Working of the Emergency Department: Ways to Reduce Turnaround Time and Improve ED Services

This report highlights the working of the emergency department. The emergency department of public hospitals need to be vigilant at all times and should serve the patients with instantaneous care. The underlying problem for such a department is the turnaround time for the patient. Thus, this report discusses ways to reduce the turnaround time and improve ED services.

Running head: SYSTEM THINKING
System Thinking
Name of the Student
Name of the University
Author Note

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Executive Summary
This report highlights the working of the emergency department. The emergency department
of public hospitals need to be vigilant at all times and should serve the patients with
instantaneous care. The underlying problem for such a department is the turnaround time for
the patient. Thus, this report discusses ways to reduce the turnaround time and improve ED
services.

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Table of Contents
Introduction................................................................................................................................3
Identification and analysis of the System Archetypes...............................................................4
Analysis of the current State Value Stream Map of the emergency department based on
System Archetypes.....................................................................................................................7
Recommended new State Value Stream Map with desired reduction in patient turnaround
time.............................................................................................................................................8
Discussions on intended and unintended consequences of the modified system.......................9
Conclusion..................................................................................................................................9
Recommendations....................................................................................................................10
References................................................................................................................................11

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Introduction
A medical emergency situation is a scenario where a person requires immediate
attention of the physicians. Any delay in attention and treatment in such a situation might
lead to the death of the person. To avoid such a fatal outcome, instantaneous medical help is
required. Most common cause of trauma is road accident and sometimes certain other
medical conditions like heart attack or stroke. Emergency cases that arrive in the hospital
without notice are unexpected, unannounced and unplanned injuries. The injuries can be of
severe damage, deformity and lastly result in the death of the person. There are estimated
records of millions people dying in road accidents every year and around ten million people
are injured in road accidents. To provide immediate attention to such unnoticed trauma and
fatal cases, every hospital has an emergency wing (Zook et al, 2016). The emergency wing
puts in effort to provide maximum essential care and investigation of the case to save the
patient’s life (Mistry, 2018). The emergency department (ED) of any hospital is well
equipped with machines and physicians to take care of the injured or the medically
traumatized patients when they arrive at the hospital emergency wing (Buchanan, Dawkins &
Lindo, 2015). The department tries to provide urgent care to patients of major illness,
traumatic injury and other medical issues. Though the hospital’s emergency wing provides
support and care, yet there are numerous shortcomings from the hospital’s side. It is noticed
that private hospital provides services on the go where as there are issues in the Public
hospital. There have been reports from the common public that the hospitals wastes time in
serving the injured or traumatized victim.

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Identification and analysis of the System Archetypes
Emergency services, which is also known as paramedic services treats the illness and
injuries that requires immediate attention. The immediate care includes quick medical
response, out-of hospital treatment, and proper transportation to the care unit. The emergency
wings of the hospital serve patients of all ages and types. Very few public hospitals in general
have specialized care units to serve medically traumatized victims. Hospitals also provide
both basic and advance support. The emergency department needs to be equipped with
defibrillator, ECG, Gauze parameters and fluid and drugs (Goldstein, Wells & Vincent-
Lambert, 2018). There are several types of services provided in case of emergency situation
which depends on the size of the hospital, the services it can provide, the nature and
seriousness of the injury and the catchments area. The types are major emergency and
disaster management, basic emergency or routine, referral emergency and finally standby
emergency. The major emergency functions of an emergency department are to serve on a 24
hours basis everyday of the year. The department needs to provide instant solution and care to
save the life of the critical victim. Service needs to be both effective and efficient. Most
importantly it should serve unannounced patients from life threatening situations. The
subsidiary function of the emergency department includes provision of ambulance services,
proper information and communication centre, porter service and IT services. For the decent
service of the emergency department, the department must operate properly to have it running
at all hours. Planning of the structure of the department includes charting of essential
requirements, location of the emergency wing, administration structure, work load, physical
facilities and amenities. EMS services can be summoned by the public at any time of
requirement. Emergency telephones numbers are used to inform about such cases before
getting the victim in the hospital. Ambulances are the primary source of deliverable to
support emergency services. The services are provided on the scene if there is a paramedic

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team present. If that’s not the case, the victim is bought to the hospital for further services.
When the victim is brought to the hospital, the victim can be an accident victim or a
medically traumatized victim, no amount of time should be wasted to in providing service to
the victim (Broyd et al., 2016). A slip of a minute of service can cause fatal consequences for
the patient. Improper treatment and delay in identifying the source of the injury and affect it
has on the victim can lead to major damage in the victim’s body and lastly result in death of
the patient.
Private hospitals mostly charge a stipulated before taking the patient in for emergency
treatment. Public hospitals mostly do not charge for emergency admissions unlike certain
private hospitals. It is mostly seen that the patient party asks about the cost of service before
admitting the injured victim in the hospital for further treatment (Carpenter, 2015). There are
different services provided for the injured or the medically traumatized depending on the
condition of the patient.
Being the part of operational team, it has been noticed that the emergency department
has received feedback from patients suggesting that the patient wait times need to be
improved. Considering the case of the public hospitals it is observed that the emergency
patients are made to wait for a considerable amount of time before service is provided to
them. Public hospitals are cheaper compared to private hospitals hence it pulls a huge amount
of emergency cases (Dutta et al., 2018). There are certain negative aspects in the emergency
wing of a public hospital. The major system archetype of a public healthcare hospital is the
waiting time. Complains have been lodged by the patients and their immediate family, that a
good deal of time is wasted in process and treating the injured or the medically traumatized
patient. As the service of the public emergency wing involves proper hierarchal governance
and protocols, it is observed that the service is slow. This slow service can produce fatal

