Effective assessment has been demonstrated in a reduced number of post-intervention hospital admissions and/or representations to the A&E, reduced hospital days, nursing home admissions and community agency referrals, including a reduced rate of hospital admissions in the long-term, and reduced service use.
One of the biggest barriers to effective patient assessment is not listening to the patient's history...i.e. what the patient is sharing with/ telling the health care provider who is doing the assessment.
Often the biggest barriers to effective patient assessment in the emergency department setting are:
- time
- staffing levels
- and resources (capacity versus demand)
We know that the patient history is the most important thing in making a diagnosis, and that this can often be confirmed by examining the patient properly and performing confirmatory or 'rule out' investigations.
However, how many times do nurses not have time to undress the patient appropriately during their initial assessment, or go back to record further vital signs including pain score? ED doctors are often rushed and under pressure to multi-task rather than listen to patients. More investigations get done to try to save time, which may give false positive results and lead to overdiagnosis and further medicalisation of a patient's problems.
Overcrowding leads to error, potential harm and poorer outcomes.
Sorry, busy shift..
Adding to these very valid reasons I think that the systems in which the work is done also don't always help. Triage systems are highly standardized with the purpose of coming to quick conclusions about priority and are increasingly used by lower trained personnel in order to cut time and costs. So if you are setting up research in this area I would certainly also look at the practices around the triage systems and the way they are embedded in the organization of the ward.
Then, there are whole systems of evaluation that are discounted out-of-hand by current "standards of practice". This is supposed to be science. This is what parades as science. Obviously, it is not. Any system that has such a philosophy is not science. Real science is open-minded. That's it definition. What is science doing with a philosophy--especially one that forbids using (e.g.) traditional means of health evaluation? Tell me! Protecting its turf? Fearful of discovering something valuable, inexpensive, and that obviates invasive procedures? Uh, I think so! Therefore, we have a barrier. One that needs to come down!