Capella Patient Outcomes in a Median Low Volume Emergency Department Bibliography

attachment_1Ethical Dilemma at the Emergency Department:

Name

Capella University

Applying Ethical Principles

November 7, 2020

Identifying the Dilemma

Health care professionals often find themselves in ethical dilemmas in executing their professional duties.  A case study on the overuse of emergency services at county general hospitals in Texas shows how the emergency department is used by many people repeatedly (Spikes, 2019). Also, the hospital has to provide health care services to many people hence overcrowding of the facility. The majority of the people receiving the services are not satisfied, putting pressure on the professionals’ side. Additionally, the hospital owner is in the dilemma of providing health services without making any profits to the Texas residents when the hospital faces many financial problems since it stopped receiving subsidies as it used to accept when it was county-owned.

Overview of the Case Study

Matt Losinski is the CEO of the county general hospital. He faces a challenge after reading an article that provided gloomy details about the emergency department’s overuse. He informs the financial officer who doesn’t treat the matter with the urgency it deserves to get the necessary information. According to Spikes (2019), the financial officer, Mary Scott, reminds him that Medicaid paid 75% of eligible emergency department users’ costs (Spikes, 2019). The cross-subsidy from privately insured and self–pay emergency department admissions covered most of the additional unpaid fees.

Furthermore, the CEO, not justified by the financial officer’s statements, seeks to get details from the administrative resident tasked to gather data to identify the use rates for persons repeatedly admitted to the county General hospital’s emergency department. The report from the administrative resident proves that there were people who often used the emergency department. Still, it was not as extreme as earlier shown by the central Texas report. Another challenge of missing details arose where clinical information that was important to run the hospital was missing. According to Spikes (2019), there was the problem of some payments that had not been sent to the hospital to ensure that services run smoothly. Moreover, there were problems with how the health facility was heavily crowded, treatment delays, and general dissatisfaction of patients because of increased admissions to the emergency department.

Moreover, another big challenge arose when the CEO presented the data to his executive committee, including all vice presidents, the director of development, and the medical staff’s elected president. Contrary to his expectations, the executive committee member responded with different views than a consensus in providing a solution (Spikes, 2019). Additionally, the county general hospital’s release of funds was already limited, and there was no hope for any increased disbursement of funds in the future. Lack of an agreed solution led to the CEO asking his senior management team for recommendations to address emergency department overuse.

Components of Ethical Decision-Making Model

Moral awareness is one of the three components of the ethical decision-making models.  Moral awareness refers to the capability to notice and acknowledge a person’s choice (Miller & Springer 2020). To recognize the ethical issue, they know that their actions may either benefit or harm other people. In the case study above, the hospital’s management does not professionally conduct themselves. For instance, after the CEO called the executive committee’s meeting, the committee did not even work towards getting a solution for the emergency department; instead, they just brought up different issues. The management failed to put into consideration how their actions would affect the patients and the facility itself. Additionally, they also failed to appreciate the financial position the hospital would find itself.

Moral judgment is another component of the ethical decision-making model. This component evaluates the correctness or incorrectness of an ethical issue. On this issue, the hospital management fails to manipulate their export activities with truth and fairness to show professionalism. Firstly, management has been unable to come up with solutions to address the problem at hand, but instead, they brought up different ideas that did not urgently address the matter. The management could not evaluate if the solution answered the question since they could not come up with the solution.

Ethical behavior is another component of the proper decision-making model. It refers to how moral agents should overcome any resistance and opposition to develop ideas to attain their goals (Özsoy & Ekici 2017). First of all, the county general hospital management failed in its professionalism since it could not overcome any resistance and develop strategies to deal with the problem. Additionally, the administration members did not even listen to each other, but instead, everyone gave their ideas, and little was done to deal with the matter at hand.

Effectiveness of Communication Approaches in the Case Study

Communication plays an essential role in any discussion to arrive at a solution. Communication is used to pass information, inspire, or persuade a person or a group of people (Liu& Manias 2016). Communication has consequences since a person is supposed to make a critical decision after effective communication. In the case study, the CEO asks his assistant to see him once she has finished reading the report; face-to-face communication is considered significant. It shows exactly how someone’s response would be concerning a particular subject. He noticed how indifferent Scott was relating to the matter and looked for other gathering strategies. When communicating with Aniysha Patel, he was a bit vague in his communication; he didn’t specify the data for whichever period he needed from Aniysha Patel. Moreover, this led to Aniysha gathering relatively shallow data as compared to that from Central Texas.

Resolving the Dilemma Using the Components of Ethical Decision-Making Model

The hospital management should work to ensure better solutions are reached. The four principles of ethics are autonomy, beneficence, nonmaleficence, and justice. First of all, autonomy refers to the principle of independence. Members of the executive committee should be allowed to make their own decisions based on their professional achievements. The Company’s CEO should not expect a particular response from the members but should give them the freedom to make decisions. Also, the CEO should provide basic information on the situation to ensure better decisions by the executive committee members.

