PERCEPTION BY HEALTH WORKERS IN THE ACCIDENT AND EMERGENCY - PowerPoint Presentation

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PERCEPTION BY HEALTH WORKERS IN THE ACCIDENT AND EMERGENCY - PPT Presentation

HOSPITAL KATH BY DR NANA SERWAA A QUAO OVERCROWDING IN THE EMERGENCY DEPARTMENT ED DR GEORGE ODURO DR JOE BONNEY DR PAA KOBINA FORSON COAUTHORS INTRODUCTION PURPOSE OBJECTIVE METHOD ID: 618166

overcrowding emergency department health emergency overcrowding health department patient workers 108 freq delays care 2015 data patients source field

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Slide1

PERCEPTION BY HEALTH WORKERS IN THE ACCIDENT AND EMERGENCY CENTRE, KOMFO ANOKYE TEACHING HOSPITAL (KATH)BYDR. NANA SERWAA A. QUAO

OVERCROWDING IN THE EMERGENCY DEPARTMENT (ED):Slide2
Slide3

DR. GEORGE ODURODR. JOE BONNEY

DR. PAA KOBINA FORSON

CO-AUTHORSSlide4

INTRODUCTIONPURPOSEOBJECTIVE

METHOD

SAMPLE

RESULTS

DISCUSSION

RECOMMENDATIONCONCLUSIONREFERENCES

OUTLINESlide5

Emergency department (ED) overcrowding is gradually becoming a growing trend in many hospitals worldwide.According to a 2002 national US survey, more than 90% of large hospitals report EDs operating “at” or “over” capacity.

In a 2001

report, 91% of US ED directors (525 out of 575 directors) reported problematic crowding in their departments, and 39% reported overcrowding on a daily basis.

INTRODUCTIONSlide6

Overcrowding can be defined as “a situation in which demand for service exceeds the ability to provide care within a reasonable time, causing physicians and nurses to be unable to provide quality care”. (CAEP & NENA, 2001)

boarded patient is defined as a patient who remains in the emergency department after the decision to admit him or her to the hospital has been made

. (ACEP Joint taskforce, 2007)

INTRODUCTIONSlide7
Slide8

INTRODUCTIONAs part of the problem-solving process, it

is important

to distinguish what crowding means

in the emergency department versus the inpatient units of most hospitals.

Inpatient

units, when their normal patient beds are full, are considered “full

” and

thus not

“capable

”

of taking more patients.

Emergency

departments

are considered

“

full

”

when

all their rooms are

full

, all their

hallway stretchers

are

full,

and

all their chairs are full

Thus, there

is a striking contrast between the

emergency department

and the inpatient units in

their respective

views of what constitutes “at

capacity” or

being crowded

. (ACEP Joint Taskforce, 2007)Slide9
Slide10
Slide11
Slide12

A number of effects have resulted from ED overcrowding:Inadequate patient care

Prolonged delays in the treatment of pain and suffering

Long waiting times and patient dissatisfaction

Ambulance diversions

Decreased nurse/physician satisfaction

Negative effect on teaching and research

(Canadian Association of Emergency

Physicians and

National

Emergency Nurses

Affiliation,

CJEM

(2001

)).Slide13

KATH ED receives an average of 84 patients per day and 28,000 patients in a year.

Overcrowding

and long boarding hours has been a challenge in the EDSlide14
Slide15

To assess the perception and causes of patient overcrowding among health personnel and to identify strategies to reduce overcrowding in the emergency department.PURPOSE OF THE STUDYSlide16

To determine the perception of overcrowding in the emergency department among health personnel

To identify the factors contributing to overcrowding in the emergency department

To ascertain the effects of overcrowding on patient care among health personnel

To identify strategies to reduce patient overcrowding in the emergency department

SPECIFIC OBJECTIVESSlide17

The research was submitted to the Committee on Human Research, Publications and Ethics (CHRPE) at KATH, for ethical clearance before embarking on the study (REF: CHRPE/AP/359/15).

