The Causes of Long Stay in Emergency Department of Aliman Hospital in Saudi Arabia - Research Paper Example

Name Professor Title Date The Causes of Long Stay in Emergency Department of Aliman Hospital in Saudi Arabia 1.0 Introduction Policy makers and hospital administrators have become more concerned with lengthy waiting times because it is a measure of organizational efficiency (Zhu et al., p. 156). Waiting for treatment, notably during emergency services can be extremely frustrating given the unproductive time spent. Literature ion service quality suggests that the waiting experience is essentially negative and has increasingly shown to affect the overall satisfaction of consumers (Bielen and Demoulin, p. 174). In Saudi Arabia, for example, emergency department in hospitals such as Al-Noor has realized such issues as discussed by Haber et al., p. 41). Alsharqi et al., p. 18 researched on this issue and examined the causes whereas Chen et al p. 76 posits that majority of such lengthy waiting time in emergency department are attributed to existence of long processes and special consultation. In many hospitals one of the major challenges associated with this section is lengthyg waiting times caused by overcrowding in hospital and the existence of access blocks as a result of inadequate inpatient beds and long consultation procedures which triggers a need to understand the causes, effects and the preventions strategies to gap crowding. (Haber et al 2016 pg112). In measuring the throughput of the emergency department, the patient length of stay is considered an important aspect which arguably has contributed to overcrowding in the section. The length of stay in the emergency department can be associated with the long processes that a patient has to undergo before admission, severity of the ailment faced by the patient.to This retrospect paper will, therefore, examine the probable causes of a lengthy stay at Aliman Hospital, receiving approximately 1,308,210 number of patients per day. This follows an in-depth research on literature by Haber et al., p. 43), Chen et al p. 76 and Alsharqi et al., p. 18 in relation to the theory of the impact and causes of long periods of stay by patients in the emergency department. Self-administered questionnaires were the main method of the data collections, where two sets of the questionnaires were employed. The first set of questionnaires solicited information from the patients and their expeience in waiting times. The second set of questionnaires were elucidated from Aliman’s employees on the probable cause of the lengthy waiting times. 2.0 Aims of research The main objective of this study was to understand the causes of patient’s lengthy waiting times and how it has significantly affected the provisioning of emergency services at Aliman hospital in Saudi Arabia. It was important to understand the causes in order to recommend effective strategies that can improve the hospital management in provisioning emergency services. Since the length of stay can be associated with many factors as discussed by Alsharqi et al., p. 18, focusing on this factors was paramount in the prioritization of the action plan of eradicating the issue. Secondly, this study will critically analyze the implications of patient’s long periods of stay to the patients themselves and hospital medical staff. It was critical to understanding the effects in order to communicate the urgency of the matter to the hospital management of Aliman hospital. 3.0 Literature review The emergency department is a critical section for hospitals. Many hospitals are faced with a challenge of patient long stay in the emergency section. Many researchers have conducted comprehensive research on the causes of patient’s long periods of stay in the emergency departments in different hospitals in Saudi Arabia drawing various literature findings on this critical issue (Kujala et al., p. 512; Cayirli et al., pg. 339). The length of stay in the emergency sections according to Allaudeen et al., pg 65 is the major cause of overcrowding in hospitals. According to research by Allaudeen et al., pg 65, overcrowding makes it incapable of the physicians to attend to the patients making many patients leave the hospital without the medical attention required. Overcrowding can be as a result of long patient-physician consultations before the patient is admitted to the hospital. The emergency department of Aliman hospital plays a vital role in providing healthcare to millions of patients yearly in Saudi Arabia especially during the Alhaj season as discussed by Alsharqi et al., p. 32. The medical staff faces a lot of challenges in providing efficient, quality and optimized services to the patients. In the emergency department, time is considered a significant tool to measure the service quality as the patient waiting time can impact the outcome of patient situation and satisfaction according to Gray et al., p. 64). The problem of long waiting time can indicate a poorly managed, resourced and coordinated emergency department in a hospital. The National Health Service in the UK as shown by Alhabeeb et al., p. 34 has established that no patient should take more than 4 hours in the emergency department from arrival to the emergency department to admission, discharge or in the case of transfer. In another research study by Qannam et al., p.43 one of the direct factors influencing the emergency department length of stay is the access block which refers to a situation in which patients who are in need of an emergency admission to hospital remain more than 7 hours in the emergency department as a result of lack of access to the inpatient hospital beds. Qannam et al., p. 77 argues that the relationship between access block in the emergency department which can be defined as the total time exceeding 7 hours of the patient initial arrival in the