Incident 2: Emergency Department Repeat Admissions Essay

Incident 2: Emergency Department Repeat Admissions Essay

Incident 2: Emergency Department Repeat Admissions Essay

Applying Ethical Principles
The present case pertains to the ramifications of recurrent admissions and excessive utilization of the emergency department (ED) at the County General Hospital (CGH). According to the data, a total of 9 individuals residing in central Texas have had more than 2,000 admissions within the last 6 years (Capella University, n.d.). Given an estimated expenditure of more than $2 million in resources. Frequent non-urgent visits to emergency departments are a prevalent concern in numerous nations. The Federal Emergency Medical Treatment and Active Labor Act (EMTALA) requires that all hospitals that receive federal funding provide medical treatment to any individual who presents themselves at the emergency department, regardless of their financial capacity to pay for the services rendered. The purpose of this paper is to evaluate the facts presented in the case study by utilizing peer-reviewed scholarly articles as substantiation to bolster the analysis of the case. This includes elucidating the rationale behind the selection of the articles and how they reinforce the analysis.

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Ethical Issue
County General Hospital’s CEO, Matt Losinki, voiced alarm about the fact that more than $200,000 in revenue was not being collected annually and blamed it on frequent trips to the ER. This is referred to as “moral awareness” in the ethical decision-making paradigm. The Chief Executive Office observed that frequent visits to the emergency room were driving up the cost of care, as well as congestion, lengthening treatment and wait times, and creating dissatisfied patients. People who often use the emergency department are people who don’t think they’re in great shape and, as a consequence, need quick medical care. The amount spent on healthcare is significantly impacted by frequent trips to the emergency department. Regular visitors to the Emergency Department will be significantly impacted by the quality of care improvements since they will assist to cut down on and eventually end frequent visits (Lindor & Ghaith, 2022).
Using the Ethical Decision-Making Model
The three pillars of the ethical decision-making paradigm are moral awareness, moral judgment, and ethical conduct. All cooperate to find a resolution to the conundrum. Moral awareness is an interpretative process in which a person becomes aware of an issue and the potential consequences of their choice. Moral decision-making entails deciding what is right or wrong. This choice may reflect the individual’s prejudices or differences (Schein, 2020). Acting after making the proper decision is the outcome of ethical conduct. When behaving ethically, one makes the best decision possible in light of past research. The narration on the overuse of ED services in the Texas region sparked Mr. Losinski’s moral consciousness. He reasoned that CGH may be dealing with a similar problem as a result. His choice to do a study on the problem inside his institution and offer it to the management group to resolve the conundrum was morally sound. Matt should decide to address the current problem using his ethical conduct as a healthcare practitioner and four ethical standards. The root causes of the problem are overuse of ED services and income loss.
Peer-Reviewed Journal
The issue of overcrowding in emergency departments (EDs) is a growing concern in the field of public health. This phenomenon is closely linked to escalating healthcare expenditures, extended waiting periods, prolonged ED stays, reduced patient contentment, and elevated mortality rates. The issue of overcrowding in Emergency Departments (EDs) has a noteworthy financial implication for the healthcare system. The implementation of a strategy aimed at enhancing the transfer of patients from emergency departments to inpatient clinics has resulted in a reduction of overcrowding in US county hospitals and US university hospitals. This approach has been associated with a potential cost savings of 10 million dollars in charges for county hospitals and an additional 4 million dollars in costs per year for university hospitals (Sartini et al., 2022).
Communication Strategies and Effectiveness of Approach
Effective communication is a crucial aspect of leadership. Effective problem-solving necessitates active listening and constructive participation in generating ideas. Through the use of active listening, Mary apprised Matt that Medicare provides coverage for 75% of qualified recurring Emergency Department visits. Mary did not provide a sufficient explanation to Matt regarding the prioritization of the piece. Matt demonstrated effective communication skills when he reached out to Aniysha, the administrative resident, to request statistical data about patients who have made multiple visits to the emergency department.
Matt could potentially engage in communication with the management team through the delivery of a presentation that outlines his concerns and relevant statistical data to the executive committee. Matt expressed his concerns while actively listening. Effective communication practices facilitate the expression of ideas and opinions from all parties involved. According to Moreira et al. (2019), employing closed communication is unsuitable for addressing or resolving a problem that involves multiple individuals. The ability to communicate effectively enables individuals to participate and arrive at informed, comprehensive conclusions, while ineffective communication results in heightened levels of discord.
Matt’s decision to request a time for studying before presenting his concerns to the executive committee demonstrated a high level of effectiveness in his approach. Matt effectively organized and managed his information. The researcher discovered that frequent visits to the emergency department resulted in financial losses for the hospital. According to Moreira et al. (2019), the initiation of a problem-solving discourse was triggered by the presentation of factual information to the management. Matt, in his capacity as CEO, established commendable hospital objectives by highlighting this issue.
Applying Ethical Principles
The ethical principles of healthcare serve as a framework for resolving ethical dilemmas. The four ethical principles that are commonly recognized in the field of healthcare are autonomy, beneficence, nonmaleficence, and justice. According to Varkey (2020), the principles of autonomy, beneficence, nonmaleficence, and justice are fundamental in healthcare. Autonomy refers to the acknowledgment of patients’ rights, while beneficence entails assisting patients. Nonmaleficence, on the other hand, involves refraining from causing harm to patients, while justice requires that patients be treated equitably. It is recommended that CGH (Community General Hospital) undertake the responsibility of educating patients who frequently visit the emergency department, thereby addressing the issue at hand.
The provision of patient education regarding available resources, scheduling of subsequent appointments with medical practitioners, and identification of pertinent symptoms and appropriate courses of action for contacting healthcare providers or seeking emergency medical attention. Improving patient care and reducing readmission rates for individuals with ED can lead to enhanced educational outcomes and increased revenue for the organization. This issue is by the principle of beneficence. The implementation of this resolution is expected to enhance the quality of patient care while also reducing costs, thereby promoting collaborative efforts among healthcare professionals. Enhanced performance and improved patient care.

