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Acil Servis Kalabalıklığının Nedenleri ve Çözüm Önerileri: Sağlık Personeli Perspektiflerinin Nitel Bir Çalışması

Yıl 2023, Cilt: 32 Sayı: 5, 391 - 400, 19.02.2024
https://doi.org/10.17942/sted.1324994

Öz

Giriş: Acil servislerin aşırı kalabalıklığı küresel bir sorundur. Bu durum uzun bekleme süresi, hastaların ve sağlık personelinin memnuniyetinin azalması, acil bakıma en çok ihtiyaç duyan hastaların tedavisinin gecikmesi, sağlanan sağlık hizmetinin kalitesinin düşmesi ve sağlık bakım maliyetlerinin artması gibi birçok olumsuz sonuca yol açmaktadır. Bu çalışmanın amacı, hastaların acil servisleri neden kullanmayı tercih ettiklerini, acil sağlık hizmetlerinin güncel sorunlarını belirlemek ve acil servislerin kalabalıklığını ve buna bağlı sorunları hafifletmek için acil servis sağlık personelinin bakış açılarından çözüm geliştirmektir.
Yöntem: Bu çalışmada nitel desen kullanılmıştır. 20 Aralık 2021-18 Şubat 2022 tarihleri arasında 22 acil servis sağlık personeli ile derinlemesine yarı yapılandırılmış görüşmeler gerçekleştirilmiştir. Verilerin analizinde tematik analiz yöntemi kullanılmıştır.
Bulgular: 22 acil servis sağlık personeli ile mülakat yapıldı; 16'sı erkek, 6'sı kadındı. Acil servis sağlık personeli görüşmeleri, acil serviste en az 1 yıllık iş deneyimine sahip 14 acil servis hemşiresi, 6 acil servis doktoru ve 2 acil tıp uzmanı ile cinsiyetleri veya yaşları dikkate alınmadan gerçekleştirilmiştir. Veri analizi sonucunda 5 ana tema belirlenmiştir: Yetersiz sağlık sistemi, hastayla ilgili sorunlar, acil servislerin avantajları, acil servislerin aşırı kalabalıklığının sonuçları ve acil servis kalabalıklığı için çözümler.
Sonuç: Sağlık sistemindeki çeşitli yetersizlikler, acil servislerin avantajlarının olması ve hastaların sağlık hizmetlerini kullanma konusundaki algıları acil servislerin hastalar tarafından kullanımını arttırmış ve bu durum acil servislerde kalabalıklaşmaya sebep olmuştur. Acil servislerin kalabalıklığını hafifletmek için etkili çözümlere ihtiyaç vardır. Acil olmayan acil servis ziyaretlerini azaltmaya yönelik önlemler yeterli değildir. Acil servislerdeki kalabalıklığı azaltmak için birçok faktörün göz önünde bulundurulması ve hepsinin birlikte uygulanması gerekmektedir.