Permission

was sought from the administrative heads of A&E Centre at KATH.

Verbal consent was sort from the health workers before participation.

ETHICAL CLEARANCESlide18

A cross-sectional study was used.The study was carried out for three months in 2015.

Analysis

was done using

Epi

Info 7 by CDC.

METHODSlide19

A total of 513 health workers (236 health workers in emergency department, (47 doctors and189 nurses), 277 health workers

in internal medicine, surgery, trauma and orthopaedics, EENT combined) work in the Emergency units of yellow, red, orange and CDU under the Emergency Department.

Systematic

sampling was adopted for this study to reduce the potential of human bias in the selection of the population to be included in the sample.

SAMPLESlide20

With a 5% margin of error and a 95% confidence interval, a sample size of 110 was obtained out of the total staff population in the Accident and Emergency Centre.

One-third

of the total number was chosen and in each department, health workers were randomly selected for the study.

Using systematic random sampling method, 110 health workers were selected.

SAMPLESlide21

Questionnaire based interviews were conducted among health workers to give their perception about patient overcrowding and its effects. Closed ended questions were administered.

The instruments for data collection were subjected to pre-testing to ascertain the validity and consistency prior to the study. No errors or ambiguities were identified after the pre-testing thus confirming the suitability of the tools.Slide22

RESEARCH QUESTIONWhat is the perception of overcrowding of patients in the emergency department among health personnel?

What

are the effects of overcrowding in the emergency department on health care personnel?

What

are the contributory factors to patient overcrowding in the emergency department?

Which strategies can be used to reduce patient overcrowding in the emergency department?Slide23

A total of 110 health workers were surveyed with 59 (53.64%) being nurses and 51(46.36%) as doctors.

Females were 52(47.27%) and males were 58 (52.73%).

All workers had attained some

level

of education with Diploma as the

most attained 41(42.27%). Majority of the respondents were residents, 21(19.44%), senior nursing officers, 20(18.52%), and house officers,

14(12.96

%).

RESULTSSlide24

VARIABLE (N)

Frequency

Percent

SEX (N=110)

MALE

52.73%

FEMAE

47.27%

AGE (N=96)

20-29

42.71%

30-39

51.04%

40-49

5.21%

50-59

1.04%

OCCUPATION (N=110)

NURSING

53.64%

MEDICAL DOCTOR

46.36%

EDUCATIONAL LEVEL (N=97)

DIPLOMA

42.27%

UNIVERSITY UNDERGRADUATE

3536.08%TERTIARY1111.34%POST GRADUATE77.22%MGCS22.06%CERTIFICATE11.03%

Source: Field Data, 2015

UNIVARIATE ANALYSIS OF HEALTH WORKERSSlide25

VARIABLE (N=108)

Frequency

Percent

RANK

RESIDENT

19.44%

SENIOR NURSING OFFICER

18.52%

HOUSE OFFICER

12.96%

SPECIALIST

8.33%

NURSING OFFICER

7.41%

MEDICAL OFFICER

4.63%

STAFF NURSING

2.78%

ENROLLED NURSE

1.85%

CONSULTANT

0.93%

RANKS OF HEALTH WORKERS

Source: Field Data, 2015Slide26

RESULTSThe average waiting time of a patient at the ED as perceived by majority of

health workers was 30minutes before being seen by a physician.

