in the clinic in that, members in the emergency room will be willing to volunteer to emergency cases in the emergency room if the volunteer is rewarded or given compensation. Staff will be willing and ready to attend to emergency issues arising in the emergency room since no legal action will be taken incase anything goes wrong during the process when the volunteer decides to offer assistance to the injured person provided consent by the patient is available. However, this does not mean that staff should not abide to the principles of duty of care.
Different levels of emergency services
Emergency care services are carried out by a myriad of people within a state. This is done at two main different levels: basic and advanced life support. The basic life support level entangles emergency services provided by ambulance emergency cares assistant, first responders (good Samaritans), and medical emergency care technicians among others. Advanced emergency care levels encompass service given by critical emergency care paramedics, paramedics, and emergency care practitioners. Irrespective of variation of the degree of care given at each different level, all services offered to people in case of emergency are essential for their recovery process. They are important for alleviation of conditions that may be fatal and threatening to their lives.
Plan to treat adults, minors, emancipated minors, or incompetent adults in the new ER organization
Incompetent adults are given treatment based on factors such as wishes and beliefs of the patient, and the wellbeing of the patient. Information on how to treat ineffectual sick people can be gathered from the family, acquaintances or social group people who may help to guide on the patient’s demands and predilections. Any consent for treatment given by a minor is treated by law as null and void to the extent that such a consent cannot be relied upon in a court of law should any further injuries occur on the patient during a medical procedure.
This means that while the consent given by adults considered as legally competent would be used in a court of law, as the evidence for permission to conduct a given procedure, consent given by minors and incompetent adults is invalid. Incompetent adults refer to persons who have limited capacity to make legally binding decisions such as persons of unsound mind.
Therefore, based on the expositions already made in the paper, the subject of care stands out as one that is crucial as it determines a lot when it comes to the life of people. From the above argument, it is crucial to provide care to different persons through different procedures. However, patients may refuse to agree to treatment (Clark, Field & Koontz, 2008). In fact, they have legal right to that. The following procedure is proposed for providing care to those who refuse to take treatment.
- If an adult refuses treatment, this should be clearly documented in their notes. If a patient already signed a consent form but later changes his or her mind, it is also noted.
- In the situation that a patient has refused a particular treatment, it must be ensured that appropriate care is provided to which he or she has agreed. It is also advisable to ensure that patients know they are allowed to change their mind and consent to treatment if they later wish to do so. In case of a delay, which may affect their treatment choices, then the patient is advised accordingly.
- If a patient agrees to treatment but disagrees to some aspects of the process, the person responsible for giving the treatment must explain the various repercussions of the refusal to undergo the whole procedure.
- Cognition of the fact that failure to undergo treatment procedure would worsen the condition of the patient make a patient consider making a decision in favor of undergoing the treatment procedure as proposed by professional at the ER.
Reference List
Canale, T. (2013). Code Blue: America’s emergency care system. American Academy of orthopaedic surgeons, 7(5), 212-231.
Chmiel, C., & Huber, C. et al. (2011). Walk-ins seeking treatment at an emergency department or general practitioner out-of-hours service: a cross-sectional comparison. BMC Health Services, 2(2), 11- 94.
Clark, J., Field, J., & Koontz, L. (2008). Emergency department crowding: an action plan. Med Care, 11(8), 532–550.
O’Connell, M, Johnson, A., Stallmeyer, J., & Cokingtin, D. (2007). A satisfaction and return-on-investment study of a nurse triage service. American Journal of emergency medical care, 7(2), 159–169.
Rolfsen, L (2007). Medical care provided during a disaster should be immune from liability or criminal prosecution. The Journal of the Louisiana State Medical Society: official organ of the Louisiana State Medical Society, 159(4): 224-229.