Urgent and Unscheduled Care: A summative Care Study - Essay Example

?Urgent and Unscheduled Care: A Summative Care Study In case of a medical condition, especially one that is urgent but does not qualify to be an emergency, an urgent care unit is available to attend to patients. The medical conditions handled in an urgent care unit cannot be predicted to schedule for an appointment with a general practitioner or a specialist. This is because these conditions occur at the spur of the moment, but are not severe enough to be handled in an emergency and they do not warrant the hospitalisation of a patient. This means that the unit works on a walk-in-walk-out basis, and customers are released once they are comfortable enough to go, and completion of recovery occurs after the patient has left (Bickerton et al. 2011, p. 7). Most health facilities have urgent and unscheduled units, though they are also found in other facilities like pharmacies, as long as they have a medical professional qualified to give ambulatory care to patients. It is crucial for every medical practitioner to understand the parameters of urgent and unscheduled care as many a time there are patients that require immediate attention but do not fit in the emergency criteria, but have to be treated. In addition, the unit saves on resources and time as patients get timely attention and care and go to their homes, leaving more resources for more demanding cases like admissions and emergencies (Alcock 2003). This study will use case study to analyse the processes involved in care; accounting for the contributions of various team members, risks for the patient and significant others, and the role of the healthcare policy on urgent and unscheduled care. Statement of the Problem Sara had been up all night due to excruciating earache, which was unresponsive to Paracetamol. On calling the NHS Direct for advice, she was directed to the minor injuries unit for help; and the 45-year-old woman arrives at the unit in looking extremely tired and in immense pain. Many underlying factors that will contribute to her well-being, safety, treatment, and recovery during the time she stays at the unit, some of which are discussed in the following subtopic. Clinical Decision-Making Processes All decisions arrived at by the medical staff should account for informed opinion of the patient and acceptable clinical ethics. In addition, the medical staff attending the patient should take recommended and effective decision-making approaches, including those involving the prioritization criteria for patients’ treatment schedule. Consent Sara is suffering from an earache that does not respond to painkillers, which pints to a likelihood of an ear infection at best or a nervous problem at worst. Both scenarios require one invasive technique or the other, which may cause harm to the patient, are costly and may not be included in Sara’s medical insurance cover. Therefore, it is necessary for the medical staff to inform Sara and her relatives of these shortcomings of the proposed procedures. For instance, they should mention that Sara runs the risk of poor or no hearing especially if inserting a tympanostomy tube is required; as her tympanic membrane may not heal, or may heal incorrectly. In addition, the medical staff should let them know that these procedures, though paid for, may not point to the cause of the earache, they are part of an elimination process of identifying the cause. Consequently, they may have to pay for more procedures before the cause is identified (NHS 2011; Schiff 2012, p. 90). Ethics Medical ethics prohibit professionals from keeping patients for longer periods than is necessary; therefore, Sara should be tested and treated by the least risky but most effective approach while the medical staff and her relatives deliberate on the way forward. This reduces her pain to enable her give informed consent on more invasive procedures, and to minimise her suffering. The ethics also expect professionals to use the most effective but economical approach, whereby they should not put Sara on procedures that are costly in terms of finances and health until less costly ones have been exhausted. Drugs used on Sara should be FDA approved, as using drugs that have not completed their clinical trials is unethical despite the fact that they might be of benefit to the patient. Finally, the medical staff should refrain from any quick fixes, despite how much they want to help the patient, as these often result in cases of medical malpractice (Salisbury and Bell 2010 pp. 186-188; Cox and Hill 2010, p. 34). Problem Solving Approaches When solving the case of Sara, team members should know that the case has no direct solution, may have many options, or may turn out to be unique compared to other cases and may have multiple factors that the team should consider. To deal with the case, they should take one or many approaches including analogy, research, cause