employees play an important role in emergency care of patient and they are  one of the most sensitive areas of health care. This sensitivity is commonly based on a combination of factors such as urgency and crowd of the patient. Urgency of care results from a combination of physical and psychological distress, which appears in all emergency situations in which a sudden, unexpected, agonizing and at times life threatening condition leads a patient to the emergency department (ED). in my opinion, enhancing the employees awareness and their responsiveness and developing the e construct related to these issues may be helpful in covering the topic.

please read the followng link

https://bmcemergmed.biomedcentral.com/articles/10.1186/1471-227X-11-16

Regards 

 Dr. Dhani, Thank you very much for quoting my article.

Regards

Hi Cady,

I am not sure what your question is. Are you aiming at detecting illegal behaviour in hospitals?

That may happen, but very rarely in Europe I guess. Even in ambulant treatment of emergencies this is not an option. All structures prevent such illegal behaviour. I was involved in emergency calls quite a bit and had tens of thousands of cases. The number of patients who actually didn't pay for various reasons was not very high. On recalling my records I would estimate that this happened in less than 1/1000 cases.

We, at least some of us, still follow the oath of Hippocrates. Thus we treat patients in need regardless wether they can pay.

Finding out the truth about illegal behaviour via a questionaire has to face the fact, that people who did something illegal, will not tell the truth when asked.

So I think, before proceding on such a path, it is recommendable to enter the field and do some kind of investigation. Watch what happens and talk to people who work there who are trustworthy. Maybe that could bring up a reliable approach via a questionaire.

Maybe this is not a scientific question, rather an issue for the police.

Hope that helps

Cheers

Hans

I read some of the linked article, which looks great on first glance. Obviously misuse of ED is an issue.

Possibly if huge crowds are involved, this starts at the reception. In the German ambulance system I was involved, mainly in Hamburg and Munich, both large cities, the initial phone call was received by especially trained receptionists, who distributed the calls somewhat like this. 1. not urgent, can see his regular doctor the next day, 2. questionable, can enter the central ambulance to see a doctor, 3. needs a visit, a doctor will be scheduled to do that, 4. receptionist brings in the ambulance doctor to clarify what is needed, 5. high emergency case, ambulance or mobile intensive care unit is alarmed and takes care.

Obviously this type of system can only take place in highly developed countries and may not be applicable elsewhere. Also this only applies to times when regular doctors are out of office. And obviously patients can directly call an ambulance and try to get access to hospital care.

Misuse in this type of setups I have encountered like this: patient exaggerated, was unwilling to wait until next day to go to his regular doctor, receptionist failed to find this out. Patients keep doing this although informed and reminded. On home calls patients ask if more people can be treated to save time.

Misuse appeared an almost negligible problem during almost twenty years from 1980 to 2000.

Hans

Thank you!

Though, can you please post the link you mentioned?

I would appreciate that.

Cady, financial and adminstrative instruments can be a measure in this case. Hospital payment exemption are in categories in our own situation. First there disease specific exemptions like cancers and tuberculosis that have administrative gazette a and budgets that can reflect the scale of use.  Then situational exemptions like very sick unaccompanied or in some situations unidentified individuals brought in by police, road marshals ambulances or self presenting. This category have administrative requests made on their behalf by managing teams and these records are centrally kept and are useful as data.  Finally we have socially indigent or pauper patient. That the social welfare services assesses and serviced. They equally keep central record useful as data for studies. Thank you

A simple questionnaire could have mistakes or false answers. For this I would propose to give time to accreditate the answers. If it is possible before of treatment well, but if not, it would be possible to give time to make the opportune comprobations after.

Hi,

In the following link you can find "Measuring Emergency Department Performance" guidelines. I hope it will help your research:

http://www.ahrq.gov/research/findings/final-reports/ptflow/section3.html