Emergency Care Case Study

Institutional Affiliation
The problem at hand involves an emergency room facility with 15 beds.
This paper will discuss the root causes of the problems and complaints
about the clinic and formulate a strategic plan to address them. In this
discussion, this paper will also analyze the different emergency
services that should be prioritized in the strategic plan. In the
discussion, this paper will also discuss the formulation of a plan to
treat various classes of patients such as adults, minors, emancipated
minors, or incompetent adults in the new ER organization and also create
a procedure that provides emergency care to those who refuse to assent
the treatment. In the illustration of the details of the emergency room
case, this paper will induce the concepts of the Good Samaritan law and
the concept of negligence and liability in context to the case under
Problem Discussion
As a chief operating officer, of the Emergency Room, there are various
responsibilities in the hospital that require immediate attention to
avert the looming problems. This is because patients have complained of
poor emergency room management, lack of beds which makes patients to be
turned down or being sent away and long waiting time. There has also
been complaints that patients are experiencing long wait times and lack
of enough physicians to attend to them leading to the wait time or turn
down. To address these problems, I will formulate a strategic plan and
implement it to the hospital in addition to the human resource
One of the main causes of the problem is the lack of stronger
administrative supervision leading go laxity and uncoordinated service
delivery. The main problem lies in my office as the Chief Operating
Officer of the hospital since my authority is not felt. This is because
there are many responsibilities falling down under this position which
makes it cumbersome for me to handle the very minute details of
supervising the emergency room. Duties of this office also coincide with
those of the chief executive officer which should also be investigated
and responsible for the problems.
This position normally reports to the facility’s Chief Executive
Officer but some of the responsibilities and roles include supervision
of all the daily operations of the facility. The operating officer
should also set ethical standards that he or she should abide himself by
and also integrate it into organizational culture, patient’s needs and
the expectations of the employee. According to Drench, Noonan, Sharby
and Ventura (2007), ethics complement the guidelines set by an
organization. They are a set of moral principles that shape the
behavior and philosophy of all the employees including the operating
officer which I should abide to.
Another common complaint that was received from the patients was
regarding poor ER management. A keen investigation reveals that the
problem was due to the lack of integration of the facility’s
leadership in the organizational operation and lack of accountability
for quality of emergency care. The Emergency Department also lacked
leadership which affected the ability of the management to monitor the
facility’s day-to-day operations. This became a direct consequence of
the poor performance of the ER Department.
The other complaint was the sending of patients away and long waits due
to the lack of space and lack of physicians to appropriately provide
care for them. After investigations, it was realized that the problem
was due to the coverage that was held by on-call physicians. This
problem led to presented many problem recognitions, long wait times,
delayed treatment, turning of patients away and the lack of space
(Ashton, 2013)
Finally, as the chief operating officer, the investigations determined
that the Emergency Room in its current state is a liability according to
several various laws such as the Emergency Medical Treatment and Labor
Act (Thaddeus, 2008). This law is consistent with the philosophy that
healthcare during an emergency is a moral right which ought to be
provided despite the patient’s ability to afford the services. The law
also prevents patients from unfair treatment during emergency service
situations in any hospital or when they are being transferred to another
hospital with no cause for such medical condition (Ashton, 2013)
Strategic Plan
First, the governing body is responsible for the professional standards
of the emergency department, just as it is their responsibility to
oversee other clinical standards of the organization. As part of the
governing body, I will implement the necessary strategic plan to create
the needed improvements and reduce the organizational liabilities. The
strategic plan’s primary focus will be centered on adequate staffing,
facility expansion, and billing restructuring.
Secondly, as the Chief Operating Officer, it is my duty to ensure the
emergency department staff to provide reasonable care to the presented
patients. This is achieved by maintaining well-staffed, well-organized
and qualified personnel. The emergency department will be equipped with
the physical means necessary to ensure prompt diagnosis, stabilization,
treatment, and referral. (Ashton, 2013) The number and types of
employees in the health care setting vary with the practice and setting.
Generally, the more specialized the setting, the more specialized the
personnel. The staff in the emergency department will maintain
specifically trained, licensed and certified in emergency care only
Rarely is any health care treatment given without the involvement of a
“team” of employees responsible for certain aspects of a patient’s
care. Employees in the health care setting may fall into the following
categories: first are those who are licensed, the second are those who
are registered, and the third are those who are certified. A part of the
strategic plan to improve the performance of the emergency department,
we will ensure the staff will be licensed, certified or registered, or
have a combine of the three.
The facility’s Emergency Room will ensure staffing of an adequate
amount of physicians for the ER. The physician will be contracted to
have privileges in the emergency department on a full-time basis. The
contract will incorporate guidelines that will provide coverage for
full-time coverage, supervision of hospital nurses and house staff,
maintenance of equipment and facilities, billing and referral of
patients. The contract will also specify the duration of the arrangement
and provisions for renewal. (Ashton, 2013)
The second part of the plan for the emergency department is to have a
facility expansion of the emergency department. This project will have
an approximate 9 month completion time. The ER expansion project will
add 20 additional beds capacity to the department will allow for an
increased number of patients being seen. The capacity will allow for
total number 35 patients to be seen at a given time.
The final process improvement will be the restructuring of the billing
process that will allow for dual billing. The financial arrangements
between the hospital and the contracted physician group may legally
allow two charges to the patient: one for hospital services and another
for the physician’s service. (Ashton, 2013) This will allow for the
physician group to bill the patient directly for services rendered or
assign the account to New Guinea Medical Campus for billing and
Good Samaritan Law
This law offers the grounds for people and healthcare professionals to
offer assistance to people who deserve their services on rescue basis
and not necessary for official treatment services (Gulam & Devereaux,
2007). In this case, the services of the emergency room should be
availed to patients without being turned away despite the level of
capacity the hospital has or the prevailing limitations. The Good
Samaritan law affects the appropriate treatment of the emergency room
patients. Therefore it is the moral duty of the management to respond to
the complaints of the patients in line with this law.
Negligence and Liability
Negligence is the improper or the unprofessional treatment of a patient
by a health professional that leads to damage or undeserved or undesired
effects (Feinman, 2010). Negligence leads to liability both in theory
and practice as the person is responsible due to the duty of due care,
standard care expected and the compensation injury suffered by the
victim. In this case, the Emergency Room of the health facility is
liable for any negligent consequence that may arise from the service
that attract complaints that have been recorded on the facility by
Emergency room services are essential to any healthcare and should be
taken care of with the full attention of all the personnel involved
including the executive officers. The case of the emergency room
discussed above lacked this attention to the extent that the patients
complained which should not be the case. The case above disregarded the
Good Samaritan law of service delivery by healthcare officers and risked
allegations of negligence and liability by the staff at the facility. To
solve these problems now and for the future, the strategic plan
formulated will ensure smooth running of the emergency room is fully
Ashton, A. (2013). Issues in Critical and Emergency Medicine.
Drench, M.E., Noonan, A., Sharby, N. & Ventura, S.H. (2007).
Psychosocial Aspects of Health.
Care, 2nd Edition. Upper Saddle River, NJ: Prentice Hall, 2007.
Feinman, J. (2010). Law 101. New York: Oxford University Press.
Gulam H, Devereaux J (2007). “A brief primer on Good Samaritan Law for
health care
professionals”. Aust Health Rev 31 (3): 478–482
Thaddeus M. P. (2008). EMTALA: Its Application to Newborn InfantABA
Health. The eSource, Vol. 4, No. 7

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