The literature shows that this problem has an impact on the functioning of the health care system and on the quality of care provided. According to Shactman and Altman (2002) the hospital ED is the core of the health care safety net.
Problem statement
In the ED/CHUK one nurse cares for 7 critically ill patients as illustrated in the current ED/CHUK staffing below. An unpublished study conducted in ED/CHUK by Kamali Inocent found that one nurse was caring for 9 trauma patients instead of one patient as accepted by international norms.
Purpose of the study
Objectives
Research questions
Significance of the study
Concept framework
Intermediate outcomes include; ED Nurses busy with inpatient, slow throughput, and decreased quality of care, patient education, compassion, patient comfort, medical safety, speed and quality, morale problems, stress, teamwork, atmosphere, conditions. Other minor outcomes include keeping doctors and patients waiting, security issues and patients leaving before being treated.
- Emergency department overcrowding
- Emergency department (ED)
- Nurse
- A Phenomenon
The nurses in this study are Al (registered nurses) and A2 (enrolled nurses) working in the emergency department of CHUK.
Conceptualization of overcrowding in ED
Triggers of ED overcrowding .................................................... .l7
Boarding patients in the ED results in significant ED congestion and is associated with poor outcomes (Fatovich et al., 2005). Overcrowding in the emergency department often results in long waiting times for patients and an increased risk of unwanted and poor patient outcomes (Derlet and Richards, 2002).
Solutions to ED overcrowding
Regular primary care visits could reduce the number of patients presenting to the emergency department for uncontrolled diabetes, hypertension, obesity, and hyperlipidemia. One temporary measure to help reduce the backlog of patients waiting to be admitted to the ED is to provide an alternative place for them to go. ED observation units have been shown to alleviate ED overcrowding for a short time by allowing the ED to control patient outflow to some extent (Trzeciak and Rivers, 2003).
Schafermeyer and Asplin (2003) emphasized that inpatient lodgments in the ED are inappropriate and result in increased risks for patients and providers.
Conclusion
Study setting
The central level includes the central directorates and programs in the Ministry of Health and the national referral hospitals. This study was conducted in the ED at CHUK, which is one of the three national referral hospitals. It provides a wide range of health services to almost the entire population of Rwanda and neighboring countries such as Burundi and the Democratic Republic of Congo.
Highly sophisticated equipment that is expensive to purchase and maintain, the availability of skilled and experienced clinicians, and the need for continuing educational preparation of all professional health care providers.
Study population
A Level III facility is most often a community hospital located in an area that lacks Level I or Level II hospital facilities. It must provide a strong commitment to the optimal care of the trauma patient, and clear and precise transfer protocols are essential (Carbona et al., Based on the above description of trauma center levels, ED/CHUK can be described as a level I trauma center because it is a teaching hospital , with a capacity of 500 beds, specialized and experienced doctors, with high technical equipment and engaged in ongoing training of health personnel.
Sample and sampling
Based on the above description of trauma center levels, ED/CHUK can be described as a level I trauma center because it is a teaching hospital, with a capacity of 500 beds, specialized and experienced doctors, with high technical equipment and dedicated to continuous education. of health professionals. 339). Non-probability sampling requires the researcher to assess and select those subjects who know the most about the phenomenon, and who are able to articulate and explain nuances to him (Polit and Beck, 2008, p. 343). A non-probability Convenience sampling technique was used to include all the 40 nurses working in the ED at CHUK due to a limited number of nurses in this particular setting.
Sample size
Instrument description
Data collection procedure
The researcher was given the opportunity to explain the purpose of the study and its relevance. Participants were informed that participation was voluntary and that they could withdraw from the study at any time.
Reliability and Validity
- Reliability
- Test-retest reliability
- Validity
- Table highlighting content validity
The instrument was administered twice to 10 ED nurses from one of the government hospitals in Kigali. Of the 18 items that make up the outcome variable, the reliability was .908 which means it was reliable because it was above .80. Content validity was ensured by aligning corresponding elements of the instrument with the research objectives and research questions.
Second, the instrument was subject to scrutiny by experts in research and health services administration for content validity.