emergency department to transfers to other departments has caused a lot of delays in the consultation sections and therefore incapacitate many patients from being directly admitted to hospital. The patient faced by access blocks as further explored by Sayah et al., p. 59 tend to take a higher mean length of stay of about 4.91 days as compared to patients who are not faced with access blocks who only take approximately 4.1 days. The effects of access blocks vary depending on the severity of diagnoses and illness as purported by Hosseininejad et al., pg 50). For instance, the patients of cardiac diagnosis faced by access block have a low mean length of stay of about 3.8 days in comparison with the mean length of stay of 5.7 days in a cardiac patient who did face access block. The near universal and recurrent issue in Saudi Arabia of inpatient bed capacity limitation which has been the major cause of emergency department overcrowding as shown by Gray et al., p. 56 which has also contributed to general overcrowding in hospitals forming a crucial contributor to access block. The problem of emergency department long stay in Saudi Arabia is mainly critical at trauma, tertiary care, high volume hospitals emergency department and teaching referral hospitals according to Haber et al., pg 76. The consequences associated with long patient stay at the emergency department seem to be however similar across all the emergency care system, referring hospitals and the ambulances get it hard to access the secondary and tertiary care department facilities in a timely manner. For example, Chen et al p. 76 argues that despite the existence of adequate acute care capacity in many hospitals in Saudi Arabia, the peripheral hospitals still experience access blocks in the manner of delayed transfers to final care for their patients. In hospitals, the access blocks occur on multiple levels. In the emergency department, when the inpatients occupy the emergency department stretchers for longer periods they block access to these crucial care spaces by injured patients in the waiting room and hence increase the waiting time for the arriving patients as further argued by Chen et al p. 76 In Saudi Arabian hospital elective surgery is also considered as a cause of long periods of stay in the emergency department. The elective surgery cases according to Alsharqi et al., p. 18 have been canceled or in other instances delayed in an effort to eradicate the emergency department overcrowding, and in so doing the patients awaiting scheduled surgery are forced to stay longer in hospital hence long stay in the emergency department. The length period of stay can also be associated with triage level, diagnostic tests and comprehensive consultations (Gray et al., pg. 55). The waiting time to meet a physician by patients is one of the variables affecting the length of time taken in the emergency department. Patients who are in the intermediate triage level which is level 3 and 4 spent the longest waiting time for nurses and physician assessment and hence the longest emergency department length of stay. The use of diagnostic imaging and comprehensive laboratory tests is also associated with long periods of stay which also depends on the type tests ordered. Specific consultations are also associated with long periods of stay which highly varies depending on the service consulted (Gray et al 2016 pg 20). Hosseininejad et al., pg. 77) research shows that the pressure on the ambulance facilities mainly occurs when emergency departments are locked with the admitted patients and the inability of the paramedics to transfer the needed patient care to the staff in the emergency department. In this case, the ambulance offload delays and in uncommon cases the ambulance diversion forms an access block and the overcrowded emergency departments hinder the patient prehospital care. The demographic characteristics comprising age and ethnicity and the existence of medical junior medical students in the hospital can lead to longer emergency department length of stay Sayah et al., p. 59. The younger medical students tend to take more time taking patients through the required processes in the emergency department. This can be associated with the experience and accuracy of delegating duties in the department. Younger patients take a little time in the emergency department as compared to older patients. The study also discovered that overcrowding by patients in hospitals can both be a cause of long patient’s periods of stay and also an effect of long periods of stay by patients in the emergency department as presented by Qannam et al., pg 50). In another research by Allaudeen et al., pg 65 the author has recommended that hospital management has to establish the key organizational benchmarks for the intervals in the emergency department and report them publicly. The interventions on performance must be communicated to ensure accountability and public attention on the duration of stay by patients in the emergency department. The set targets should be clearly evaluated to ascertain the deviation from the actual emergency department performance and the projected performance so that the progress can be measured and relevant interventions evaluated. The length of stay in the emergency department benchmarks should be linked with the incentives and infrastructure investment to achieve meaningful change (Alhabeeb et al., pg 99). This can be done by tackling the inpatient bed access delays and the establishment of accountability frameworks and incentive measures coupled by financial support to acquire specialist doctors who take minimal time with patients in the emergency department. 