Kaynakça

  • Katı S, Durak V, Aydın Ş. Acil Serviste Çalışmakta Olan Hekimlerin Sosyodemografik Özellikleri ve Depresyon Olasılığının Değerlendirilmesi. Sürekli Tıp Eğitimi Dergisi STED. 2020;29(2):131-136.
  • Söyük S, Kurtuluş SA. Acil servislerde yaşanan sorunların çalışanlar gözünden değerlendirilmesi. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi. 2017;6(4):44-56.
  • Ersel M, Karcıoğlu Ö, Yanturalı S, Yürüktümen A, Sever M, Tunç MA. Bir acil servisin kullanım özellikleri ve başvuran hastaların aciliyetinin hekim ve hasta açısından değerlendirilmesi. Türkiye Acil Tıp Dergisi. 2006;6(1):25-35.
  • Bozdağ Z. Amaç dışı acil servis kullanım nedenleri ve amaç dışı kullanımı azaltmaya ilişkin yönetimsel öneriler: Çorum ili örneği: Hitit Üniversitesi Sosyal Bilimler Enstitüsü; 2019.
  • Sultanoğlu H, Gamsızkan Z, Cangür Ş. Acil Servise Bir Yılda Başvuran Hastalarda Mükerrer Başvuruların İncelenmesi ve Çözüm Önerileri. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi. 2021;11(1):50-5.
  • Butun A, Kafdag EE, Gunduz H, Zincir V, Batibay M, Ciftci K, et al. Emergency department overcrowding: Causes and solutions. Emergency and Critical Care Medicine. 2023;3(4):171-6.
  • American College of Emergency Physicians. Crowding. 2019 28.06.2022. Available at: https://www.acep.org/patient-care/policy-statements/crowding/
  • Fieldston ES, Alpern ER, Nadel FM, Shea JA, Alessandrini EA. A qualitative assessment of reasons for nonurgent visits to the emergency department: Parent and health professional opinions. Pediatric Emergency Care. 2012;28(3):220-5.
  • Kusumawati HI, Magarey J, Rasmussen P. Analysis of factors influencing length of stay in the Emergency Department in public hospital, Yogyakarta, Indonesia. Australasian Emergency Care. 2019;22(3):174-9.
  • Sun BC, Hsia RY, Weiss RE, Zingmond D, Liang LJ, Han W, et al. Effect of emergency department crowding on outcomes of admitted patients. Annals of Emergency Medicine. 2013;61(6):605-11.e6.
  • Weber EJ, Hirst E, Marsh M. The patient’s dilemma: Attending the emergency department with a minor illness. BMJ. 2017;357.
  • Hoot NR, Aronsky D. Systematic Review of Emergency Department Crowding: Causes, Effects, and Solutions. Annals of Emergency Medicine. 2008;52(2):126-36.
  • Lowthian JA, Curtis AJ, Cameron PA, Stoelwinder JU, Cooke MW, McNeil JJ. Systematic review of trends in emergency department attendances: An Australian perspective. Emergency Medicine Journal. 2011;28(5):373-7.
  • Ellbrant J, Akeson J, Akeson PK. Pediatric Emergency Department Management Benefits From Appropriate Early Redirection of Nonurgent Visits. Pediatric Emergency Care. 2015;31(2):95-100.
  • Butun A, Lynn F, McGaughey J, McLaughlin K, Linden M. Exploring attendance at emergency departments for children with non-urgent conditions in Turkey: a qualitative study of parents and healthcare staff perspectives. Emergency and Critical Care Medicine. 2022;2(2):50-60.
  • Xu HG, Johnston ANB, Greenslade JH, Wallis M, Elder E, Abraham L, et al. Stressors and coping strategies of emergency department nurses and doctors: A cross-sectional study. Australasian Emergency Care. 2019;22(3):180-6.
  • McCormick E, Devine S, Crilly J, Brough P, Greenslade J. Measuring occupational stress in emergency departments. Emergency Medicine Australasia. 2023;35(2):234-41.
  • Derrick K, Green T, Wand T. Assessing and responding to anxiety and panic in the Emergency Department. Australasian Emergency Care. 2019;22(4):216-20.
  • Streubert HJ, Carpenter DR. Qualitative research in nursing : Advancing the humanistic imperative. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2011.
  • Cowling TE, Cecil EV, Soljak MA, Lee JT, Millett C, Majeed A, et al. Access to primary care and visits to emergency departments in England: A cross-sectional, population-based study. PLoS One. 2013;8(6):e66699.
  • Kuye IO, Conway SJ. Specialty care in skilled nursing facilities: Tackling a hidden disparity. Journal of Hospital Medicine. 2023;18(2):202-3.
  • Benger JR, Jones V. Why are we here? A study of patient actions prior to emergency hospital admission. Emergency Medicine Journal. 2008;25(7):424-7.
  • Wang L, Tchopev N, Kuntz-Melcavage K, Hawkins M, Richardson R. Patient-reported reasons for emergency department visits in the urban Medicaid population. American Journal of Medical Quality. 2015;30(2):156-60.
  • FitzGerald G, Toloo G, Aitken P, Keijzers G, Scuffham P. Public use and perceptions of emergency departments: A population survey. Emergency Medicine Australasia. 2015;27(4):336-42.
  • Morrison AK, Schapira MM, Gorelick MH, Hoffmann RG, Brousseau DC. Low Caregiver Health Literacy Is Associated With Higher Pediatric Emergency Department Use and Nonurgent Visits. Academic Pediatrics. 2014;14(3):309-14.
  • Morrison AK, Chanmugathas R, Schapira MM, Gorelick MH, Hoffmann RG, Brousseau DC. Caregiver Low Health Literacy and Nonurgent Use of the Pediatric Emergency Department for Febrile Illness. Academic Pediatrics. 2014;14(5):505-9.
  • Penson R, Coleman P, Mason S, Nicholl J. Why do patients with minor or moderate conditions that could be managed in other settings attend the emergency department? Emergency Medicine Journal. 2012;29(6):487-91.
  • Butun A, Hemingway P. A qualitative systematic review of the reasons for parental attendance at the emergency department with children presenting with minor illness. International Emergency Nursing. 2018;36:56-62.
  • Butun A, Linden M, Lynn F, McGaughey J. Exploring parents’ reasons for attending the emergency department for children with minor illnesses: A mixed methods systematic review. Emergency Medicine Journal. 2019;36(1):39-46.
  • Bornais JAK, Crawley J, El-Masri MM. One Stop: Examining the Reasons Patients Use the Emergency Department for Nonurgent Care and the Barriers They Face. Journal of Emergency Nursing. 2020;46(2):163-70.
  • Alshiakh S, Abdulwahab F, Baz A, Ghonaim B, Alanizi S, Altowygry S, et al. Factors and Solutions Addressing Overcrowding in Emergency Department. Journal of Healthcare Sciences. 2023;3(1):1-6.
  • Herman A, Young KD, Espitia D, Fu N, Farshidi A. Impact of a Health Literacy Intervention on Pediatric Emergency Department Use. Pediatric Emergency Care. 2009;25(7):434-8.

