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Planned Change in Accident and Emergency Unit Essay

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Updated: Nov 11th, 2020


Various units in hospitals have their challenges and shortcomings. The emergency unit plays a significant role in the performance of a hospital. Due to crowdedness, working in the emergency unit is always stressful and unpredictable. This essay discusses the issue of crowding and proposes a change with a guiding plan.


The accident and Emergency unit provides immediate health care for patients with acute, unexpected pain. The staff of this unit has to know how to treat a wide range of illnesses, starting from a simple injury to severe, life-threatening conditions. Due to the nature of an emergency, it is impossible to schedule patients or know how many patients will come. Also, the demand for emergency care seems to be increasing every year, while resources in the unit are insufficient.

Therefore, the most common issue in the emergency unit is crowding. It significantly affects the quality of provided health care; patients wait for extended periods and suffer from pain or even die. Nurses and doctors also experience burnout, and their work is less productive. This issue is highly attractive to researchers. A study of Pitts, Pines, Handrigan, and Kellermann (2012) shows that crowding in the emergency department is an annually growing problem in the United States related to poor quality of care.

According to several studies, crowding and long waiting hours correlated with patient outcomes, morbidity, readmission, and mortality; researchers also encourage the development of appropriate policies to address this issue (Carter, Pouch, & Larson, 2014; Liu, Hamedani, Brown, Asplin, & Camargo, 2013). Unfortunately, despite a substantial body of research, there is no national consensus on the measures of dealing with crowding in ED.


One of the main reasons for crowding is long waiting times, which highly depends on staff management. For example, patients have to wait four hours before a doctor decides whether to admit them. It happens because doctors have to wait for lab results and housekeepers to get the bed ready (Sharon, n.d.). The obvious solution seems to be the reduction of the waiting time in an emergency room. However, since the standardized solution is not established yet, unusual methods can be applied. For instance, the Ontario Ministry of Health and Long-Term Care suggested reducing demands for emergency care through supporting patients with chronic diseases, creating and informing people about other urgent care facilities (“Ontario wait times,” n.d.).

Thus, my plan consists of two parts. The first part is addressing the issue inside a specified unit. For example, it could include steps such as assigning one person in a laboratory to do tests for emergency patients only, monitoring and evaluating results daily, etc. The second part is focused on leadership, communication among staff, and communication with society. Thus, my plan would align with the hospital’s mission by decreasing death rates, increasing the quality of health care, and patient satisfaction. It would contribute to the increase of staff effectiveness through leadership and engagement. Communication with society, and showing support to patients would greatly align with the hospital’s social responsibility values.


The strategy for achieving my plan is a careful examination of the issue, paying attention to staff effectiveness. Consequently, the goal is to identify factors that slow down the admission process because it is the root of the crowding problem in the emergency unit. Working in the emergency department implies quick changes in responsibilities. When staff members feel their importance and belongingness to the team, they will work more efficiently.

Studies report that positive leadership styles directly influenced patient outcomes across a broad range of clinical settings (Wong, Cummings, & Ducharme, 2013). Therefore, it is necessary to encourage informal leadership among nurses and motivate staff by engaging them in the decision-making process of a unit. It is important to raise awareness of other available urgent care centers in the community because it will significantly contribute to the solution of this issue. Additionally, it is necessary to encourage other units to show support for patients with chronic diseases outside hospital settings in order to prevent the high number of visits to the emergency unit.


As mentioned previously, the very first step is an evaluation of the problem. Defining the root of crowding in a specified unit is important because reasons can vary from hospital to hospital. Next, depending on results, it is necessary to allocate staff members appropriately for the most efficient conduct: for example, improving staffing ratios, appropriate distribution of responsibilities, and more. The second step is increasing informal leadership among staff in the unit by encouraging networking, mentorship, and trust.

The third step is communication with society – it can be either done inside a hospital or outside through various methods. The last step, showing support for patients with chronic diseases, obviously falls under another unit. Therefore, cooperation with other units within the hospital is required.

People Involved in Plan

All workers of the emergency unit are expected to participate in initiating this change successfully. Managers play an important role here because through their behavior they should encourage leadership, monitor effectiveness, and communicate with the staff. Team members should actively participate in the implementation of these changes, and as a result, improve the quality of health care. Together, as a unit, they cooperate with other departments and the community. Most importantly, managers, as well as nurses, should have excellent leadership, networking, and communication skills to decrease crowding in the emergency unit.

Thus, my plan suggests improving the crowding problem in the emergency unit through a combination of effective staff management, encouragement of leadership, and communication with society.


Carter, E. J., Pouch, S. M., & Larson, E. L. (2014). The relationship between emergency department crowding and patient outcomes: A systematic review. Journal of Nursing Scholarship, 46(2), 106–115.

Liu, S. W., Hamedani, A. G., Brown, D. F. M., Asplin, B., & Camargo, C. A. (2013). Established and novel initiatives to reduce crowding in emergency departments. Western Journal of Emergency Medicine, 14(2), 85–89.

. (n.d.). Web.

Pitts, S. R., Pines, J. M., Handrigan, M. T., & Kellermann, A. L. (2012). National trends in emergency department occupancy, 2001 to 2008: Effect of inpatient admissions versus emergency department practice intensity. Annals of Emergency Medicine, 60(3), 679–686.

Sharon, T. A. (n.d.). Higher ED waiting times cause higher mortality when housekeepers play cards. Web.

Wong, C. A., Cummings, G. G., & Ducharme, L. (2013). The relationship between nursing leadership and patient outcomes: A systematic review update. Journal of Nursing Management, 21(5), 709-724.

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