Running head: SELF REFLECTION 1

Self-Reflection

Desire' Patrick

Bon Secours Memorial College of Nursing

Business of Healthcare in Complex Systems

NUR 4243

Ashley Cavanna MSN, RN

February 23, 2020

“I Pledge”
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Self-Reflection

For this assignment, we were asked to construct a Zero Based Budget to propose an idea

of change we would like to see in our workplace. This presentation included an objective,

identifying the audience, the current state within the organization, driving and restraining forces,

three alternatives to achieve the objectives (advantages, disadvantages, and costs), and a

reference page. After constructing this presentation, we were asked to construct this reflection

paper that includes the process, presentation, and reflection. The following paper will analyze

these sections.

PROCESS

When researching my proposed changes, there was no place better for me to start than my

own Behavioral Health Department and the Emergency Room. Although I was not privy to a lot

of information, with the help of my manager, I was able to get a roundabout number to assist me.

We were able to look at an overall bill of a patient admitted through the ER versus a patient who

was not admitted through the ER. We concluded the total estimated savings of $1500-$5000.

Another method I used during research was to interview staff from both departments to

determine potential or current issues and discuss possible solutions to these issues. Many issues

that were discussed by staff in both departments was the amount of time a Behavioral Health

patient spends in the ER (anywhere from 5-10 hours), the issue of Behavioral Health patients

occupying beds in the ER that are needed for emergency patients, and that many ER staff

members do not feel competent or do not feel they have received adequate training to assess

Behavioral Health patients. Many ER staff members stated they do not have adequate staff or

resources to accommodate BH patients properly and feel they worry for other patient’s safety.

The most common suggestion was to eliminate admissions to the ER by directly admitting them
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into the Behavioral Health Unit and have a hospitalist follow up with patient within 24 hours. A

visit from the hospitalist would solve not only the ER issues but also decrease the ordering of

unnecessary procedures and testing.

Challenges I experienced during this time was limitation of time, access to patient charts,

and different views or suggestions from staff. Since I was not able to access much of this

information, I had to rely on the help of my Nurse Manager to assist me. I had many staff

participants from the ER and the Behavioral Health Unit, but I had to narrow the suggestions and

problems to a compiled list. All of these suggestions and problems were legitimate, but I did not

have the time or bullets in my presentation to add them all.

PRESENTATION

For the presentation, I had to decide best what items or topics would be best to add into

the presentation for my selected audience, the Medical Director. I decided to focus on ways to

reduce unnecessary cost and admission for Behavioral Health patients in the ER. My three

suggestions were: 1) admit patients directly to the Behavioral Health Unit instead of the

Emergency Department, 2) Have a hospitalist follow up within 24 hours to ensure patient is

medically stable to be at the Behavioral Health Unit, and 3) Order specific labs or test for that

patient when needed and not just a complete screening or procedure when they are not

warranted.

All of these suggestions proposed ways to not only save the patient money but also to

save the hospital and both departments money and time that may be necessary with other

patients. By bypassing the ER and directly admitting into the Behavioral Unit, we are still able to

perform screenings on patients and only conduct necessary procedures or testing based on a

Hospitalist’s assessment.
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REFLECTION

This assignment helped open my eyes and see all of the potential and current problems

the patient, hospital, and specific units face. To help educate myself during this time, I also

interviewed with a patient to hear their perspective on the current process and suggestions that

they might have. The female patient told me that she was in the ER for roughly 13 hours. She

arrived at 9 am for her assessment, but the ER was packed with flu patients and patients with

chest pain. She stated she had to wait six hours before she was brought into the ER.

After arriving in the ER bed, it still was another 2 hours before she was able to see a

provider and begin ordered testing. She had not had anything to eat or drink during this time and

was ready to give up and go home. It was not until midnight that she arrived at the Behavioral

Health unit after consuming one sandwich and a few drinks.

Trying to imagine myself or a loved one going through this is unbelievable. I would not

want to go through all of this to seek voluntary admission. If I were a patient, I would probably

even view this all as unnecessary and as insurance fraud as nothing had warranted these orders

on some patients.

I have also learned that there is a whole other level of finance and leadership that I have

not been exposed to before. Having to account for every test, procedure, and item used for each

patient to ensure they are correctly charge has to be time-consuming and stressful. I could also

see how many errors happen during this time. Our priority should always be patient care and

assisting them with explanations of tests and procedures. I think by doing this, the patients would

be more understanding and more knowledgeable.