Causes and Solutions for Emergency Department Crowding: A Qualitative Study of Healthcare Staff Perspectives

Yıl 2023, Cilt: 32 Sayı: 5, 391 - 400, 19.02.2024
https://doi.org/10.17942/sted.1324994

Öz

Introduction: Emergency Department (ED) crowding is a major problem globally. This situation leads to many negative consequences such as long waiting time, decreased satisfaction of patients and healthcare staff, delay in treatment of patients most in need of emergency care, decrease in the quality of healthcare provided and increase in healthcare costs. The aim of this study is to determine why patients prefer to use the ED, to identify the current problems of ED services and to develop solutions from the perspectives of ED healthcare staff in order to alleviate the ED crowding and related problems.
Methods: This study utilised a qualitative approach. In-depth semi-structured interviews were conducted with 22 ED healthcare staff between 20th December 2021 and 18th February 2022. Thematic analysis method was performed to analyse the data.
Results: Twenty-two ED healthcare staff were interviewed; 16 were male and 6 were female. ED healthcare staff interviews were conducted with 14 ED nurses, 6 ED doctors, and 2 ED consultants, who had at least 1-year of work experience in the ED, without any consideration of their gender or age. As a result of the data analysis, five main themes emerged: Insufficient healthcare system, patient-related problems, advantages of EDs, consequences of ED crowding, and solutions for ED crowding.
Conclusion: Insufficient healthcare system, advantages of ED, and patients’ perceptions about using healthcare services led patients to use ED and subsequently to the ED crowding. There is a need for effective solutions to alleviate ED crowding. The precautions to reduce non-urgent ED visits are not enough. Many factors need to be considered and all of them should be applied together accordingly.

