financial impact of boarding psychiatric patients in the emergency department


Submission Folder
Week 2 Project
Instructions
Interview Decision Makers By the due date assigned, interview co-workers or those responsible for finance in your organization on the financial management issue that you identified in Week 1. Your interview should capture salient information about the issue including information which you derived from the literature. Potential questions you might want to use include: How long has the organization tried to address this issue? What measures have been taken to address this issue in the past? What future steps have been planned to address this issue? What problems does the organization foresee as blocks to addressing this issue? How did your perception of the financial issue differ from the perception of those who are actually working on finances in the organization? Take the information you have learned from the interviews and create a 2-3 page paper with your findings. Be sure to explain the roles of the individuals you interviewed. As you reflect on the results of the interview, use current literature to further explain the important points. Post your response in a Word document to the Submissions Area. Cite all sources in APA format.

Criteria	No Submission 0 points	Emerging (F through D Range) 1 point	Satisfactory (C Range) 2 points	Proficient (B Range) 3 points	Exemplary (A Range) 4 points
The interviews contained information on the financial management issue in the organization including a description of the organization, the role within the organization of two individuals interviewed and his or her viewpoint on the financial issue under st	Student did not submit assignment.	Lacked information about the financial management issue in the organization including a description of the organization, the role within the organization of one individual interviewed and his or her viewpoint on the financial issue under study.	Provided minimal information about the financial management issue in the organization including a description of the organization, the role within the organization of one individual interviewed and his or her viewpoint on the financial issue under study.	Provided information about the financial management issue in the organization including a description of the organization, the role within the organization of two individuals interviewed and their viewpoints on the financial issue under study.	Thoroughly discussed information about the financial management issue in the organization including a description of the organization, the role within the organization of two or more individuals interviewed and their viewpoints on the financial issue under study.
Interview included at least two people in the organization.	Student did not submit assignment.	Interview lacked information about one person in the organization.	Provided minimal information about one person in the organization.	Provided information about two people in the organization.	Provided thorough and detailed information about two or more people in the organization in detail.
Criteria	No Submission 0 points	Emerging (F through D Range) (7-8) 8 points	Satisfactory (C Range) (8-9) 9 points	Proficient (B Range) (10-11) 11 points	Exemplary (A Range) (11-12) 12 points
The interviews contained details of at least three measures taken to address the issue.	Student did not submit assignment.	Details included one measure taken to address the issue.	Provided details of two measures taken to address the issue.	Provided details of three measures taken to address the issue.	Thoroughly provided details of three or more measures taken to address the issue.
Criteria	No Submission 0 points	Emerging (F through D Range) (7-8) 8 points	Satisfactory (C Range) (8-9) 9 points	Proficient (B Range) (10-11) 11 points	Exemplary (A Range) (11-12) 12 points
The interviews contained details about three future steps that have been planned to address the issue.	Student did not submit assignment.	Provided details of one future step that have been planned to address the issue.	Provided details of two future steps that have been planned to address the issue.	Provided details of three future steps that have been planned to address the issue.	Provided thorough details of three or more future steps that have been planned to address the issue.
Criteria	No Submission 0 points	Emerging (F through D Range) (7-8) 8 points	Satisfactory (C Range) (8-9) 9 points	Proficient (B Range) (10-11) 11 points	Exemplary (A Range) (11-12) 12 points
The interviews contained information about three problems on the blocks that the organization foresees in resolving this issue.	Student did not submit assignment.	Information about one problem on the blocks that the organization foresees in resolving this issue.	Information about two problems on the blocks that the organization foresees in resolving this issue.	Discussed information about three problems on the blocks that the organization foresees in resolving this issue.	Discussed thoroughly information about three or more problems on the blocks that the organization foresees in resolving this issue.
Criteria	No Submission 0 points	Emerging (F through D Range) (7-8) 8 points	Satisfactory (C Range) (8-9) 9 points	Proficient (B Range) (10-11) 11 points	Exemplary (A Range) (11-12) 12 points
Contained statistical information providing background on three financial issues, including numbers of patients or nurses affected and some indication of the actual dollar cost and its percentage of the total hospital budget and any additional information	Student did not submit assignment.	Statistical information providing background with one financial issue, including numbers of patients or nurses affected and some indication of the actual dollar cost and its percentage of the total hospital budget and any additional information to illustrate and further describe the financial issue.	Statistical information providing background with two financial issues, including numbers of patients or nurses affected and some indication of the actual dollar cost and its percentage of the total hospital budget and any additional information to illustrate and further describe the financial issue.	Provided statistical information about background with three financial issues, including numbers of patients or nurses affected and some indication of the actual dollar cost and its percentage of the total hospital budget and any additional information to illustrate and further describe the financial issue.	Thoroughly provide statistical information about background with three or more financial issues, including numbers of patients or nurses affected and some indication of the actual dollar cost and its percentage of the total hospital budget and any additional information to illustrate and further describe the financial issue.
Criteria	No Submission 0 points	Emerging (F through D Range) 5 points	Satisfactory (C Range) 6 points	Proficient (B Range) 7 points	Exemplary (A Range) 8 points
Utilized current literature to further explain three identified issues.	Student did not submit assignment.	Current literature explained one identified issue.	Current literature explained two identified issues.	Current literature explained three identified issues.	Thoroughly used current literature to further explain three or more identified issues.
Criteria	No Submission 0 points	Emerging (F through D Range) (12-14) 14 points	Satisfactory (C Range) (14-16) 16 points	Proficient (B Range) (16-18) 18 points	Exemplary (A Range) (18-20) 20 points
Used APA style (which includes grammar, spelling, and punctuation, as well as formatting).	Student did not submit assignment.	Introduction is limited or missing entirely. Poorly organized document. Transitions are infrequent, illogical, or missing entirely. Conclusion is limited or missing entirely. Writing contains numerous errors in spelling, grammar, or sentence structure that severely interferes with readability and comprehension. No attempt at APA formatting.	Introduction is present but incomplete or underdeveloped. Poorly organized document that interferes with readability and comprehension. Transitions are sporadic. Conclusion is present, but incomplete or underdeveloped. Writing contains numerous errors in spelling, grammar, or sentence structure that somewhat interfere with readability or comprehension. APA format is attempted to paraphrase, quote, and cite, but errors are significant.	Introduction has a clear opening, provides background information, and states the topic. Loosely organized document that may haveto be inferred. Transitions are appropriate and help the flow of ideas. Conclusion summarizes main argument and has a clear ending. Writing follows conventions of spelling and grammar throughout. Errors are infrequent and do not interfere with readability or comprehension. APA format is attempted to paraphrase, quote, and cite, but few errors are present.	Introduction catches the reader’s attention, provides compelling and appropriate background information, and clearly states the topic. Well organized document with an appropriate introduction. Transitions are thoughtful and clearly show how ideas relate. Conclusion leaves the reader with a sense of closure and provides concluding insights. Writing follows conventions of spelling and grammar throughout that helps establish a clear idea and aid the reader in following the writer’s logic. APA format is used throughout when appropriate or called for.
Overall Score	No Submission 0 or more	Emerging (F through D Range) 66 or more	Satisfactory (C Range) 76 or more	Proficient (B Range) 90 or more	Exemplary (A Range) 100 or more