Data analysis
Ethical consideration
Data management, storage and disposal
Introduction
Population and sample description
Characteristics of the study respondents
- Age of nurses
- Nurse's work experience in ED
- Nurses qualifications
Correlation
- a Overcrowding and triggers correlation table
- b Overcrowding and triggers correlation
- a Overcrowding and outcomes correlation table
- b overcrowding and outcomes correlation
There is no linear correlation between overcrowding and triggers, because (Pearson's) r=.047 is above the cutoff of 0.05. According to Polit and Beck (2008, p. 571), the relationship is low or even non-existent when the points are spread over the entire graph. There is also no weaker correlation between overcrowding and the outcome variable, because (Pearson's) r=.161 is above the 0.05 mark. OJ).
According to Polit and Beck (2008, p. 571), the relationship is low or non-existent when the points are spread over the entire graph.
Characteristics of CHUKIED overcrowding
- Reasonable patients waiting time to be seen by a physician nurse's
- Emergency department bed occupancy
- Patient placed in the hallways
- Patient occupancy of ED waiting room
Findings showed that 39% (n=15) of respondents reported emergency bed occupancy for 1-5 hours, which is a marker of overcrowding. Another characteristic examined in this study is the hours patients spend in the hallways. The majority of participants, 84% (n=32), reported that patients are placed in hallways for more than 24 hours, which is typical of an overcrowded ED.
The time spent by patients waiting in ED has also been considered a feature of overcrowding.
Causes ofED/CHUK Overcrowding
- Causes of ED/CHUK Overcrowding related to the population
- Causes of ED overcrowding related to community care factors
- Causes of ED overcrowding related to emergency department
- Cause of ED overcrowding related to emergency support
- Causes of ED overcrowding related to inpatients factors
Of the 87% who highlighted high costs of private clinics as one of the reasons, about 40%. n=15) of respondents believed that private clinic costs were a major cause of ED overcrowding, and 47% (n=18) of respondents rated it as a minor cause, with only 13% (n=5) respondents do not see it as a reason. Reasons for ED overcrowding included space limitations (92%) insufficient care beds (97%) and length of stay for inpatients in the ED (87%), stretcher occupancy (81%) lack of ED nurses on shift (74%) too large a number of not -urgent examinations (58%) as well as delays in completing the consultation (48%) and lack of emergency doctors on duty (47%). About 19% (n=7) of respondents perceived that lack of nurses on shift was a major cause of ED overcrowding; 55%.
Almost the majority of respondents 95% (n=36) claimed that the lack of beds was a major reason for ED overcrowding, and 5% thought it was a minor reason.
Outcomes ofED/CHUK overcrowding
- Major outcome
- Intermediate outcomes
- Other outcomes
About 47% (n= 18) of respondents noted that negative impact on teaching and research is the main result of ED overcrowding, (32% n=12) thought it was a minor result, 16% (n=6) indicated that they had no comments and 5% (n=2) said that he/she did not know. n=10) of respondents noted that delays in improving physical, emotional, and mental well-being are a major outcome of ED overcrowding, 53% (n=20) thought it was a minor outcome and 21% (n=21) they said it is not included. About 34% (n=13) of respondents claimed that current poor outcomes are a primary result of ED overcrowding; 42% (n=16) thought it was a small result and 24% (n=9) said it was not included. Approximately 16% (n=6) of respondents judged the increase in medical errors to be a major result of ED overcrowding, 24% (n=9) perceived it to be a minor cause, 52% (n=20) stated that is not included and 8% (n=3) said he/she did not know.
Violence between health care providers, patients or family members was perceived by the majority of respondents 60% (n=23) as a major impact of ED overcrowding, 21% (n=8) thought it was a minor result, 16% estimated that it is not involved and 3% (n=l) said that he/she did not know.
Interventions to reduce or control overcrowding at ED/CHUK
- Attempt interventions
- Emergency nurse's suggestions to alleviate ED crowding
Twenty-six percent (n=10) of respondents felt that improving the referral system in Rwanda was critical. Twenty-nine percent (n = 11) of respondents suggested hiring new surgeons because they believed surgical cases were being delayed by the ED due to surgeon overload. Eleven percent (n=4) of respondents suggested an increase in operating rooms because surgeons are available for some time and theaters are busy.