Kaynakça

  • Katı S, Durak V, Aydın Ş. Acil Serviste Çalışmakta Olan Hekimlerin Sosyodemografik Özellikleri ve Depresyon Olasılığının Değerlendirilmesi. Sürekli Tıp Eğitimi Dergisi STED. 2020;29(2):131-136.
  • Söyük S, Kurtuluş SA. Acil servislerde yaşanan sorunların çalışanlar gözünden değerlendirilmesi. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi. 2017;6(4):44-56.
  • Ersel M, Karcıoğlu Ö, Yanturalı S, Yürüktümen A, Sever M, Tunç MA. Bir acil servisin kullanım özellikleri ve başvuran hastaların aciliyetinin hekim ve hasta açısından değerlendirilmesi. Türkiye Acil Tıp Dergisi. 2006;6(1):25-35.
  • Bozdağ Z. Amaç dışı acil servis kullanım nedenleri ve amaç dışı kullanımı azaltmaya ilişkin yönetimsel öneriler: Çorum ili örneği: Hitit Üniversitesi Sosyal Bilimler Enstitüsü; 2019.
  • Sultanoğlu H, Gamsızkan Z, Cangür Ş. Acil Servise Bir Yılda Başvuran Hastalarda Mükerrer Başvuruların İncelenmesi ve Çözüm Önerileri. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi. 2021;11(1):50-5.
  • Butun A, Kafdag EE, Gunduz H, Zincir V, Batibay M, Ciftci K, et al. Emergency department overcrowding: Causes and solutions. Emergency and Critical Care Medicine. 2023;3(4):171-6.
  • American College of Emergency Physicians. Crowding. 2019 28.06.2022. Available at: https://www.acep.org/patient-care/policy-statements/crowding/
  • Fieldston ES, Alpern ER, Nadel FM, Shea JA, Alessandrini EA. A qualitative assessment of reasons for nonurgent visits to the emergency department: Parent and health professional opinions. Pediatric Emergency Care. 2012;28(3):220-5.
  • Kusumawati HI, Magarey J, Rasmussen P. Analysis of factors influencing length of stay in the Emergency Department in public hospital, Yogyakarta, Indonesia. Australasian Emergency Care. 2019;22(3):174-9.
  • Sun BC, Hsia RY, Weiss RE, Zingmond D, Liang LJ, Han W, et al. Effect of emergency department crowding on outcomes of admitted patients. Annals of Emergency Medicine. 2013;61(6):605-11.e6.
  • Weber EJ, Hirst E, Marsh M. The patient’s dilemma: Attending the emergency department with a minor illness. BMJ. 2017;357.
  • Hoot NR, Aronsky D. Systematic Review of Emergency Department Crowding: Causes, Effects, and Solutions. Annals of Emergency Medicine. 2008;52(2):126-36.
  • Lowthian JA, Curtis AJ, Cameron PA, Stoelwinder JU, Cooke MW, McNeil JJ. Systematic review of trends in emergency department attendances: An Australian perspective. Emergency Medicine Journal. 2011;28(5):373-7.
  • Ellbrant J, Akeson J, Akeson PK. Pediatric Emergency Department Management Benefits From Appropriate Early Redirection of Nonurgent Visits. Pediatric Emergency Care. 2015;31(2):95-100.
  • Butun A, Lynn F, McGaughey J, McLaughlin K, Linden M. Exploring attendance at emergency departments for children with non-urgent conditions in Turkey: a qualitative study of parents and healthcare staff perspectives. Emergency and Critical Care Medicine. 2022;2(2):50-60.
  • Xu HG, Johnston ANB, Greenslade JH, Wallis M, Elder E, Abraham L, et al. Stressors and coping strategies of emergency department nurses and doctors: A cross-sectional study. Australasian Emergency Care. 2019;22(3):180-6.
  • McCormick E, Devine S, Crilly J, Brough P, Greenslade J. Measuring occupational stress in emergency departments. Emergency Medicine Australasia. 2023;35(2):234-41.
