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The National University Hospital Overcrowding In The Emergency Department Case Solution

Solution Id Length Case Author Case Publisher
2006 1935 Words (7 Pages) Muhammad Adnan Zahid Chudhery, Jingui Xie, Mabel C. Chou, Joe Sim, Sarah Safdar, Zhiying Liu Ivey Publishing : W18343
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The possible causes of the emergency department’s overcrowding at National University Hospital are that firstly, the Emergency Department of the hospital gets four other sources of patients including those that get admitted in High Dependence Wards, ICUs, same day admission patients and the referral patients. Apart from this, there was a huge time gap between when the patients were discharged and new patients were admitted. Because of the delays in getting the beds free, more patients would have to wait to be able to get a bed, which resulted in overcrowding in the ED. These delays were mainly because of limited doctors and nurses which resulted in delayed discharges and less number of porters available particularly during the peak hours which further worsened the situation. 

Case Analysis for The National University Hospital Overcrowding In The Emergency Department Case Solution

Moreover, overall the healthcare needs in Singapore have substantially increased due to the ageing population, which is why NUH, being one of the major hospital in the region faces an increased patient inflow in its ED that require immediate care or treatment, placing additional pressure on the hospital’s limited resources of ED doctors, nurses and the support staff. 

Apart from this, the bed allocation through BMU was also not being done efficiently, as the patients were allowed to choose their beds regardless of the specialty, which caused inconvenience for the doctors who had to travel unnecessarily from one bed to another to deal with the patients which resulted in long treatment times and hence further restricted the productive capacity of the hospital. Together with this, inefficient BMU operations also resulted in a longer time between the time when the bed was made available and the time when a bed was requested, indicating delays in the patient flow and ultimately resulting in overcrowding at the ED of the hospital.

Talking about the expected bottlenecks in the overall processes of the hospital, the major one is the inefficiency of the BMU system that is being used to allocate the beds. Because the operations are not managed in a systematic manner, it takes time to allocate beds to the patients once they have been given a go ahead by the doctors to get admitted. Also the slow rate of discharges can also be linked to this situation. As a result of which, there is a backlog of increasing customers who are waiting to be admitted and hence, overcrowding happens in the Emergency Department. Secondly there is inadequate staffing which means that the doctor to patients and nurses to patients ratio is too low resulting in a medical staff member dealing with a large number of patients that even affected the quality of the healthcare provided as well as the treatment delays. Apart from this, bed shortages can also be considered as bottlenecks, resulting in more patients waiting in the queue to get admitted and even a higher number of patients being referred to the other hospitals. Also, the peak hours also need to be taken in consideration when the patient flow is the highest and it becomes difficult for the hospital to manage a large number of patients at the same time causing longer waiting times. 

Also, it should be noted that the same day patients were called to the hospital in te afternoon one day before the surgery. This was also the peak discharge time. Hence the SDA patients had to wait in the emergency department only to be allocated a bed once the discharge of the previous patient was completed. Furthermore, the limited number of doctors in the hospital and the high work load on them results in delayed business operations as they are responsible for attending the 24 hours emergency calls as well during their work shifts.

Now referring to the Exhibit 5 of the case, it can be seen that from the time patient entered the Emergency Department till the nursing triage, it took an average patient around 40 minutes to get his temperature screened, get registered and make payment for the required treatment. However, on an average basis, as the patient got checked from the nurses and was referred to the doctor in took him average of 1 to 3 hours and further 1.5 hours if any lab test would be required. Further, when the patient would be admitted he would have to wait further 3 to 10 hours to be admitted. During the peak hours, the overcrowding in ED mainly occurs due to restricted patient flow as they get themselves checked from the nurses and then the doctors and then as they wait for a bed to get admitted.

2. In order to reduce the emergency department’s overcrowding, the National University Hospital can hire more doctors and nurses who will then be able to manage a larger number of patients at a time. This will reduce the patients wait time at the time of Nurse triage and ED doctor consultation. Hence, patients will eb quickly referred to the pharmacist or for a lab test in case of less severe conditions or referred to be admitted depending on their medical emergency. Secondly, National University Hospital will have to increase its spending to increase the number of beds available in the hospital for each department so that the patients are admitted as per their specialty. This way the doctors would not have to face the inconvenience of travelling to different wards for dealing their patients. Apart from this to deal with the 24-hour emergency calls, it is proposed that a separate resource or a doctor may be hired who would solely be responsible for handling the incoming emergency calls in the hospital. This would help streamline the overall process of managing the admission and the discharge of the patients and reduce the ED patient waiting time as the designated doctors would be managing the emergency department patients only. Also, it will help in reducing the quality of care received by each patient and hence reduce the volume of the returning patients who might not be treated well in the first time. Hence, this will also help improving the patient satisfaction level and would ensure sustainable growth of the hospital in the long run. 

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