Twenty-one percent (n=8) of respondents suggested training ED nurses in emergency procedures to improve their skills and speed in performing emergency procedures.
Conclusion
Although each variable contributed to ED overcrowding, the discussion is limited to those variables that were perceived by the majority of respondents as contributing most to ED overcrowding.
Demographic data
Most nurses have several years of work experience in the emergency room, 74% have less than 1-3 years of work experience in the emergency room. The same problem was highlighted by the American Nurse Association, which suggested that hospital emergency departments are one of the hospital departments where employers have difficulty finding experienced nurses (Schriver et al., 2003). To solve this problem, several month "internships" in emergency and critical care nursing are now offered to new graduates in selected institutions (Alban, Coburn and May, 1999) and advanced training in emergency nursing administration is offered .
Schriver et al., (2003) suggest that the complexity of emergency nursing practice today has promoted new and more comprehensive educational preparation, this author documented a series of challenges that require more specialized knowledge and skills to ED nurses involving special and evolving skills . require triage nurse performance, developing patients nursing care; service administration; multitasking driven by moment-to-moment changes in demand; supervision of allied health personnel; language diversity and interpretation; and the broad base of professional skills required to provide nursing care to patients of both sexes, all age groups, virtually all diseases and the range of disease acuity.
Characteristics ofED/CHUK overcrowding
In this study, the majority of respondents (84%) indicate that patients are placed in the hallway for more than 24 hours. Participants revealed that the reasons for staying in the hallways for a long time were mainly due to waiting for surgical beds in the hospital or waiting to perform a surgical procedure. The findings from this study show that patients are placed in the hallway for long periods of time, in contrast to research by Richards, Navarro, and Derlet (2000).
These authors found that in Canadian emergency departments, patients were placed in the corridor for 6 hours per day.
Triggers ofED/CHUK overcrowding
Most respondents in this survey believed that non-emergency social cases were a major cause of overcrowding. The majority of respondents (76%) in this survey suggested that limited space in the emergency department is a major cause of overcrowding. In this particular study, 26% (n=10) of respondents claimed that emergency floor occupancy was a major cause of overcrowding.
In this study, ninety-five percent (n=36) of respondents claimed that the lack of hospital beds is a major cause of emergency room overcrowding.
Outcomes ofED/CHUK overcrowding
Seventy-nine percent (n=30) of respondents in this study claimed that increased stress among nurses was a major result of ED overcrowding. Fifty-eight percent (n=22) of respondents in this study claimed that staff dissatisfaction was the main result of ED overcrowding. In this study, 34% (n = 14) of respondents claimed that actual poor patient outcome was a major influence of ED overcrowding.
In this study, 58% (n=22) of respondents perceived that patient wait times increased as a result of ED overcrowding.
Conclusion
Recommendations
- Nurse's work experience in the ED
- Nurse's qualifications
- Reasonable patients waiting
- Emergency Department Bed Occupancy
- Patient Placed in the Hallways
- Patient Occupancy of ED Waiting Room
- Causes of ED Overcrowding Related To the Population Served
- Cause of ED Overcrowding Related To Community Care Factors
- Causes of ED Overcrowding Related to Emergency Department
- Causes of ED Overcrowding Related to Emergency Support Services
- Causes of ED Overcrowding Related to Inpatients Factors
- Major outcomes ................................................... '"
- Intermediate Outcomes
- Other Outcomes
Canadian Journal of Emergency Medicine Access block causes emergency department pressure and ambulance diversion in Perth, Western Australia. 2008) Frequency, determinants and impact of overcrowding in emergency departments in Canada: a national survey of emergency department directors. A US government report prepared to provide national data on issues of emergency department overcrowding.
Re: Participation in a study re: exploring phenomena of overcrowding in the context of CHUK emergency department in Rwanda "Nursing perspective.". My area of interest is "Investigation of Overcrowding Phenomena in CHUK Emergency Department in Rwanda. The aim of this study is to explore the main causes of emergency department overcrowding and its consequences.
