Paper Example on Triage Unit at St. Mary Medical Center: Delayed Diagnosis & Treatment

Introduction

One of the performance indicators at St. Mary Medical Center is the extent to which the need for early diagnosis and treatment of patients is achieved. All practitioners are encouraged to adhere to the established professional guidelines to achieve effective diagnosis and treatment. However, in recent months, the triage unit at St. Mary Medical Center has registered an increasing number of cases categorized as delayed diagnosis and treatment, especially for tuberculosis patients. The issue of delayed diagnosis and treatment among tuberculosis patients is a multidimensional problem that originates from a range of variables such as individual, community, and healthcare system factors (Bello et al., 2019).

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The problem of delayed diagnosis and treatment among tuberculosis patients affects the ability of St. Mary Medical Center to achieve effective patient outcomes. The triage unit faces significant challenges such as the inability to meet immediate patients’ needs based on the high number of exacerbated cases presented and reported each day (Beltran et al., 2019). Since St. Mary Medical Center is a community-based facility, this problem adversely impacts the ability of the facility to meet the healthcare needs of the hospital. I selected this issue because tuberculosis is one of the major causes of death globally. It is estimated that over 19-30% of people are affected by the condition. Over $616 billion loss globally comes from tuberculosis mortality from 2000 to 2005 while another $984 billion loss is estimated to be incurred globally between 2015 and 2030 (Bello et al., 2019). According to Bello et al. (2019), in the United States, over $7 billion is spent on tuberculosis prevention and care each year.

The charge nurse for triage at St. Mary Medical Center has been keen on following the outcomes of the cases associated with delayed diagnosis and treatment among tuberculosis patients and found out that the problem incorporates factors beyond the hospital settings. According to scholarly analysis based on clinical assessment, delayed diagnosis, and treatment among tuberculosis patients increases mortality and exacerbates the process of effective treatment and recovery (Bello et al., 2019). The charge nurse has ascertained the need to address this issue to assist both the facility and the unit as well as the community at large. The justification for her point of view stems from the role that triage plays in a healthcare facility. Successful coordination and management of the triage impact the subsequent processes such as diagnosis, treatment, and patient management (Beltran et al., 2019). In this case, the management of tuberculosis patients in our facility depends on the extent to which the problem of delayed diagnosis and treatment could be mitigated.

Owing to the adverse effects of delayed diagnosis and treatment of tuberculosis patients, there are significant advantages that could be attained for St. Mary Medical Center as well as the triage unit. By mitigating the problem of delayed diagnosis and treatment among tuberculosis patients, there will be improved patient outcomes among this population. The triage unit will achieve minimum time required per patient after arrival at the facility, which will, in turn, improve general patients’ satisfaction level. Additionally, such a move will cumulatively contribute towards reduced mortality while increasing the rates of recovery for patients suffering from tuberculosis (Bello et al., 2019).

Literature Review of the Problem

As noted earlier, different factors are linked to delayed diagnosis and treatment of tuberculosis patients across different healthcare settings. Scholars have endeavored to determine the prevalence, effects, and mitigation measures for this healthcare challenge. Therefore, scholarly evidence ascertains the adverse impact of delayed diagnosis and treatment among tuberculosis patients and the need for strategies to mitigate this problem.

A study carried out by Bello et al. (2019) showed that the reason for increased delayed diagnosis and treatment of this group of patients is because tuberculosis is associated with non-specific symptoms. In this case, most non-trauma patients to not seek medical interventions at an early stage. It follows from the study by Bello et al. (2019) that delayed diagnosis and treatment is a critical challenge in healthcare and should be given utmost attention. The study, which was a systematic review, showed that well-articulated interventions that are focused on mitigating delayed diagnosis and treatment could cumulatively improve the fight against tuberculosis both locally and globally (Bello et al., 2019).

Another study by Li et al. (2018) investigated the effect of patient-related delays and healthcare system factors specific to the immigrant population in China among tuberculosis patients. The study focused on immigrant groups because of the underlying external factors that could impact their access to immediate healthcare during emergencies. Based on the evidence gathered and assessed by the scholars, it was evident that timely diagnosis and treatment are vital for tuberculosis patients from different immigrant groups in China. The cross-sectional study revealed that immigrant persons with tuberculosis impacted by delay diagnosis and treatment either due to their personal or healthcare system factors are at a high risk of poor patient outcomes (Li et al., 2018).