Health personnel thought that there was not much variation in the days when the ED is overcrowded but agreed afternoon shifts were mostly crowded among all shifts. Slide27

Source: Field Data, 2015Slide28

RESULTSHealth personnel most agreed strongly that inappropriate referrals 59.63% and

delays in getting radiological imaging 49.07%

were the main causes of overcrowding.Slide29

Table 4.1.3

CAUSES OF OVERCROWDING

VARIABLE

STRONGLY AGREE

AGREE

INDIFFERENT

DISAGREE

STRONGLY DISAGREE

FREQ

Lack of Hospital beds (106)

28.30%

32.08%

9.43%

15.09%

Inappropriate Referrals (109)

59.63%

26.61%

4.59%

7.34%

1.83%

Patients who come without referrals (105)

38.10%

2523.81%1918.10%1615.24%54.76%Inadequate Personnel/staff(107)3229.91%3128.97%1413.08%2119.63%98.41%Inadequate logistics and tools (108)4440.74%

4339.81%

6.48%

11.11%

1.85%

Radiology Delays (108)

49.07%

40.74%

65.56%54.63%00.00%Laboratory Delays (106)3734.91%4441.51%109.43%1413.21%10.94%Delays in dispensing drugs (108)1715.74%4137.96%2220.37%2725.00%2725.00%Theatre Delays (107)4037.38%4441.12%1413.08%98.41%00.00%Delays in transporting patients (108)3229.91%3128.97%1413.08%2119.63%98.41%Delays in billing or assessments (108)3027.78%4238.89%1614.81%1917.59%10.93%

Source: Field Data, 2015Slide30

NEGATIVE EFFECTS OF OVERCROWDING ON PATIENT CARE

Table 4.1.4

NEGATIVE EFFECTS

OF OVERCROWNDING ON PATIENT CARE

VARIABLE (N=108)

STRONGLY AGREE

AGREE

INDIFFERENT

DISAGREE

STRONGLY DISAGREE

FREQ

INCREASED DELAY IN CLINICAL ASSESSMENT

48.15%

40.74%

6.48%

4.63%

0.00%

INCREASED MARGIN OF MEDCAL ERROR

32.41%

47.22%

8.33%

12.04%

0.00%

INCREASED STAFF STRESS

7771.30%2926.85%21.85%00.00%00.00%POOR WORK SATISFACTION6257.41%3734.26%76.48%21.85%00.00%Source: Field Data, 2015Slide31
Slide32

Majority of the health workers (95%), said that overcrowding in the ED contributed to poor patient outcome.Ways in which health workers think overcrowding contribute to poor patient outcome include:

staff exhaustion (40.37%),

compromised quality of patient care (36.70%),

standard procedures not followed

(36.70%),

long waiting time of patients before being assessed by a physician

(29.36%) and

poor working conditions

(27.52%).Slide33

VARIABLE

FREQUENCY

PERCENTAGE

Long Waiting Time

29.36%

Logistics Not Enough

15.60%

Poor Health Worker Concentration

27.52%

Staff Exhaustion

40.37%

Can’t Explain

15.60%

Cross Infections

25.69%

Preventable Poor Outcome

25.69%

Standard Procedure Not Followed

36.70%

Quality of Care Compromised

36.70%

Don’t know

2.75%

EFFECTS OF OVERCROWDING ON POOR PATIENT OUTCOME

Source: Field Data, 2015Slide34

RESULTSHealth personnel strongly agreed that

Equipping district hospitals to handle non-emergency cases (77.78%),

Appropriate referral system (75.93%),

Provision of adequate logistics and consumables (57.41%) can help curb the problem of overcrowding.Slide35

Table 4.1.5

STRATEGIES

TO REDUCE PATIENT OVERCROWDING

VARIALE (N=)

STRONGLY AGREE

AGREE

INDIFFERENT

DISAGREE

STRONGLY DISAGREE

FREQ.

