Emergency department
Due to the unplanned nature of patient attendance, the department must provide initial treatment for a broad spectrum of illnesses and injuries, some of which may be life-threatening and require immediate attention.
The emergency departments of most hospitals operate 24 hours a day, although staffing levels may be varied in an attempt to reflect patient volume.
It was further developed in the 1930s by surgeon Arnold Griswold, who also equipped police and fire vehicles with medical supplies and trained officers to give emergency care while en route to the hospital.
As patients can arrive at any time and with any complaint, a key part of the operation of an emergency department is the prioritization of cases based on clinical need.
Conversely, patients with evidently serious conditions, such as cardiac arrest, will bypass triage altogether and move straight to the appropriate part of the department.
Typical resuscitation staffing involves at least one attending physician, and at least one and usually two nurses with trauma and Advanced Cardiac Life Support training.
The fear of missing something often leads to extra blood tests and imaging scans for what may be harmless chest pains, run-of-the-mill head bumps, and non-threatening stomach aches, with a high cost on the health care system.
For example, California requires wording such as "Comprehensive Emergency Medical Service" and "Physician On Duty",[9] to prevent persons in need of critical care from presenting to facilities that are not fully equipped and staffed.
Larger communities often have walk-in clinics where people with medical problems that would not be considered serious enough to warrant an emergency department visit can be seen.
[13] A survey of New York area doctors in February 2007 found that injuries and even deaths have been caused by excessive waits for hospital beds by ED patients.
[15] One inspection of Los Angeles area hospitals by Congressional staff found the EDs operating at an average of 116% of capacity (meaning there were more patients than available treatment spaces) with insufficient beds to accommodate victims of a terrorist attack the size of the 2004 Madrid train bombings.
[22] In 2004, a study found that emergency room visits were the most common reason for appealing disputes over coverage after receiving service.
[24] All accident and emergency (A&E) departments throughout the United Kingdom are financed and managed publicly by the National Health Service (NHS of each constituent country: England, Scotland, Wales and Northern Ireland).
Other influential factors identified by the report included temperature (with both hotter and colder weather pushing up A&E visits), staffing and inpatient bed numbers.
[37] This emergency usually results from an electrical disturbance in the heart that disrupts its pumping action, stopping blood flow to the rest of the body.
The services that are provided in an emergency department can range from x-rays and the setting of broken bones to those of a full-scale trauma centre.
In many jurisdictions (including many U.S. states), patients who appear to be mentally ill and to present a danger to themselves or others may be brought against their will to an emergency department by law enforcement officers for psychiatric examination.
[38] At the same time, according to a study conducted in England, people who self-harm often experience that they do not receive meaningful care at the emergency department.
Busy EDs exchange a great deal of equipment with ambulance crews, and both must provide for replacing, returning, or reimbursing for costly items.
Cardiac arrest and major trauma are relatively common in EDs, so defibrillators, automatic ventilation and CPR machines, and bleeding control dressings are used heavily.
Survival in such cases is greatly enhanced by shortening the wait for key interventions, and in recent years some of this specialized equipment has spread to pre-hospital settings.
The best-known example is defibrillators, which spread first to ambulances, then in an automatic version to police cars and fire apparatus, and most recently to public spaces such as airports, office buildings, hotels, and even shopping malls.
Volume metrics including arrivals per hour, percentage of ED beds occupied, and age of patients are understood at a basic level at all hospitals as an indication for staffing requirements.
Cycle time metrics are the mainstays of the evaluation and tracking of process efficiency and are less widespread since an active effort is needed to collect and analyze this data.
[45] However, subsequent studies have shown that identifying non-emergency visits based on discharge diagnoses is inaccurate because people commonly present for emergency care for other reasons and are assigned a diagnosis after testing and evaluation.
To reduce the strain on limited ED resources, American Medical Response created a checklist that allows EMTs to identify intoxicated individuals who can be safely sent to detoxification facilities instead.
(Journal of Trauma and Acute Care Surgery[51]) Equipment in emergency departments follows the prompt treatment principle with the least possible patient transfers from admittance to X-ray diagnostics.
[58] Federal laws and regulations in the United States, like EMTALA and HIPAA, limit the options of hospital personnel when an individual presents to the ER with a fabricated problem.
For example, in United States Military Hospitals, Air Force Aerospace Medical Technicians and Navy Hospital Corpsmen perform tasks that fall under the scope of practice of both doctors (i.e. sutures, staples and incision and drainages) and nurses (i.e. medication administration, foley catheter insertion, and obtaining intravenous access) and also perform splinting of injured extremities, nasogastric tube insertion, intubation, wound cauterizing, eye irrigation, and much more.
The presence of highly trained enlisted personnel in an Emergency Departments drastically reduces the workload on nurses and doctors.
