The primary care providers have the key responsibility of maintaining and providing first contact medical services to all the patients and it is expected that they are responsible for the overall ordination of medical services. The emergency Department is responsible to handle cases in the first contact if they are referred and require emergency attention which is available 24 x 7 and is only a one-time service and may not provide a continuous support like the primary care provider team. There is a specialty care Department is then which cannot be a first contact and is only used for patients in cases where the primary care provider mentions about certain special medical conditions where a specific treatment and a critical handling may be required. In this paper the concentration will be on the primary care provider and the emergency Department and the focus will be on the Misuse of the Emergency Department (ED) by Diabetic patients at the Veterans Administrative Hospital who have a Primary Care Provider (PCP) but frequent the ED for care. Mission is to reduce the misuse of diabetic patients who have a PCP who frequent the ED to less than 5% a month or an acceptable level.
Action plan that could work towards achieving improvement outcomes . . .
Before, the various practices related to the admission to ED are discussed, it is important to create a boundary data collection plan in order to regularly identify the cases where an inappropriate admission is noticed.
KPI
Operational Definition
Defect Def
Performance Std
Admission Guidelines for Diabetic Patient
Admission guidelines decide the Department of admission for the patient which can be either ED or PCP.
Any admission in ED which could have been handled as outpatient by PCP will be termed as Defect
GTT 200 mg/dl
-
200+ mg/dl
ED Admission
Usually, the patient's who are admitted to the emergency Department due to an emergency situation of diabetes, have common symptoms like vision changes, weakness, dehydration and numbness in hands and feet. There are also certain situations where the speech and mental capacity of the patient may be impacted due to which communication may not be easily possible. In such kind of emergency admissions, most of the tests take place by the department nurses only however these tests can easily be done by the PCP and after the application of first aid methods a decision can be taken about whether the patient should be referred to ED or at the same is not required. The specification limit for admission to ED must be on the basis of blood sugar glucose level however if symptoms persist then exceptions can be made which are also supposed to be identified in advance.
Impacting Factors
Weight age
Availability
Of Test Results
Availability
Of Patient History
Previous Hospitalization
Emergency
Symptoms
Result of First Aid Process
Initial Assessment Test
Admission Time
Source Type
Source Name
The project performance and an expected impact . . .
The nursing department is required to mention for each case, handled as a part of the ED, the interventions that have taken place in order to stabilize the patient's condition and whether the same interventions are available as a part of PCP or not. The availability of patient history and details of the hospitalization due to the same condition are important factors which can assist take the right decision of an entry to the emergency department. Lastly, the symptoms which may be considered for an emergency admission and the response of the first aid are also factors which can impact the decision of admitting or continuing with interventions or treatment within an emergency department. Our regression equation is created in order to identify the impact of the outlying emergency Department admissions, where the lower specification limits are not met however the admissions are done and on the basis of the same there is the calculation of the number of nursing resources who are employed to cater to those patients who would have been dealt with in the PCP department only. The extra number of resources from the emergency Department who are employed to look after the patient is not eligible for their emergency Department can be calculated by finding out the total number of patients who are admitted to the emergency department in error and the ratio of nursing resources for each patient admitted to the emergency department.
The nursing department is required to mention for each case, handled as a part of the ED, the interventions that have taken place in order to stabilize the patient's condition and whether the same interventions are available as a part of PCP or not. The availability of patient history and details of the hospitalization due to the same condition are important factors which can assist take the right decision of an entry to the emergency department. Lastly, the symptoms which may be considered for an emergency admission and the response of the first aid are also factors which can impact the decision of admitting or continuing with interventions or treatment within an emergency department. Our regression equation is created in order to identify the impact of the outlying emergency Department admissions, where the lower specification limits are not met however the admissions are done and on the basis of the same there is the calculation of the number of nursing resources who are employed to cater to those patients who would have been dealt with in the PCP department only. The extra number of resources from the emergency Department who are employed to look after the patient is not eligible for their emergency Department can be calculated by finding out the total number of patients who are admitted to the emergency department in error and the ratio of nursing resources for each patient admitted to the emergency department.
The regression equation is
LSL Test Results = 90.7 - 0.23 Joining Time
Predictor
Coef SE Coef T P
Constant
90.75 19.17 4.73 0.000
Admission to ED
-0.226 1.005 -0.22 0.823
S = 93.4695 R-Sq = 0.1% R-Sq (adj) = 0.0%
Analysis of Variance
Source
DF SS MS F P
Regression
1 441 441 0.05 0.823
Residual Err
73 637768 8737
Total
74 638209
R denotes an observation with a large standardized residual.
X denotes an observation whose X value gives it large leverage.
The above regression equation signifies the fact that on the total scale, if a particular data is taken approximately 74% of the patients are a part of the emergency department based on their eligibility however 26% patients, who are admitted to the emergency department may not have met the lower specification limit on the basis of the test results and are therefore not eligible to be a part of the emergency department.
Project Summary and Final Implementation
It is important to find out the previous history of the patient, and assess whether a similar emergency has taken place in the past and the level of interventions which were helpful in controlling the situation. While the admission formalities are done by the Department, it is the role of the nursing department and the first aid measures regardless of the fact whether the patient is to be looked after by the PCP or ED. A quick response of the first aid process is also sufficient to advise if the patient is recovering quickly and may be handled at the PCP itself, thus saving another position for any other eligible patients who may require ED more.
Works Cited
Boushy, D., & Dubinskey, I. (1999). Primary care physician and patient factors that result in patients seeking emergency care in a hospital setting: the patient’s perspective. The Journal of Emergency Medicine Volume 17, Issue 3 , 405-412.
Kumar, S., & McKewan, G. W. (2011). Six Sigma DMAIC Quality Study: Expanded Nurse Practitioner’s Role in Health Care During and Posthospitalization Within the United States. Home Health Care Management vol. 23 no. 4 , 271-282.
MedIndia.net. (n.d.). Blood-Sugar Chart. Retrieved May 9, 2012, from Medindia.net: http://www.medindia.net/patients/calculators/bloodsugar_chart.asp
Sun, B., Burstin, H., & Brenan, T. (2003). Predictors and outcomes of frequent emergency department users. Acahemy of Emergency Medicine Journal Vol.10 No.4 , 320-328.
Taylor, M., Pletz, B., Cheu, D., & Russell, P. (2008). HOSPITAL EMERGENCY INCIDENT COMMAND SYSTEM. San Mateo: County Health Services Agency.