Literature Review of the Solution

Scholarly reviews and assessments have ascertained the need for multidimensional solutions to curb the problem of delayed diagnosis among patients with tuberculosis. Late diagnosis because of the close relation between extrapulmonary tuberculosis (EPTB) and fever of unknown origin (FUO) could be mitigated through two key interventions: the combination of diagnostic criteria or tests and patient education or sensitization especially in areas with a high rate of tuberculosis cases. Different studies have investigated the use of these measures among patients to curb the problem of late diagnosis.

In a study by Kim et al. (2018), the delayed diagnosis was assessed among patients diagnosed with EPTB in countries with intermediate burdens. The scholars focused on the efficacy of differentiating EPTB and FUO during diagnosis to prevent late detection and treatment of the later. The assessment was based in three different hospitals that are affiliates of Seoul National University. The observations and evaluation of interventions were spread over eight years. Patients involved were above 5 years. From the three hospitals, patients with FUO during referral were identified and selected for further examination. Patients with fever associated with concurrent infections, fever originating from drugs, and those with non-infectious conditions were not included for further examination. The purpose of this inclusion and exclusion was to determine an effective approach to curbing delayed diagnosis, which was defined in this implementation as the failure to determine the accurate diagnosis after more than two days of a comprehensive assessment of the patient.

From the three Seoul National University affiliate hospitals, it was ascertained that from the 95 included patients, 49.5% were diagnosed with pulmonary tuberculosis even though they had been initially diagnosed with FUO. The evidence gathered and assessed by Kim et al. (2018), therefore, showed that practitioners at triage require additional tests intervention for patients with FUO to ensure that potential tuberculosis diagnosis is not discovered after the exacerbation stage. In this case, where there are non-specific manifestations from the initial patient assessment, the active application of comprehensive tests such as cross-sectional imaging should be combined with invasive tests or diagnostic interventions (Kim et al., 2018).

Another study regarding the effectiveness of the interventions to mitigate delayed diagnosis among tuberculosis patients was carried out by Paz-Soldan et al. (2014). The assessment involved five healthcare centers and the local regional hospital in Lima, Peru. The inclusion criterion was limited to facilities within the peri-metropolitan region of Villa Maria del Triunfo. The selected facilities served people with low income living in areas with poor sanitation levels. Participants were majorly adults as well as parents of children who had been receiving DOTS tuberculosis treatment. The patients had negative sputum results when they were presented in the hospital but were on active tuberculosis treatment.

Paz-Soldan et al. (2014) showed the need for patient awareness and education to limit cases of delayed diagnosis because, from the 27 cases assessed and followed after treatment, eight adults were co-infected with HIV, three children acquired HIV through vertical transmission, and the rest had contacts or were living with a tuberculosis patient. From the evidence gathered and analyzed by Paz-Soldan et al. (2014) from the healthcare facilities, the use of health promotion interventions that target specific groups of patients could mitigate delayed diagnosis of tuberculosis, improve patient outcomes, and prevent cross-transmission of the disease at community and household levels.

Implementation

The recommended solution for delayed diagnosis among tuberculosis patients at St. Mary Medical Center and ascertained in the literature is a combination of comprehensive diagnostic tests and patient education. The first step entails the separation of patients depicting FUO and tuberculosis symptoms. Patients depicting FUO but are with prior infection or under medication should be excluded from further combined tests; however, the remaining patients presented at the facility should be recommended for further assessment. The second step of the intervention entails the process of carrying out the distinguishing tests. At this level, the health history of the patient should be assessed to identify individuals living with another tuberculosis patient or those with an underlying condition such as HIV. The third step entails multidimensional diagnosis, which should incorporate an active application of comprehensive tests such as cross-sectional imaging. The final step is patient education to guarantee effective prevention as well as to cultivate a culture of seeking medical interventions early.

The implementation of the solution should be undertaken immediately owing to the critical implications associated with this problem. The triage charge nurse and the nursing manager should provide a localized documented guideline to be shared to all practitioners in the unit. An in-service communication, training, and awareness program should be carried to ensure that the nurses are aware of the new strategy to curb delayed diagnosis for tuberculosis in the medical center. A summary of the guideline in the form of brochures should be created by the nursing manager’s office and strategically displayed in diagnostic rooms as reminders.

For the administration at St. Mary Medical Center to determine the impact and changes associated with the intervention, a comparative measurement of effectiveness should be carried. Cumulative patient-related quality indicators before the intervention should be compared to the period after the solution was enacted. The first milestone to be observed is the number of patients living with HIV who received an early diagnosis. The second key indicator to be observed is the number of children living with another tuberculosis patient but managed to receive early tuberculosis diagnosis. The third observation to be compared is the number of patients who only depicted FUO symptoms but the comprehensive diagnosis approach revealed the onset of tuberculosis.