Developing a Health Care Perspective

Case Study Review[JMV1] 

The case study “Emergency Department Repeat Admissions- A Question of Resource Use” will be examined in this evaluation. County General Hospital is the subject of the case study (CGH). The case study investigates the well-worn, or rather, usage of emergency services by Central Texas residents. According to the report, nine residents have spent 2.7 million dollars on resources (Emergency Department Repeat Admission- A Question of Resource[JMV2]  Use, n.d.). Regular visits to the emergency room are a problem in the United States of America, as well as other countries.

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“Moral Awareness” of an Ethical Issue

Matt Losinki, the Chief Executive Officer of County General Hospital, expressed concern about the fact that more than $200,000 in income was not being received each year, blaming it on frequent visits to the Emergency Department. According to the ethical decision-making model, this is referred to as “moral consciousness.” The Chief Executive Office noticed that frequent trips to the Emergency Department were causing an increase in treatment costs, as well as crowding, longer treatment and wait times, and unhappy patients.

People who frequent the emergency room on a regular basis are those who do not believe they are in excellent condition and, as a result, require immediate medical assistance. Regular visits to the emergency room have a significant impact on health-care costs. Improvements in the quality of care will have a significant influence on regular visitors to the Emergency Department, since they will help to reduce and eliminate frequent visits. (Bieler et al., 2012; McHale[JMV3]  et al., 2013; Morriss et al., 2012; Rea et al., 2010; Wooden, Air, Sharader, Wieland & Goldney, 2009; Wooden, Air, Sharader, Wieland & Goldney, 2009).

Factors that contribute to the “Moral Judgement”

The Emergency Department is an extremely fast-paced department, with workers continuously on the go treating patients and making vital judgments about the best treatment plan for those who enter the department. The majority of the time, these patients go to the ER for non-emergencies. The patient may have sought medical attention from a primary care physician or even an urgent care facility.

A frequent visitor is someone who attends the Emergency Department on a regular basis, such as four or more times per year. The Emergency Department providers who treat these frequent visitors are morally and legally obligated to handle them with extreme caution, speaking to them in a way that does not offend them or expose sensitive information. Patients who attend the Emergency Department on a regular basis but do not have an emergency take time away from[JMV4]  patients who have more critical or urgent needs. In the Emergency Department, overcrowding is a problem that might result in frequent or repeated visits. In the waiting room, patients may have to wait longer. Temporary mattresses are occasionally set up in the available spaces or in hallways with privacy screens to aid with crowding issues.

There are a variety of reasons why someone would contemplate going to the emergency room. These frequent visitors frequently have mental health and substance addiction concerns that require more attention than an ER doctor can provide. Patients might benefit from seeing a primary care physician rather than an ER doctor whose primary focus is on delivering emergency care rather than psychiatric care.

Pediatric patients, the elderly, uninsured patients, homeless patients, and psychiatric patients are some of the most common visitors to the Emergency Department. Colds, high fevers, and respiratory problems are the most common reasons for children to attend the emergency room. Patients in their eighties and nineties frequently attend the emergency room for a number of causes, including falls, difficulty breathing, discomfort, and heart and circulatory problems. Patients who are uninsured or homeless frequently visit the Emergency Department for medical care since it is their only choice if they do not have insurance to cover the costs[JMV5]  of the services they require. For medication refills and psychiatric holds, psychiatric patients frequently attend the Emergency Department. If the patients are not taking their medications, behaving inappropriately, making threats, or injuring themselves or others, the patients’ family or caretakers will call 911.

Communication Strategies Used and Effectiveness of Approach Used

The[JMV6]  article was given to the Chief Financial Officer, who studied it and described the action of restitution to the spent or lost money, or rather reimbursement from insured and private pay patients, to help offset the expenditures not covered by Medicaid. The Chief Executive was unimpressed with the report and demanded information from the Administrative Resident.

The Chief Executive Officer was concerned about the two hundred thousand dollars[JMV7]  per year not accounted for due to frequent visits to the Emergency Department, according to the Emergency Department use data received from the Administrative Resident, and informed the Executive Committee formally. Because of the Emergency Medical Treatment and Active Labor Act, an Emergency Department that receives federal funding for services may not refuse to treat any patient who comes the Emergency Department for any reason (EMTALA). Patients who did not require emergency treatment made up the majority of regular Emergency Department visits.

