Jennifer K. Taylor and Professor Russ Wilshaw RN, MS, CEN, Nursing
Emergency Departments provide health care to individuals twenty-four hours a day. To better meet the needs of consumers it is necessary to understand the main population groups utilizing emergency departments. This can be accomplished through demographic studies of various emergency departments. The research project I was involved with studied the clients of American Fork Emergency Room in Utah.
The research method of this study included a descriptive review of 7,000 medical records. Starting January 1, 1996, twenty medical records from each day of the week were selected randomly to obtain demographic information. Information from charts included; day of week, week of month, time of admittance, date of visit, age, city, sex, religion, marital status, source of reimbursement, chief complaint, onset of sign and symptom prior to admission, day of onset of sign and symptom, race, method of arrival, whether illicit drugs or alcohol were used, the mechanism of injury, who offered health care, discharge diagnosis, length of stay, final disposition, referral, if the patient had a private medical doctor, employment status, and treatment offered. After collecting data from 7,000 client’s medical records the information will be analyzed and conclusions drawn. Currently 4,060 medical records have been examined.
Problems that will need to be addressed in the final analysis of data include religion, illicit drug or alcohol use, and race. On the medical records chart, a space is provided for religion, but religion is not often questioned upon admission. The few records reporting religion were mainly Latter-day Saints. Because of the lack of data about religion this will not be included in the analysis. In the case of drug or alcohol use this is also not often reported. While working in an Emergency Room it is apparent that some clients have clearly abused alcohol or drugs. This information is only found in the medical records if the final diagnosis is an over-dose. American Fork Emergency Room sees a homogenous population. Medical records show a large majority of Caucasians are seen at this Emergency Room. The few other races include Hispanics or African-Americans. This lack of heterogeneity may limit the ability to generalize findings.
When transferring the data from the collection sheets to the computer an adjustment will need to be made for mechanism of injury category. On the data collection sheet mechanism of injury was both written down and then coded into specific categories. Categories included motor vehicle accidents and sports injuries. Motor vehicle accident category included accidents with cars-trucks-bus, motorcycle-moped, bicycle, and other. Sport injury category excluded diving and cycling. As I collected data on charts any bicycle accidents were coded under motor vehicle accidents. This may be confused with a MVA involving a bicycle. Because of the confusion the person entering the data on computer must be made aware to check the written mechanism of injury before entering the code. New groups should also be made to include more specific categories.
This study can benefit both society and more specifically local hospitals when it is completed. Information provided by this study can help target specific populations that may be utilizing the Emergency Department unnecessarily. For example, if a majority of children are brought to the Emergency Department because of a fever and the main intervention the hospital performs is administering acetaminophen (tylenol) and are discharged with the diagnoses of febrile illness, parents could be educated about using tylenol at home. Pediatricians and nurses can educate parents about taking infants and children’s temperature and the proper dosages of acetaminophen at well-baby checkups. This may cut down on costly and unnecessary trips to the emergency room. It will be helpful to know which age groups are most likely to visit the emergency department and for what reasons. If women in their twenties come in for lower abdominal pain and after hundreds of dollars of tests are done and they are diagnosed with dysmenorrhea and told to take aleve. This problem could also be taken care of outside of the emergency room through education by primary care doctors.
An important aspect of this study is the inclusion of what source of reimbursement clients are utilizing. Emergency Departments are a costly area to receive health care, yet many patients choose to receive this type of care because Emergency Departments can not refuse to treat patients. Whereas primary care physicians can refuse not to accept patients based on their type of insurance, for example if they carry Medicare or Medicaid coverage. With new health care reforms being discussed this issue should be taken into account. Because patients with Medicare or Medicaid are being refused treatment by primary care doctors, they seek treatment for minor illnesses in a costly Emergency Department. This study will also be beneficial on a local basis. It will be helpful for staffing at the American Fork emergency room to know what time of day people are most likely to visit the emergency room. With possible additions to the facility in the near future it is necessary to know the client’s needs. If the majority of clients are visiting the Emergency Room for lacerations and orthopedic injuries, new rooms to accommodate these injuries could be added. Another area that can be improved is referring the patient to other sources of health care. If the follow up teaching was to see your primary care physician, yet the patient’s medical records state he has no primary care physician this inconsistency needs to be fixed. Many unnecessary return visits to the emergency room could be taken care of by proper referrals to other health care resources.
Data collection from patient’s medical records will be concluded in December of 1996 at which time 7,000 charts will have been reviewed. Following this the data will be entered into a computer and analyzed. The findings from this Emergency Room demographic study will then be submitted for publication in a Nursing-Medical Journal.