The Problem with Care

(In the Emergency Department)

Sonal Muthalali, Wade Hall, Nate Martin, and Dr. Natalie Mountjoy
Life Science Academy, Daviess County High School

INTRODUCTION

METHODS

The American Health Care System is one of the most important

assets that the United States has possession of. It allows people to
receive needed care when and whenever they need. But this
power is often abused and misused in multiple ways. The
emergency department is where most of the problems exist.
Patients approach the emergency department as a safe haven to all
their medical and physiological needs. The United States Health
Care is not allowed to revoke any patient from service which
causes a waste of time and money for the staff members who need
to treat the more emergent issues. Other problems with the
emergency departments also consist of the lack of communication
between physicians. Current efforts have been made to make
physicians jobs easier with the use of technology. Most of the
time, technology causes more problem when dispersing
information from physicians in the emergency department and the
primary care physicians of the patient. The problem that our
group have decided to improve on is the lack of continuity of
care. We have come to the conclusion that the lack of continuity
of care can be solved through a patient care plan that will
discharge patients of the less urgency to their primary care
physicians instead of holding them in the emergency department.

The problem in many Emergency Departments is the lack of

continuity of care within the E.R. The communication barrier
between the primary care physicians and the emergency room staff
is one of the most important factors in this problem. Primary care
physicians often have a much more personal relationship with the
patients, so they can categorize their condition often without a
need for dispatch to the ER for evaluation (Dr. Martin 9/17/15).
However, patients sometimes show up who have never been seen
by the E.R. physician, and due to cross coverage even the primary
care physician who is on-call may not know anything about the
patient. These cases often receive lower levels of care because
information isnt relayed through the proper channels and mistakes
are made.
Another factor in this is that since the
staff members in the E.R. are so
overwhelmed, many problems are created
with other departments because they are
attempting to keep up with the influx of
patients. To avoid lawsuits, hospitals
often times over-treat patients with
defensive medicine. For example, a patient
Mistakes are most
was recently rushed to another hospital for
commonly made
what one physician thought was a tumor
when communication
but if they had been able to consult better
fails; this would be
with the primary care physician they would less likely to happen
have realized it wasnt. These cases cause with higher rates of
unnecessary stress on the family and waste continuity of care.
productivity time and resources.
Another important factor that affects the continuity of care is
the amount of outsourcing the Emergency Department does. It is
becoming common for E.D.s to outsource the as much unnecessary
resources as possible. This is good in some ways; it cuts down on
cost and promotes a more collaborative treatment atmosphere.
Outsourcing dies have its drawbacks though. For example when
lab work is outsourced it is harder for the E.D. staff to
communicate with the lab staff on questionable results. This leads
to inefficiency, which is one of the worst problems that an
Emergency Department can have.

OUR STUDY
We searched for evidence on how having multiple Emergency
Department staff members treating the same patients effected the
efficiency and quality of their care. We expected to find that the
more people that were involved in the care of a patient the more
likely it was that mistakes would be made and efficiency and
quality of care would go down. To test this we interviewed
multiple members of Emergency Department to ask what their
personal views where. We also studied multiple articles written
on the continuity of care of Emergency Department patients.

The outsourcing of basic lab work by Emergency

Departments can be viewed as a good and bad.
It cuts down on cost but also creates another
way from information to be more easily
misunderstood

RESULTS
In our interview, a pediatrician described the problems faced in
collaboration with emergency departments. While Owensboro
Health uses electronic medical records, the hospitals in the
surrounding counties do not. They use paper records, which are
inefficient, because physical transport isnt instantaneous like
electronic records are. They are also often illegible, because
scribes recording the dictations are having to write extremely
quickly. We want to make electronic records the norm for
surrounding hospitals, which is a lot easier to transport and
analyze. One orthopedic surgeon mentioned that medical records
arent available to emergency departments, which leaves the ED
doctor knowing nothing about the patient (Martin, pers. comm.)

While electronic records are very helpful, they dont fix all the
communication problems. Patients might be seen in the ED, and
discharged to a primary care physician other than the one they
usually visit. The ED doesnt send discharge reports in a timely
fashion, instead calling the on-call pediatrician that knows very
little background on the patient. (Martin, pers. comm.) Ideally,
medical records would be completed at the time of the ED visit,
and then sent electronically to the primary care physician. A
change in the patient discharge summary indicating that a copy
needs to be sent immediately to the primary care physician
would fix this problem.

DISCUSSION
In conclusion, if electronic medical records are used more
often, communication between EDs and primary care
physicians will be streamlined. We believe that by simply
using electronic medical records more often and sending a
copy to primary care physicians will help in this process. Our
research shows that it isnt a technology problem, it is a lack
of use of technology. Eventually, we hope to potentially
create our own system of communication specifically for
doctors. Although emergency rooms are widely considered
expensive places for diagnostic care, physicians are
increasingly relying on them to determine whether a patient
needs to be hospitalized. Patients frequently go to the
emergency room because they feel they have no alternative,
and the researchers also noted that emergency rooms served
as a medical safety net for patients without health insurance.
Our mission is to make the ED a workplace for the needy
and not for those who are not urgent. In the future, we hope
to see emergency departments are being used properly to
make physician jobs easier and that patient communication
care plans are put into course of action to allow information
to be dealt accordingly.

REFERENCES

ACKNOWLEDGEMENTS
We want to thank the Owensboro Health Regional Hospital
providing us a tour and information of their emergency
department. We also want to thank Theresa Hall, Robert Martin,
and Lynette Martin who graciously took time out of their day for
us to conduct an interview with them on their experiences in and
out the emergency department. We also want to thank our
facilitator Natalie Mountjoy who was able to answer our
problems throughout the project.