elimination, and trial and error. Analogy method of problem solving requires them to identify cases that presented similar symptoms to Sara’s, and then apply the methodologies used in those cases on Sara. Secondly, the medical staff could brainstorm, whereby each member of the team comes up with ideas for discussion, that is before or after they have researched the topic exhaustively for any new ideas. They could try eliminating all possible root causes, or if all fails, take the trial and error approach as long as they do not expose Sara to too much discomfort. However, when all as been said and done, the head of the department or the team leader decides what happens to Sara, as someone has to take responsibility and be held accountable even for teamwork (Stahl 2008, p. 7; Rowe and Lang 2008, p. 68). Assessment and Prioritisation In an urgent and unscheduled unit, patients are not treated in the same order as it happens in other departments. The leader of the team of employees in the unit work together to arrange patients and assign treatment priorities depending on the severity of condition and the urgency at which the patient needs attention. Consequently, the patients in an urgent and unscheduled unit are not handled on a fist come first served basis, the condition determines the urgency that the patient is awarded. Sara is in so much pain, and her case is likely to have complications; therefore, unless the unit has another patient in a worse condition than Sara, she should be treated as the first patient in the unit. In addition, even if the unit had the aforementioned patient, the team could try to work on both patients simultaneously by dividing itself into two groups (Rubin 2010, pp. 100-103; Glasper, McEwing and Richardson 2011, p. 12; Hall 2011, p.36). Contributions of Team Members The urgent and unscheduled care unit has professionals in various aspects of clinical health, and since treating a patient could require different services, team members should work seamlessly for the patient’s benefit. For instance, the nurse should care for Sara and ensure that she is as comfortable as possible during the period that her case is being handled. The general practitioner or physician present in the team should examine her and combine the observations with the results of any test to come up with a diagnosis. Various other professionals will do their duties, though with more cooperation than in normal hospital cases, as the patient in this case has to be catered for in the shortest time possible. In case the team has a record keeping specialist, he or she should ensure that every step of the process is recorded for future reference. Otherwise, the other professionals have to record the case by themselves, ensuring not to miss any relevant details (Hignett, Jones and Benger 2011, p. 194; Casselbrant et al.2010, p. 1158). The team has to have a leader whose main responsibility will be to ensure that others work towards a common goal, especially by delegating duties, and giving complements, reprimands and corrections where necessary. For the team to work seamlessly, they have to be colleagues that are used to each other and have probably involved in a social activity together. This ensures that team members do not spend time that should be used on patients knowing each other and solving personal disputes; however, if they have any disputes, these should be solved once the emergency is over. Moreover, the group should work towards one goal at all times; that of ensuring patient safety at all times. NHS (2012, p. 2) suggests that the members of the team should diversify their skills to enhance flexibility within the team; however, it adds that each team member should only handle the patients in areas for which they are qualified (Klein 2006). Communication is one crucial aspect of effective teamwork, without which a team falls into disarray due to lack of cooperation. The tasks performed by each group member should be complementary, too prevent duplication of tasks and finish the job in a timely manner. For others to know what one is up to, every employee must make others aware of what he or she is doing, and the progress made at it so far. Communication in the unit may take various forms, but the most common is oral communication that is appropriate as it can be done as the person continues doing the task. However, oral communication is not particularly effective for portraying information that contains medical details, and this has to be done in written form that is convenient for use as evidence that the communication took place. However, it does not mean that professionals in the unit should keep passing notes to each other; all procedures should be put down in their respective books. If the professionals are not in the same room, then they should use the official mode of communication in the hospital (Ham 2004). Risks to vulnerable Groups Vulnerable Groups