Conclusion
Healthcare professionals can apply ethical principles to analyze situations and tackle ethical dilemmas. The present case study entails a decision-making process for the staff of a county general hospital to curtail the frequency of Emergency Department (ED) readmissions while ensuring the provision of optimal patient care. The application of the four principles of healthcare ethics by the hospital administration team can aid in the provision of superior patient care while mitigating the incidence of repeated admissions and associated losses.

References
Capella University. (n.d.) Emergency Department Repeat Admissions – A Question of ResourceUse
Lindor, R. A., & Ghaith, S. (2022). Emergency Medical Treatment and Labor Act (EMTALA). Laws of Medicine, 93–106. https://doi.org/10.1007/978-3-031-08162-0_6
Moreira, F. T. L. D. S., Callou, R. C. M., Albuquerque, G. A., & Oliveira, R. M. (2019). Effective communication strategies for managing disruptive behaviors and promoting patient safety. Revista Gaucha de Enfermagem, 40(spe), e20180308. https://doi.org/10.1590/1983-1447.2019.20180308
Sartini, M., Carbone, A., Demartini, A., Giribone, L., Oliva, M., Spagnolo, A. M., Cremonesi, P., Canale, F., & Cristina, M. L. (2022). Overcrowding in Emergency Department: Causes, Consequences, and Solutions—A Narrative Review. Healthcare, 10(9), 1625. https://doi.org/10.3390/healthcare10091625
Schein, C. (2020). The Importance of Context in Moral Judgments. Perspectives on Psychological Science, 15(2), 207–215. https://doi.org/10.1177/1745691620904083
Varkey, B. (2020). Principles of Clinical Ethics and Their Application to Practice. Medical Principles and Practice, 30(1), 17–28. https://doi.org/10.1159/000509119