First paper for reference:

Financial Impact of Boarded Psychiatric Patients in the Emergency Department

Wendy Thompson

November 18, 2017

Financial Impact of Boarded Psychiatric Patients in the Emergency Department

Introduction

The emergency department has seen a dramatic increase in the psychiatric population over the last decade or two. These patients tend to have a longer length of stay than the average emergency room patient. With the increase length of stay, the financial impact on the emergency room’s budget has been staggering.

Increase in Resources

To protect the psychiatric patient whether the concern is mental or drug abuse, these patients require constant observation to prevent self-harm, leaving before treatment is completed, or to prevent harm to staff. This means that either a sitter or security has to be assigned to sit with this population of patients usually a two to one ratio which requires more ancillary staff (Nicks, B., 2012). Also, mental health assessors have to come in to evaluate these patients. This usually involves a contract with a psychiatric facility where payment is required. Another resource that is needed for these patients is diet trays and body hygiene products which the hospital provides.

Extended Length of Stay

The psychiatric patients’ average length of stay is about eighteen hours while waiting on placement to an appropriate facility. This extended length of stay causes an extended wait time for the average emergency room patient Parks, J., 2009). Bed turnover rates are decreased which decreases the number of patients an emergency department can see within these eighteen hours (Nicks, B., 2012). The nonpsychiatric patients usually have insurance that will cover part or all of their stay. If the number of patients seen with in the eighteen hours is decreased due to the boarding of psychiatric patients, the potential payment goes down with each psychiatric hold. The increased wait times also put other patients at risk due to not being evaluated in a timely manner. Because of this risk, nurses especially in the triage area have to have excellent assessment skills and continually monitor the waiting room.

Payment Loss

Boarded psychiatric patients cost the emergency department approximately $2,264 per patient. This amount factors in the increased length of stay and payment loss due to lack of insurance. Most psychiatric patients do not have healthcare coverage and if they do, it does not cover mental health needs (Park, J., 2009). The physicians experience about a forty percent decrease in reimbursement when the emergency room boards psychiatric patients (Nicks, B., 2012).

Nurse’s Role

Nurses in the emergency department can help some to help compensate for the financial impact in the emergency room. One of the main things a nurse can do is to help with patient flow so that the average emergency department patients can still be seen and treated in a timely manner. This starts in the triage area. Placing an advanced practice provider in triage to see lower acuity patients will help to keep the beds available for the higher acuity patients. Also, the nurses who have been assigned to care for the psychiatric patients must be diligent in contacting and faxing paperwork to the mental health facilities to help expedite the placement and transfer of the psychiatric patients in an attempt to reduce the length of stay. The nurse will also have to act as a voice or advocate of the psychiatric patients and help to keep administration informed of the issues regarding this population of patients. One way of doing this is documentation either in the patient charts or incident reporting systems. By having a paper trail, the issue will be more difficult to ignore or sweep under the rug.

Conclusion

Unfortunately, this is a problem that will only increase over the next several years as the number of mental health facilities close due to lack of funding. Emergency departments will have to be creative in ways to improve patient flow without comprising patient care and safety. Nurses will have to vocal about the needs and concerns that boarding psychiatric patients can create. But for now boarding psychiatric patients in the emergency department places a big financial burden on the emergency department.

References

Nicks, B.A., & Manthey, D. M. (2012). The Impact of Psychiatric Patient Boarding in

Emergency Departments. Emergency Medicine International, 1-5.

Doi:10.1155/2012/360308.

Park, J. M., Park, L. T., Siefert, C. J., Abaraham, M.E., Fry, C. R., & Silvert, M. S. (2009).

Factors Associated with Extended Length of Stay for Patients Presenting to an Urban

Psychiatric Emergency Service: A Case-Control Study. Journal Of Behavioral Health

Services & Research, 36(3), 300-308. doi:10.1007/s11414-00909160-0.

financial impact of boarding psychiatric patients in the emergency department

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