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consequences for the injured victim. If the patient is a victim of a severe accidental trauma,
and if immediate service and care is not provided to him but the patient is constantly made to
wait. The operational team of the
The emergency care involves five steps: triage, registration, treatment, reevaluation
and discharge (de Jesus, 2019). The process which is used to determine the patient’s
condition is known as triage. This process dictates that the patient with the most severe
condition must receive instant treatment. This is also a reason why certain less critical
patients receive care later than the most serious one. When the emergency patient is brought
to the emergency wing, the emergency officer performs a primary study to determine the
gravity of the injury and collects the medical history of the patient (Grossmann, Bingisser &
Nickel, 2017). The most critical victim are provided life sustaining treatments and moved to
the critical section wing of the hospital. The patient is then registered under the hospital
following the guidelines of the hospital. This step is important to formally start the treatment
required and keep the patient under observation. Bed side registrations are also available for
the most critical patients by the nurses (Jennings, 2017). Treatment is provided initially by an
attending nurse or a mid-level practitioner. An ED physician or mid-level practitioner will
reevaluate your condition after they receive your test results because the results may give
them additional insight into the type of treatment one need (Hunsaker et al., 2015). Once the
patient is out of danger, a checkup is conducted to have a view of the overall health of the
patient and later he or she is discharged. The system requires the patient to wait a
considerable amount of time.

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Analysis of the current State Value Stream Map of the emergency
department based on System Archetypes
Figure 1
The map shows the overall working of the emergency department. The patient is
bought in, and his or her nature if injury is studied. The hospital also enquires about his or her
insurance policy if the patient has any. The patient is then registered and information about
the patient is drawn like his medical history and other important information required for the
treatment. A nurse attends the patients and gain required information from the patient. The
patient is provided with initial treatment and the further course of the treatment is discussed
which involves a lot of time. Then an in house doctor is brought in to do further diagnosis
and understand the depth of the injury or the medical condition of the patient. The patient is
provided with further treatment. The patient needs to wait for instructions from the doctor. If

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no further health care treatment is required, the patient is sent home. In case of a regular
patient, with a minor case of emergency, a nurse attends him or her firsts. Gathers
information, collects medical history, checks the hospital records for any previous record of
the patient. Vital statistics are taken and the patient is made to sit in the waiting area. The
patient needs to wait there for a considerable amount. The attending nurse moves the patient
to the ER room and examines the patient. If there is room available, the patient is shifted
there. The patient has to wait once more to understand the condition of his situation and for
further treatment. A doctor then examines the patient and asks for medical supplies if
required. The attending physician brings the medical supplies and there is again a period of
waiting. After the wait, the patient receives treatment from the doctor and departing
instructions are provided. After the check up, the patient is logged in for future reference and
the patient is sent home.
Recommended new State Value Stream Map with desired reduction in
patient turnaround time
To reduce the time around of the complete working of the system, few stages needs to
be eliminated and some can be merged. When a patient is bought in he or she can be
immediately attended by a nurse or a physician. The process of drawing information and vital
stats can be quickly done to reduce waiting time. At this time the nurse can conduct
additional test if required. Once the examination process is over, the patient can be made to
wait a little to be taken to the Doctor. The Doctor can examine the patient, and provide
council as required. And the patient can be sent home. The next time when the patient visits
he or she should be taken directly to the doctor without wasting time in performing

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examinations. The hospital can have a portal where all the information will be available and
can be easily drawn out (Freire, 2017). With the help of proper IT system, the entire process
can be made quicker and more accurate. The reports can be directly sent to the doctor’s portal
and the patient does not have to wait long (Vashi et al., 2018). This will eventually reduce
the turnaround time for the patient in ED.
Discussions on intended and unintended consequences of the modified
system
The consequences of the modified system will be mostly positive. The new method
will considerably discard time loss and more patients can be incorporated in that stipulated
time. If there is a heavy influx of patient on a particular day, each patient can be treated with
care without causing any chaos (Yang et al., 2018). The portal system will help keep all the
information and can be accessed quickly (Kobayashi, 2018). A particular nurse or an
attending physician when attending a patient reduces information time greatly. The waiting
time will gradually decrease and it will generate faster service (Kopanitsa & Taranik, 2015).
Conclusion
The emergency department of a public hospital is mostly busy throughout the day.
Time is a great factor and cannot be wasted in treating a patient. The patient brought in
judged on the basis of his or her physical condition and treatment is accordingly provided. It
is noticed that in public hospitals, the waiting time is longer and that can have negative effect
on the patient he or she is in a critical state. Changes conducted in the timeline of the system
value stream map will surely reduce the turnaround time for the patient.

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Recommendations
To reduce the turnaround time for the patients, below are few key recommendations.
 Increase staff capacity and induce trained nurse and physicians.
 Tests and examinations should be quickly conducted to reduce the fatal condition of
the patient.
 Emergency patient should go through a minimum number of protocols and service
should be immediately provided.
 Reduction in wait time in triage.
 Overcrowding should be avoided.

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References
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