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Matt Losinski finished reading an article that provided grim details of a study of the overuse of emergency services in hospitals in central Texas. He smiled that sardonic half smile that meant there was a strong possibility that County General Hospital (CGH) might have the same problem. As chief executive office (CEO), Losinski always saw the problems of other hospitals as potential problems at CGH, a 300–bed, acute care hospital in a mixed urban and suburban service area in the south central United States. CGH was established as a county–owned hospital; however, 10 years ago the county wanted to get out of the hospital business and the assets were donated to a not–for–profit hospital system. The new owner has continued a strong public service orientation, even though CGH no longer receives the tax subsidy it did when it was county owned; it must look to itself for fiscal health.
The study data showed that nine residents of a central Texas community had been seen in emergency departments (EDs) a total of 2,678 times over 6 years. One resident had been seen in an ED 100 times each year for the past 4 years. Given that an ED visit can cost $1,000 or more, the nine residents had consumed $2.7 million in resources. These high users of ED services were middle age, spoke English, and were split between male and female. To Losinski, the problem seemed like a manifestation of Wilfredo Pareto’s classic 80/20 rule.
Losinski forwarded the article on a priority basis to Mary Scott, his chief financial officer (CFO), and asked her to see him after she read it. Scott stopped by Losinski’s office late the next day and began the conversation by asking him why he thought the article was a priority. Scott reminded Losinski that Medicaid paid 75% of costs for eligible ED users and that the cross subsidy from privately insured and self–pay ED admissions covered most of the unpaid additional costs. Losinski had a good working relationship with Scott, but he was a bit annoyed by her rather indifferent response.
Losinksi wanted details on use of the ED at CGH. He asked the administrative resident, Aniysha Patel, to gather data to identify use rates for persons repeatedly admitted to the ED. The findings that Patel gave to Losinski two weeks later were not as extreme as those reported from central Texas; however, they did show that a few persons were repeatedly admitted to the ED and accounted for hundreds of visits in the past year. The clinical details were not immediately available, but a superficial review of the admitting diagnoses suggested that most admissions involved persons with minor, nonspecific medical problems—persons commonly known as the “worried well.” Although Scott was correct that Medicaid covered the majority of costs, the fact remained that over $200,000 each year was not reimbursed to CGH. Were that money available, it could go directly to the bottom line and could be used for enhancements to health initiatives for the community. In addition, repeated admissions to the ED contributed to crowding, treatment delays, and general dissatisfaction for other patients.
Losinski presented the data to his executive committee, which includes all vice presidents, the director of development, and the elected president of the medical staff. The responses ran the gamut from “So what?” to “Wow, this is worse than I imagined.” Losinski was bemused by the disparity of views. He had thought there would have been an almost immediate consensus that this was a problem needing a solution. The financial margins for CGH were already very thin, and the future for higher reimbursement was not bright. A concern echoed by several at the meeting was the requirement of the federal Emergency Medical Treatment and Active Labor Act (EMTALA) that all persons who present at an ED that receives federal reimbursement for services must be treated and stabilized.
Losinski asked his senior management team for recommendations to address the problem of ED overuse.