INCREASE NUMBER OF PERSONNEL (106)

26.42%

42.45%

12.26%

13.21%

5.66%

INCREASE NUMER OF BEDS (106)

29.25%

18.87%

12.26%

29.25%

10.38%

INCREASE THEATRE SPACE (108)

3229.63%4238.89%1715.74%1412.96%32.78%BUILD MORE EMERGENCY CENTRES (108)6459.263128.70%76.48%43.70%21.85%EQUIP DITRICT HOSPITALS TO HANDLE NON EMERGENCY CASES (108)8477.78%

2323.00%

0.00%

0.93%

APPROPRIATE REFERRAL SYSTEM (108)

75.93%

23.15%

00.00%10.93%00.00%BED MANAGER POSITION (107)4844.86%3936.45%1514.02%54.67%00.00%PROVISION OF ADEQUATE LOGISTICS AND CONSUMABLES (108)6257.41%3835.19%43.70%43.70%00.00%Source: Field Data, 2015Slide36

RESULTSA greater number of the respondents (98%) agreed that information about bed state on the wards should be sent to the ED as a means of

curbing

overcrowding whiles 2% thought it was not a good idea.

Those who agreed, majority responded that ward bed states should be sent every

six hours (four times) in a day.Slide37

VARIABLE (N)

FREQUENCY

PERCENTAGE

PHONE CALL (48)

31.97%

TEXT MESSAGE (34)

18.18%

PHYSICALY GOING UP TO CHECK (34)

17.64%

MOBILE APP/ SOFTWARE (63)

33.68%

ALL OPTIONS ABOVE (10)

5.34%

Best ways identified to send ward bed state information to the

ward

Source: Field Data, 2015Slide38

RECOMMENDATIONSInternal Emergency Department Actions and Processes That Will Improve Access and Flow:

Limit

triage to what is crucial and bypass

triage altogether when

beds are

available.Develop a fast track for treating simple fractures, lacerations, sore throats, etc.

Expand

the practice of observation medicine.

Implement

triage protocols

.Slide39

Expand the size of the ED

Carefully

evaluate

staffing needs

Establish

clearly defined turnaround-time(TAT) goals in the emergency department.

Decrease

TAT associated with ancillary

services

Provide

additional staff during times of increased volume. Slide40

Match resources to needsCreate institutional awareness of the

dangers associated

with emergency

department crowding due to boarding of emergency patients.

Address delays

in moving emergency patients admitted to the hospital caused by waiting for nursing reports.Examine the discharge process and measure all reasons for delays in discharge of the patient.Establish hospital-wide protocols for addressing capacity issues in the emergency department and implement an alert system when the hospital is over capacity.

ACEP

2007

Hospital Actions and Processes That Will

Improve Access and FlowSlide41

CONCLUSIONOvercrowding in the ED is perceived to cause staff burn-out and result in poor patient outcomes. Evidence-based interventions may improve

overcrowding. Slide42
Slide43

Cowan, R.M. & Trzeciak, S., 2005. Clinical review: Emergency department overcrowding and the potential impact on the critically ill. Critical care (London, England), 9(3), pp.291–5. Available at: http://www.ncbi.nlm.nih.gov/pubmed/15987383 [Accessed August 10, 2016].

Canadian Association of Emergency Physicians and National Emergency Nurses Affiliation, 2001.

Joint Position Statement on emergency department overcrowding. CJEM [Internet]. 2001 Apr 21 [cited 2016 Aug 12];3(2):82–4. Available from:

http://www.journals.cambridge.org/abstract_S1481803500005285

Forson

PK (2011). An audit of emergency care at the Accident and Emergency Unit of KATH, Kumasi, Ghana. Masters Thesis Community Health Department, KNUST, Kumasi. (Unpublished)

REFERENCESSlide44

Mchugh, M. & Dyke, K.V., 2011. and Reducing Emergency Department Crowding : A Guide for Hospitals Improving Patient Flow Department Crowding : improving Patient Flow and Reducing Emergency Department Crowding, p.8.

Boarding

Task Force Members et al., 2008. ACEP Task Force

Report

on Boarding Emergency Department Crowding: High-Impact Solutions, Available at: https://www.acep.org/content.aspx?id=32050 [Accessed September 6, 2016].

Ntow Marie, 2014. College of health sciences in partial fulfillment

of the requirements for the award of MPH degree in health services planning and management. Unpublished

REFERENCESSlide45