Vulnerable groups, in this case, involves people who are more likely to need the services of an urgent and unscheduled care unit than an average person; depending on their health, age, location, and social status among other factors. According to Kaye, Endacott and Kenny (2010, p. 130), they include the terminally ill, those without a means of communication like telephone, people with mental disorders, people with disabilities, and those who have recently been discharged from the hospital. These people may urgently need health care but in most cases are not able to procure it for themselves; sometimes the disease can be so debilitating that a person may require the intervention of others to secure urgent help. In addition, they may have a sense of urgency that health professionals may not agree with, predisposing them to the risk of being ignored, and their condition may deteriorate (BMA 2012c; O'Cathain, Knowles and Nicholl 2011, p. 136). Assessment of Vulnerability According to Lowe et al. (2011, p. 870), many factors contribute to vulnerability, and these factors have to be considered to ensure that a patient’s health is not put at a disadvantage by these any of them. However, it is difficult for professionals to discern the level at which these factors affect a patient’s need for urgent health. According to NHS (2012, p. 3), health care professionals should adopt the patient’s sense of urgency, and though it was a false alarm, they should do what they can for the patient, including counselling to prevent a repeat of the scenario. The urgent and unscheduled care team should consider all individuals vulnerable since some predisposing factors are hidden and can only be discerned after the patient shows symptoms for an ailment (BMA 2012b). Risks to Sara and Family Sara’s infection may heal or result in complications including spread of the infection to other parts of the body, especially those in proximity to the ear or result in perforation of her tympanic membrane, though the membrane may heal by itself in a few weeks. The nurse should administer antibiotics even before the diagnosis is over to prevent the infection from causing further damage to the ear or spreading, though he or she should communicate this decision to other team members. Everyone in the team should give his or her opinion on the matter to ensure that the well-being of the patient is the driving force in all actions of the group. In addition, the nurse should give Sara a document that shows the latter is a vulnerable person and should be treated with urgency in case her ailment recurs (Guptaa and Dentona 2008, p. 810; Pruitt, Canny and Epping-Jordan 2005, p. 26). On the other hand, Sara’s family is likely to suffer the same disease as Sara, especially if the condition is transmissible as they are exposed to the same environmental conditions as Sara. In addition, the nurse should discuss with other team members if to give them preexposure prophylaxis of mild antibiotics, or make them candidates for urgent care by giving them cards. Sara and her family should be kept under close observation for a few weeks, by ensuring that they can contact the urgent and unscheduled care unit at any time. Within this time, any changes in the health status of Sara and her family should be monitored to ensure that Sara’s condition does not get deteriorate, and her family is not infected (Casselbrant et al. 2009, p. 85; Spremo and Udovcic 2007, pp. 128). Impact of Health Care Policy Currently, few policies touch directly on the issue of urgent and unscheduled care, though the Department of Health (DH) (2012a) does mention it, and gives details on how it should go on. The health care policies of all countries in the United Kingdom obtain their funding mainly from taxes, meaning that no patient would be denied health care based on their economic status. The Department of Health stipulates the requirements for urgent care providers, giving details on the definition of quality health care (DH 2012b), and the safety precautions urgent care providers should take to protect themselves (DH 2012c) among others. However, many policies in the making will ensure that the urgent and unscheduled care is properly ingrained in the healthcare system, especially the health and social care bill (DH 2012d). Currently, the system enables service providers to obtain licences with relative ease, whereby only one licence is required instead of the previous four (Adams and Corrigan 2003, p. 19). The health and social care bill will ensure that the system is coordinated, and expectations on providers of urgent and unscheduled care are clearly stipulated by the law. However, the act will not be a rulebook, but a guide that service providers will use in their duties. Providers should strive to supersede the requirements of any act or policy to ensure the best service for patients. Moreover, passing of the bill will have a tremendous effect on patients like