Additionally, justice, as an ethical principle, should apply. Patients in the emergency department are not treated equally. Some patients are satisfied with the services offered at the county general hospital while others are not. To solve the problem of dissatisfaction of some patients, they should all be treated equally. The hospital management should also talk to dissatisfied patients to understand if there could be any other problems and address them.

Beneficence is another ethical principle that should be embraced. Charity entails helping the patient advance his or her good. The county general hospital management should, at all times, do well to all patients. The management should also avoid any negative feelings by the patients towards the clinic by doing well to all the patients. Furthermore, since the hospital serves mostly people with low incomes, it should treat them well and provide good services.

Nonmaleficence is another ethical principle that entails not bringing harm to other people. Nonmaleficence is not to harm a patient. They did not cause a hurry in treating patients, which resulted in crowding and treatment delays. To address the problem bearing nonmaleficence in mind, the hospital should avoid delays in treating the patients. Also, the management should address payment issues so that patients receive services effectively.

Moreover, the ethical decision-making models that include moral awareness, moral judgment, and ethical behavior should be adhered (Miller & Springer 2020). The most appropriate solution for the dilemma would be getting donors and well-wishers to support the facility financially. Additionally, the management should focus on increasing funds for the hospital through campaigns or registering for government support to deal with its financial problems. Capella Patient Outcomes in A Median Low Volume Emergency Department Bibliography

In conclusion, the hospital faces a major ethical challenge about the emergency department’s overuse at the county general hospital.  Additionally, the hospital’s response does not address the problem at hand; they all bring up other issues that are not related to the problem. Also, hospital management does not conduct its mandate professionally and does not follow their profession’s ethics. In solving the problem, the management should follow the ethical decision-making model components that include; moral awareness, moral judgment, and ethical behavior. Furthermore, solutions to the dilemma should be based on ethical principles: autonomy, beneficence, nonmaleficence, and justice.

References

Liu, W., Gerdtz, M., & Manias, E. (2016). Creating opportunities for interdisciplinary collaboration and patient-centered care: how nurses, doctors, pharmacists, and patients use communication strategies when managing medications in an acute hospital setting. Journal of clinical nursing, 25(19-20), 2943-2957.

Miller, B. J., & Springer, P. (2020). Ethics-Based Training for Clinicians: Moving Beyond Ethical Decision Making Models. Contemporary Family Therapy, 1-11.

Özsoy, Z., & Ekici, D. (2017). Perception of Nurses Regarding Organizational Justice and Ethical Behavior; Organızational Culture in Hospitals. Hospital practices and research, 2(2), 41-46.

Spikes Jr, C. L. (2019). Impact of Improving Emergency Department Wait Times for Better Patient Outcomes: A Case Study of Austin Texas Emergency Departments (Doctoral dissertation, Northcentral University).

attachment_2Resources: Research and Annotated Bibliographies

Top of Form

Bottom of Form

• PRINT
• How do you approach a problem or issue within your organization? How often do you need credible information to solve a personal or professional problem? Credible information is information that is trustworthy. One of the best sources for credible information is the professional literature of the field you are studying; in your case, health care. Professional literature is research that has been written and reviewed by other people in your field.

The following resources can help you as you complete your research and seek out professional literature on a health care topic.

• • Gennaro, S. (2016). Why write? Journal of Nursing Scholarship, 48(2), 117.
  • U.S. National Library of Medicine, National Institutes of Health. (n.d.). Evidence-based practice and health technology assessment. Retrieved from https://hsric.nlm.nih.gov/hsric_public/topic/evidence_based_practice/
  • Rollins, J. A. (2017). Healthcare: It’s “So complicated.” Pediatric Nursing, 43(2), 58, 102.

Each of the following research guides is written with a specific program in mind. The one for your program can provide insights about researching topics related to your field.

• • BSN Program Library Research Guide.
  • Public Health Undergraduate Library Research Guide.
  • Health Care Administration Undergraduate Library Research Guide.

The following resources provide specific information about annotated bibliographies.

• • What Not to Do: Source Material for the Annotated Bibliography.
  • Sample Annotated Bibliography [PDF].

attachment_4Ethical Case Studies

Consider the ethical dilemma the health care professional is faced with in the selected case study. Pay particular attention to details that will help you analyze the situation using the three components of the Ethical Decision Making Model (moral awareness, moral judgment, and ethical behavior).

Note: The case study may not supply all of the information you may need for the assignment. In such cases, you should consider a variety of possibilities and infer potential conclusions. However, please be sure to identify any speculations that you make.