4.0 Research methodology 4.1 Research Instruments and Measurement Scale Questionnaires The research study employed use of questionnaires in gathering the relevant information. The researcher used both open ended and closed ended questionnaires. Questionnaires were proffered as they are a cheap and easy approach in gathering social science related research. Secondly, questionnaires can easily reach out to a large number of participants within a short time, where it can yield first hand data not available to others. Additionally, it has a high validity if validated properly. The use of open ended questionnaires aimed at collection of comprehensive data on the causes of long periods of stay by patients at Aliman hospital. Closed ended questionnaires were used to get easy and quicker responses from the respondents. The closed ended questionnaires consisted of a five point likert scale which ensured that the research easily captures the respondent’s feelings, opinions and attitudes concerning certain individuals and practices at Aliman hospital.The questionnaires were administered through an online survey monkey to easy access of the target audience and get real time results for easy analysis. 4.2 Research Setting This study was cross-sectional study conducted at the emergency department of Aliman hospital. The study targeted random 20 participants at the emergency department in order to gather real time and easy to analyze data as a result of a small sample population. The research was done at a relatively less busy time, so as not to affect normal functioning within the department. 4.3 Study population and sample The participants consisted of 20 randomly selected participants: 10 patient and 10 employees within the department. The study focused on getting information from the patients and physicians. Gathering information from these participants ensured accuracy as result person experiences in the emergency department concerning the length of the period of stay and related causes coupled the relevant effects both to patients and the physicians. The researcher used a study sample of 20 participants. This small sample population ensured faster and easy data collection and data analysis. 4.4 Sampling criteria The research used random stratified sampling method which ensured collection of accurate data as a result of minimal bias associated with the sampling method. 4.5 Data collection and Representations Data was mainly collected by the use of questionnaires. Both the use of closed and open ended questionnaires ensured first that the researcher easily collects data and importantly can clarify the validity of the data. Appropriate data representations were used in representing the data. 4.6 Ethical Considerations The researcher kept the responses of the respondents confidential and anonymous in order to minimize the effects of victimization on participants who issued sensitive information concerning the hospital operations. The research maintained the principle of beneficence, where participants were not forced into taking part of the research. Work cited Allaudeen, Nazima, et al. "Using Lean Management to Reduce Emergency Department Length of Stay for Medicine Admissions." Quality Management in Healthcare 26.2 (2017): 91-96. Alsharqi, Omar Zayyan, et al. "Factors Influencing Waiting Time as Key of Patient Satisfaction in the Emergency Department in King Fahd Armed Forces Hospital, Saudi Arabia." International Journal of Business and Management 12.5 (2017): 79. Alhabeeb, Waleed, et al. "Clinical characteristics, management and outcomes of patients with chronic heart failure: Results from the heart function assessment registry trial in Saudi Arabia (HEARTS-chronic)." International Journal of Cardiology 235 (2017): 94-99. Bielen, F. and Demoulin, N. (2007), “Waiting time influence on the satisfaction-loyalty relationship in services”, Managing Service Quality, Vol. 17 No. 2, pp. 174-93. Chen, Huang-Chung, et al. "The impacts of prolonged emergency department length of stay on clinical outcomes of patients with ST-segment elevation myocardial infarction after reperfusion." Internal and emergency medicine 11.1 (2016): 107-114. Haber, Susan G., Suzanne G. Wensky, and Nancy T. McCall. "Reducing Inpatient Hospital and Emergency Room Utilization Among Nursing Home Residents the Role of Patient–Provider Relationships." Journal of aging and health (2016): 0898264316641074. Gray, Constance, and Martin Christensen. "How a short stay unit can reduce children’s waiting times: An initiative to create a short stay unit has helped to reduce the lengths of time young people wait for treatment in an Australian emergency department." Nursing children and young people 28.5 (2016): 34-39. Chang, Anna Marie, et al. "Associations of Emergency Department Length of Stay with Publicly Reported Quality‐of‐care Measures." Academic Emergency Medicine 24.2 (2017): 246-250. Cayirli, T., Veral, E. and Rosen, H. (2008), “Assessment of patient classification in appointment system design”, Production and Operations Management, Vol. 17 No. 3, pp. 338-53 Hosseininejad, Mohammad, et al. "Determinants of prolonged length of stay in the emergency department: A mixed method study from Iran." Emergency-An academic emergency medicine journal 5.1 (2017): 268-273. Kujala, J., Lillrank, P., Kronstrom, V. and Peltokorpi, A. (2006), “Time-based management of patient processes”, Journal of Health Organisation and Management, Vol. 20 No. 6, pp. 512-24. Qannam, Hazem, Husam Mahmoud, and W. Ben Mortenson. "Traumatic brain injury rehabilitation in Riyadh, Saudi Arabia: Time to rehabilitation admission, length of stay and functional outcome." Brain injury (2017): 1-7. Sayah, Assaad, et al. "Emergency department expansion versus patient flow improvement: impact on patient experience of care." The Journal of emergency medicine 50.2 (2016): 339-348. Zhu, Z.C., Heng, B.H. and Teow, K.L. (2009), “Simulation study of the optimal appointment number for outpatient clinics”, International Journal of Simulation Modelling, Vol. 8 No. 3, pp. 156-65. Read More