Sara, as there will be clear guidelines on the procedure one should take whenever he or she needs urgent care. The system will be more coordinated, with more resources available and patients will be served more efficiently and effectively (BMA 2012a). Conclusion Sometimes a person may require medical attention urgently, but may not fit in the criteria for an emergency; and that is where urgent and unscheduled care comes in. These units are not always open but should be available to give health care whenever it is needed any time of the day. However, some people are vulnerable as they have a higher likelihood of needing these services, but cannot access them due to one reason or another. The medical fraternity should work together with the makers of health policy to ensure that these vulnerable people and their beloved ones receive the health care they need. References Adams, KM and Corrigan, J 2003, Priority areas for national action: Transforming health care quality, National Academies Press, Washington DC. Alcock, P 2003, Social policy in Britain, McMillan, Houndmills. Bickerton, J, Daviesa, J, Daviesa, H, Apaua, D and Proctera, S 2011, ‘Streaming primary urgent care: a prospective approach’, Primary Health Care Research & Development, pp. 1-11. British Medical Association (BMA) 2012a, Healthcare policy, Viewed 19 February 2012, BMA 2012b, NHS reform, Viewed 19 February 2012, BMA 2012c, Health care in a rural setting, Viewed 19 February 2012, Casselbrant, ML, Mandel, EM, Jung, J, Ferrell, RE, Tekely, K, Szatkiewicz, JP, Ray, A and Weeks DE 2009 ‘Otitis media: a genome-wide linkage scan with evidence of susceptibility loci within the 17q12 and 10q22.3 regions’, BMC Medical Genetics, vol. 10, p. 85. Cox, C and Hill, M 2010, Professional issues in primary care nursing, John Wiley and Sons, New York. Department of Health (DH), 2012a, Urgent and emergency care, Viewed 19 February 2012, DH, 2012b, Ambulance quality indicators, Viewed 19 February 2012, DH, 2012c, Management of blood-exposure in personnel of public and voluntary services, Viewed 19 February 2012, < http://www.dh.gov.uk/health/2011/11/blood-exposure/> DH, 2012d, Health and social care bill explained, Viewed 19 February 2012, Glasper, EA McEwing, G and Richardson, J 2011, Emergencies in children's and young people's nursing, Oxford University Press, New York. Guptaa, D and Dentona, B 2008, ‘Appointment scheduling in health care: challenges and opportunities’, IIE Transactions, vol. 40, no. 9, pp. 800-819. Ham, C 2004, Health policy in Britain, McMillan, London. Hall, R 2011, Handbook of healthcare system scheduling, Springer, London. Hignett, S, Jones, A and Benger, J 2011, ‘Portable treatment technologies for urgent care’, Emergency Medicine Journal, vol. 28, pp. 192-196. Kaye KA, Endacott, RA and Kenny BA 2010, ‘Ambiguous and arbitrary: the role of telephone interactions in rural health service delivery’, Australian Journal of Primary Health, vol. 16, no. 2, pp. 126–131. Klein, R 2006, The new politics of the NHS: From creation to reinvention. Oxford: Radcliff Publishing Laine, MK Tahtinen, PA Ruuskanen, O Huovinen, P and Ruohola, A 2010, ‘Symptoms or symptom-based scores cannot predict acute otitis media at otitis-prone age’, Paediatrics, vol. 125, no. 5, pp. 1154–61. Lowe, R Porter, A Snooks, H Button, L and Evans, AB 2011, ‘The association between illness representation profiles and use of unscheduled urgent and emergency health care services’, British Journal of Health Psychology, vol. 16, no. 4, pp. 862–879. NHS 2012, Commissioning a new delivery model for unscheduled care in London, Health Care for London. NHS 2011, Emergency and urgent care services, Viewed 19 February 2012, O'Cathain, A Knowles, E and Nicholl, J 2011, ‘Measuring patients' experiences and views of the emergency and urgent care system: psychometric testing of the urgent care system questionnaire’, BMJ Quality and Safety, vol.20, pp. 134-140. Pruitt, S Canny, J and Epping-Jordan, JA 2005, Preparing a health care workforce for the 21st century: The challenge of chronic conditions, World Health Organization, Washington DC. Rowe, B and Lang, ES 2008, Evidence-based emergency medicine, John Wiley & Sons, New York. Rubin, G 2010, ‘Unscheduled care following attendance at Minor Illness and Injury Units (MIU): cross-sectional survey’, Journal of Evaluation in Clinical Practice, vol. 18, no. 1, pp. 100–103. Salisbury, C and Bell, D 2010, ‘Access to urgent health care’, Emergency Medicine Journal, vol. 27, pp. 186-188. Schiff, GD 2012, ‘Finding and fixing diagnosis errors: can triggers help’? BMJ Quality & Safety, vol. 21, pp. 89-92. Spremo, S and Udovcic, B 2007, ‘Acute mastoiditis in children: susceptibility factors and management’, Bosnian Journal of Basic Medical Sciences, vol. 7, no. 2, pp. 127–31. Stahl, EM 2008, Emergency department overcrowding: Its evolution and effect on patient populations in Massachusetts, ProQuest, Michigan. Read More