Having worked at an inpatient forensic psychiatric state hospital with a population of 1,500, which treats psychiatric-related problems for patients that committed crimes, each time a patient has a medical emergency, they must be transported to an off-site facility. This is usually a community-based hospital emergency room (ER). The transfer of patients results in expenditures that are rapidly increasing the costs associated with providing healthcare to patients. Most patients are sent out for conditions including chest pain, seizures, IV antibiotic treatments, stab wounds, head traumas, or the need for extraction of foreign objects that have been swallowed. With the rapidly increasing cost of health care, I propose setting up a mini ER or urgent care facility within our health care practice staffed with physicians and registered nurses capable of managing basic medical emergencies as a means of saving costs. Research suggests having an in-house clinic may reduce the cost of primary care, and hospital costs associated with non-urgent emergency care (Fertig, Corso & Balasubramaniam, 2012).
At present, the hospital in-house spends millions of dollars annually sending patients out to community-based ER facilities even for minor medical emergencies. Vinton et al. (2014) note that US healthcare spending has nearly double over the past decade, reaching an all-time high, with as much as $8100 spent per capita each year. By having staff on hand that are capable of managing these illnesses, it is possible to save this money and re-allocate it to more pressing needs. Further, the community-based ER can save time and re-allocate resources to the community.

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Policymakers and payers are more and more focused on the perceived high cost of emergency department care, and a small number of frequent ER users that account for an increasingly large amount of healthcare costs (Vinton et al., 2014). Many of these ER users often visit the ER for inappropriate reasons or are characterized as unnecessarily visiting the ER, thus consuming valuable healthcare resources (Vinton et al., 2014; Fertig, Corso & Balasubramaniam, 2012). For this reason, these users, including perhaps, incarcerated users that are transported to the ER, are blamed for crowding in ER’s, increasing wait times, and the escalating costs within the healthcare system.

Significance of Problem to Nursing
Rosenberg (ND) notes that community-based clinics are licensed and staffed specifically for the substance us disorder population. They are equipped to manage the medical and psychological aspects for this specific population’s base and have the licensure to run programs including a dedicated outpatient facility and hospital-based facility. Typically however, the care they deliver is the type that keeps patients out of the emergency room and in an appropriate medically supervised environment thus reducing unnecessary emergencies (Enard, 2013). Thus, by having patients tie up their emergency rooms, unnecessary burdens are placed on the community-based clinics that serve the forensic in-patient center for incarcerated individuals. Rosenberg (ND) also notes that the flow of patients to the emergency room is among the most difficult aspects to control, along with emergency department processes impacting patient flow. Lack of control of these factors can impact cost-reducing solutions that could prove helpful to an agency.

Simonet (2009) points out that between 1990 and 2000, 50 ER service providers were closed, and nine between the years of 1999-2000. Only 355 hospitals of more than 500 in California maintained emergency services departments due to the high costs of healthcare (Simonet, 2009). This suggests that reform and restructuring of emergency department operations is necessary to enhance the ability to care for patients, while also keeping in mind that costs may damage a hospital’s ability to continue offering traditional and non-traditional services. The forensic institution is a Medicaid operated facility, relying on federal funding. Federally funded hospitals are required to offer emergency aid so that patients suffering from emergency medical conditions can be stabilized (Enard, 2013). This also means, however, that many patients seek out ER’s for non-urgent conditions. This suggests that the burden on the community health facility is greater as more patients may be seeking out healthcare services for non-urgent conditions (Fertig, Corso & Balsubramaniam, 2012). By providing emergency care nurses and providers on staff within the state forensic psychiatric hospital, the burden placed on the community hospital may be reduced, freeing up staff to determine whether citizens coming in need to be seen elsewhere, and so that healthcare providers working there can focus on community members coming in for services.

There is an increasing body of evidence in the literature suggesting that the rapidly rising cost of healthcare has placed a burden on community healthcare centers, and on ER centers within healthcare facilities. As a result of the literature reviewed, supporting a need for this study, four research questions are to be addressed:

Research Question
What are the relationships between variables patient’s demographic (age, gender, reason for incarceration), health status (chronic condition like diabetes, arthritis, cardiac condition), with the number of ER visits in the last 4 months?

How effective would having an on-site qualified health care provider be in reducing the frequency of visits to the ER, compared with transporting patients to the community-based center? Would such an intervention demonstrate an improvement on patient’s health status and number of visits to the ER?

Would having an on-site RN or healthcare provider reduce the frequency of trips to the ER in a community-healthcare center?

Is their evidence in the literature suggesting that having an on-site healthcare provider would reduce the costs associated with providing emergency care to incarcerated patients?

  • Enard, K.R. (2013). Reducing preventable emergency department utilization and costs by using
    community health workers as patient navigators. Journal of Healthcare Management. 58(6). November/December.
  • Enard, K.R. (2013). Reducing preventable emergency department utilization and costs by using
    community health workers as patient navigators. Journal of Healthcare Management. 58(6). November/December.
  • Fertig, A.R, Corso, P.S., & Balasubramaniam, D. (2012). Benefits and costs of a free
    community-based primary care clinic. JHHSA: 457-459/
  • Rosenberg, M. Managing ER utilization: How behavioral health drives health care costs. Journal
    of Managed Care Medicine, 17(1): 6-9.
  • Simonet, D. (2009). Cost reduction strategies for emergency services: insurance role, practice
    changes and patients accountability. Health Care Anal. 17:1-19.
  • Vinton, D.T., Capp, R., Rooks. S., Abbott, J.T., Ginde, A.A. (2014). Frequent users of US
    Emergency departments: characteristics and opportunities for intervention. Emergency Medicine Journal, 31:526-532.