  • Derrick K, Green T, Wand T. Assessing and responding to anxiety and panic in the Emergency Department. Australasian Emergency Care. 2019;22(4):216-20.
  • Streubert HJ, Carpenter DR. Qualitative research in nursing : Advancing the humanistic imperative. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2011.
  • Cowling TE, Cecil EV, Soljak MA, Lee JT, Millett C, Majeed A, et al. Access to primary care and visits to emergency departments in England: A cross-sectional, population-based study. PLoS One. 2013;8(6):e66699.
  • Kuye IO, Conway SJ. Specialty care in skilled nursing facilities: Tackling a hidden disparity. Journal of Hospital Medicine. 2023;18(2):202-3.
  • Benger JR, Jones V. Why are we here? A study of patient actions prior to emergency hospital admission. Emergency Medicine Journal. 2008;25(7):424-7.
  • Wang L, Tchopev N, Kuntz-Melcavage K, Hawkins M, Richardson R. Patient-reported reasons for emergency department visits in the urban Medicaid population. American Journal of Medical Quality. 2015;30(2):156-60.
  • FitzGerald G, Toloo G, Aitken P, Keijzers G, Scuffham P. Public use and perceptions of emergency departments: A population survey. Emergency Medicine Australasia. 2015;27(4):336-42.
  • Morrison AK, Schapira MM, Gorelick MH, Hoffmann RG, Brousseau DC. Low Caregiver Health Literacy Is Associated With Higher Pediatric Emergency Department Use and Nonurgent Visits. Academic Pediatrics. 2014;14(3):309-14.
  • Morrison AK, Chanmugathas R, Schapira MM, Gorelick MH, Hoffmann RG, Brousseau DC. Caregiver Low Health Literacy and Nonurgent Use of the Pediatric Emergency Department for Febrile Illness. Academic Pediatrics. 2014;14(5):505-9.
  • Penson R, Coleman P, Mason S, Nicholl J. Why do patients with minor or moderate conditions that could be managed in other settings attend the emergency department? Emergency Medicine Journal. 2012;29(6):487-91.
  • Butun A, Hemingway P. A qualitative systematic review of the reasons for parental attendance at the emergency department with children presenting with minor illness. International Emergency Nursing. 2018;36:56-62.
  • Butun A, Linden M, Lynn F, McGaughey J. Exploring parents’ reasons for attending the emergency department for children with minor illnesses: A mixed methods systematic review. Emergency Medicine Journal. 2019;36(1):39-46.
  • Bornais JAK, Crawley J, El-Masri MM. One Stop: Examining the Reasons Patients Use the Emergency Department for Nonurgent Care and the Barriers They Face. Journal of Emergency Nursing. 2020;46(2):163-70.
  • Alshiakh S, Abdulwahab F, Baz A, Ghonaim B, Alanizi S, Altowygry S, et al. Factors and Solutions Addressing Overcrowding in Emergency Department. Journal of Healthcare Sciences. 2023;3(1):1-6.
  • Herman A, Young KD, Espitia D, Fu N, Farshidi A. Impact of a Health Literacy Intervention on Pediatric Emergency Department Use. Pediatric Emergency Care. 2009;25(7):434-8.
Toplam 32 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Hizmetleri ve Sistemleri (Diğer)
Bölüm Araştırma Makalesi
Yazarlar

Ahmet Bütün 0000-0002-6856-9389

Yayımlanma Tarihi 19 Şubat 2024
Yayımlandığı Sayı Yıl 2023 Cilt: 32 Sayı: 5

Kaynak Göster

Vancouver Bütün A. Causes and Solutions for Emergency Department Crowding: A Qualitative Study of Healthcare Staff Perspectives. STED. 2024;32(5):391-400.