INSTRUCTIONS:
Develop a solution to a specific ethical dilemma faced by a health care professional by applying ethical principles. Describe the issues and a possible solution in a 3-5 page paper.
Introduction
Whether you are a nurse, a public health professional, a health care administrator, or in another role in the health care field, you must base your decisions on a set of ethical principles and values. Your decisions must be fair, equitable, and defensible. Each discipline has established a professional code of ethics to guide ethical behavior. In this assessment, you will practice working through an ethical dilemma as described in a case study. Your practice will help you develop a method for formulating ethical decisions.
Instructions
At a minimum, be sure to address each point. In addition, you are encouraged to review the performance-level descriptions for each criterion to see how your work will be assessed.
For this assessment, develop a solution to a specific ethical dilemma faced by a health care professional. In your assessment:
1. Access the Ethical Case Studies media piece to review the case studies you will be using for this assessment. (case study is above)
 Note: The case study may not supply all of the information you need. In such cases, you should consider a variety of possibilities and infer potential conclusions. However, please be sure to identify any assumptions or speculations you make.
• Include the selected case study in your reference list, using proper APA style and format. Refer to the Evidence and APA section of the Writing Center for guidance.
2. Summarize the facts in a case study and use the three components of an ethical decision-making model to analyze an ethical problem or issue and the factors that contributed to it.
• Identify which case study you selected and briefly summarize the facts surrounding it. Identify the problem or issue that presents an ethical dilemma or challenge and describe that dilemma or challenge.
• Identify who is involved or affected by the ethical problem or issue.
• Access the Ethical Decision-Making Model media piece and use the three components of the ethical decision-making model (moral awareness, moral judgment, and ethical behavior) to analyze the ethical issues.
 Apply the three components outlined in the Ethical Decision-Making Model media.
• Analyze the factors that contributed to the ethical problem or issue identified in the case study.
 Describe the factors that contributed to the problem or issue and explain how they contributed.
3. Apply academic peer-reviewed journal articles relevant to an ethical problem or issue as evidence to support an analysis of the case.
 In addition to the readings provided, use locate at least one academic peer-reviewed journal article relevant to the problem or issue that you can use to support your analysis of the situation.
 Cite and apply key principles from the journal article as evidence to support your critical thinking and analysis of the ethical problem or issue.
 Review the Think Critically About Source Quality resource.
 Assess the credibility of the information source.
 Assess the relevance of the information source.
4. Discuss the effectiveness of the communication approaches present in a case study.
• Describe how the health care professional in the case study communicated with others.
• Assess instances where the professional communicated effectively or ineffectively.
• Explain which communication approaches should be used and which ones should be avoided.
• Describe the consequences of using effective and non-effective communication approaches.
5. Discuss the effectiveness of the approach used by a professional to deal with problems or issues involving ethical practice in a case study.
• Describe the actions taken in response to the ethical dilemma or issue presented in the case study.
• Summarize how well the professional managed professional responsibilities and priorities to resolve the problem or issue in the case.
• Discuss the key lessons this case provides for health care professionals.
6. Apply ethical principles to a possible solution to an ethical problem or issue described in a case study.
• Describe the proposed solution.
• Discuss how the approach makes this professional more effective or less effective in building relationships across disciplines within his or her organization.
• Discuss how likely it is the proposed solution will foster professional collaboration.
7. Write clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics.
• Apply the principles of effective composition.
• Determine the proper application of the rules of grammar and mechanics.
8. Write using APA style for in-text citations, quotes, and references.
• Determine the proper application of APA formatting requirements and scholarly writing standards.
• Integrate information from outside sources into academic writing by appropriately quoting, paraphrasing, and summarizing, following APA style.
Additional Requirements
Your assessment should also meet the following requirements:
• Length: 3–5 typed, double-spaced pages, not including the title page and reference page.
• Font and font size: Times New Roman, 12 point.
• APA tutorial: Use the APA Style Paper Tutorial [DOCX] for guidance.
• Written communication: Use correct spelling, grammar, and punctuation.
• References: Integrate information from outside sources to include at least two references (the case study and an academic peer-reviewed journal article) and three in-text citations within the paper.
• APA format: Follow current APA guidelines for in-text citation of outside sources in the body of your paper and also on the reference page.
Competencies Measured
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:
• Competency 1: Apply information literacy and library research skills to obtain scholarly information in the field of health care.
• Apply academic peer-reviewed journal articles relevant to an ethical problem or issue as evidence to support an analysis of the case.
• Competency 3: Apply ethical principles and academic standards to the study of health care.
• Summarize the facts in a case study and use the three components of an ethical decision-making model to analyze an ethical problem or issue and the factors that contributed to it.
• Discuss the effectiveness of the approach used by a professional to deal with problems or issues involving ethical practice in a case study.
• Apply ethical principles to a possible solution to an ethical problem or issue described in a case study.
• Competency 4: Write for a specific audience, in appropriate tone and style, in accordance with Capella’s writing standards.
• Discuss the effectiveness of the communication approaches present in a case study.
• Write clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics.
• Write following APA style for in-text citations, quotes, and references.
Use the Distinguished criteria
Applying Ethical Principles Scoring Guide
CRITERIA PROFICIENT DISTINGUISHED
Summarize the facts of a case study using peer-reviewed journal articles as evidence to support analysis of the case. Summarizes the facts of a case study using peer-reviewed journal articles as evidence to support analysis of the case. Assesses the facts of the case study using peer-reviewed journal articles as evidence to support analysis of the case, including reasons why the chosen articles support the analysis.
Discuss the effectiveness of the communication approaches present in a case study. Discusses the effectiveness of the communication approaches present in a case study. Discusses the effectiveness of the communication approaches present in a case study, explaining which approaches should be used more and which should be avoided.
Discuss the effectiveness of the approach used by the professional in a case study as it relates to the three components of the ethical decision-making model. Discusses the effectiveness of the approach used by the professional in a case study as it relates to the three components of the ethical decision-making model. Discusses the effectiveness of the approach used by the professional in the case study as it relates to the ethical decision-making model, including consequences of using effective and noneffective approaches.
Apply ethical principles to a possible solution to the proposed problem or issue from a case study. Applies ethical principles to a possible solution to the proposed problem or issue from a case study. Applies ethical principles to a possible solution to the proposed problem or issue from the case study, explaining why the proposed solution is based in ethical principles.
Produce text with minimal grammatical, usage, spelling, and mechanical errors. Produces text with minimal grammatical, usage, spelling, and mechanical errors. Produces text free of grammatical, usage, spelling, and mechanical errors.
Integrate into text appropriate use of scholarly sources, evidence, and citation style. Integrates into text appropriate use of scholarly sources, evidence, and citation style. Integrates into text appropriate use of scholarly sources, evidence, and citation style without errors and uses current reference sources.

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