Applying Ethical Principles to a Possible Solution[JMV8] 

The Chief Executive Officer discussed alternative options with the Senior Management team regarding the problem of frequent visits to the Emergency Department. Identifying patients who are frequent visitors to the Emergency Department and developing a care plan that ensures the[JMV9]  patients are provided appropriate care to enable them to reduce or eliminate frequent trips to the Emergency Department are examples of intervening activities. The expense of visiting the Emergency Department will be reduced as a result of fewer visits. Another way to intervene[JMV10]  is through education. This entails informing patients about the types of illnesses that are on the verge of becoming well-known (emergent) as well as those that are not. Identifying a main care physician, mental health care providers, and providing physician recommendations for follow-up care would all help to decrease and eliminate frequent visits to the ER. In order to reduce and/or eliminate frequent visits to the Emergency Department, comprehensive or detailed discharge planning with clear discharge instructions for patient follow-up would be beneficial.

Conclusion[JMV11] 

The Emergency Department is a fast-paced, or should I say, rapidly evolving workplace. The providers are always on the move, making quick judgments that necessitate critical thinking. The majority of people who visit the Emergency Department require immediate medical attention. Frequent flyers or anxious wells are the terms used to describe this group of patients. Case management for frequent Emergency Department visitors is a method that uses diagnostic testing and time spent in the Emergency Department to potentially reduce frequent visits.

Reference[JMV12] 

Capella University. (n.d.) Emergency Department Repeat Admissions – A Question of Resource Use

George, Jane (12/23/2016). “Reducing frequent visits to Emergency Departments”. Aotearoa New Zealand social work (1178-5527), 28 (4), p. 109.

Grover, Casey A (03/01/2018). “Case Management Reduces Length of Stay, Charges, and Testing in Emergency Department Frequent Users”. The western journal of emergency medicine (1936-900X), 19 (2), p. 238

Grover, C. A., & Close, R. J. (2009). Frequent users of the emergency department: risky business. The western journal of emergency medicine, 10(3), 193-4.

Han, C., Chen, L., Barnard, A., Lin, C., Hsiao, Y., Liu, H., & Chang, W. (2015). Early revisit to the emergency department: An integrative review. Journal of Emergency Nursing, 41(4), 285-295. doi: http://dx.doi.org.library.capella.edu/10.1016/j.jen.2014.11.013

Iloghalu, S., Underdahl, Louise, MSLS, M.P.A., PhD., Umeh, O. J., PhD., & Bazargan-Hejazi, S. (2016). Understanding the role of ethics in health care administrators’ decision-making process: A qualitative exploratory case study approach. Paper presented at the 1-2. Retrieved from http://library.capella.edu/login?qurl=https%3A%2F%2Fsearch.proquest.com%2Fdocview%2F1817053331%3Faccountid%3D27965


 [JMV1]Your SafeAssign Score was too high. Use a draft SafeAssign for editing of future papers. Review the shaded matches in the report. When quoting the work of others, use quotation marks and citations with the page number. The other option is to rewrite using your own words. See the SafeAssign tab in the course room for additional details about SafeAssign.

 [JMV2]Use: (Capella University, n.d.).

 [JMV3]Add the matching APA references in the reference list.

 [JMV4]Well-stated.

 [JMV5]Informative details.

 [JMV6]Indent the first line of each paragraph – .5

 [JMV7]You aptly discussed how Matt communicated in this case. You prudently discussed how Matt’s message was not readily received. As you proceed in the program, you will discover many more communication strategies that are useful and effective in healthcare communication.

 [JMV8]This paper successfully incorporated the three components of the ethical decision-making model to analyze the ethical problem that Matt was facing.

 [JMV9]Good planning!

 [JMV10]Your paper reasonably discussed the need for preventing Emergency Room overuse as one possible solution to the ethical dilemma. 

 [JMV11]An informative summary!

 [JMV12]Only list references which have APA citations in the narrative.

All lines after the first line of each entry in your reference list should be indented one-half inch from the left margin. This is called hanging indentation.

The APA formatting for journal articles needs corrected. Check each journal reference to see if you have included all of the required components.  Here is a template.

Author, A. A., Author, B. B., & Author, C. C. (Year). Title of article. Title of Periodical, volume number(issue number), pages. https://doi.org/xx.xxx/yyyy

Note: Title of Periodical, volume number should be italic font.