View All

Incident 2: Emergency Department Repeat Admissions — A Question of Resource Use

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. Capella Patient Outcomes in A Median Low Volume Emergency Department Bibliography

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.

attachment_5Assessment 2 Instructions: Applying Research Skills

Top of Form

Bottom of Form

• PRINT
• Create a 3-5-page annotated bibliography and summary based on your research related to best practices addressing one of the health care problems or issues in the Assessment Topic Areas media piece faced by a health care organization that is of interest to you.

Introduction

In your professional life, you will need to find credible evidence to support your decisions and your plans of action. You will want to keep abreast of best practices to help your organization adapt to the ever-changing health care environment. Being adept at research will help you find the information you need. For this assessment, you will review the Assessment Topic Areas media piece and select one of the health care problems or issues to research a current health care problem or issue faced by a health care organization that is of interest to you.

Demonstration of Proficiency

By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:

• • Competency 1: Apply information literacy and library research skills to obtain scholarly information in the field of health care.

• • • Identify academic peer-reviewed journal articles relevant to a health care problem or issue and describe the criteria used for the literature search.
  • Competency 2: Apply scholarly information through critical thinking to solve problems in the field of health care.

• • • Assess the credibility and relevance of information sources.
    • Summarize what was learned from developing an annotated bibliography.
    • Analyze academic peer-reviewed journal articles using the annotated bibliography organizational format.
  • Competency 4: Write for a specific audience, in appropriate tone and style, in accordance with Capella’s writing standards.

• • • Summarize a health care problem or issue and describe a personal interest in it and experience with it.
    • Write clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics.
    • Write following APA style for in-text citations, quotes, and references.

Instructions

Note: The requirements outlined below correspond to the grading criteria in the scoring guide. 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, research best practices related to a current health care problem. Your selected problem or issue will be utilized again in Assessment 3. To explore your chosen topic, you should use the first two steps of the Socratic Problem-Solving Approach to aid your critical thinking. Capella Patient Outcomes in A Median Low Volume Emergency Department Bibliography

4. View the Assessment Topic Areasmedia piece and select one of the health care problems or issues in the media piece to research. Write a brief overview of the selected topic. In your overview:
   • Summarize the health care problem or issue.
   • Describe your interest in the topic.
   • Describe any professional experience you have with this topic.
5. Identify peer-reviewed articles relevant to health care issue or problem.
   • Conduct a search for scholarly or academic peer-reviewed literature related to the topic and describe the criteria you used to search for articles, including the names of the databases you used. You will select four current scholarly or academic peer-reviewed journal articles published during the past 3–5 years that relate to your topic.
     • You will want to access the applicable Undergraduate Library Research Guide related to your degree (found at the NHS Learner Success Lab) for tips to help you in your search.
   • Use keywords related to the health care problem or issue you are researching to select relevant articles.
6. Assess the credibility and explain relevance of the information sources you find.
   • Determine if the source is from an academic peer-reviewed journal.
   • Determine if the publication is current.
   • Determine if information in the academic peer-reviewed journal article is still relevant.
7. Analyze academic peer-reviewed journal articles using the annotated bibliography organizational format. Provide rationale for inclusion of each selected article. The purpose of an annotated bibliography is to document a list of references along with key information about each one. The detail about the reference is the annotation. Developing this annotated bibliography will create a foundation of knowledge about the selected topic. In your annotated bibliography:
   • Identify the purpose of the article.
   • Summarize the information.
   • Provide rationale for inclusion of each article.
   • Include the conclusions and findings of the article.
   • Write your annotated bibliography in a paragraph form. The annotated bibliography should be approximately 150 words (1–3 paragraphs) in length.
   • List the full reference for the source in APA format (author, date, title, publisher, et cetera) and use APA format for the annotated bibliography.
   • Make sure the references are listed in alphabetical order, are double-spaced, and use hanging indents.
8. Summarize what you have learned from developing an annotated bibliography.
   • Summarize what you learned from your research in a separate paragraph or two at the end of the paper.
   • List the main points you learned from your research.
   • Summarize the main contributions of the sources you chose and how they enhanced your knowledge about the topic.

Example Assessment: You may use the following to give you an idea of what a Proficient or higher rating on the scoring guide would look like:

• • Assessment 2 Example [PDF].

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 template: Use the APA Style Paper Template [DOCX] as the paper format and the APA Style Paper Tutorial [DOCX] for guidance.
  • Written communication: Write clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics.
  • Content: Provide a title page and reference page following APA style.
  • References: Use at least four scholarly or academic peer-reviewed journal articles.
  • 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.

If you would like assistance in organizing your assessment, or if you simply have a question about your assessment, please do not hesitate to ask faculty or the teaching assistants in the NHS Learner Success Lab for guidance and suggestions.