CASE STUDY: Mary knew her husband, Ron, was in a lot of pain when he agreed to go to the emergency room on Saturday afternoon. That morning he had fallen from a ladder, and now he was unable to bear any weight on his swollen ankle. She drove him to the emergency room of United General Hospital, an acute-care facility that serves their suburban Midwestern community. After she made sure that Ron was settled in the waiting area, Mary stood in line for 30 minutes to register. She was surprised at the length of the wait because the waiting room was less than half full. The registration process took another 15 minutes because the registration nurse had to enter data into three computers. The nurse had to leave her desk twice to escort patients to exam rooms. Ron's insurance required a co-payment for emergency room (ER) visits that Mary wanted to pay with a credit card. She waited 10 more minutes while the registration nurse used multiple computers to validate the co-pay amount and process the credit card. The registration nurse accompanied Ron and Mary to a second waiting room. She told the couple that Ron was fourth in line for an exam room, and he would be seen in about 30 minutes. Ron told the nurse that he was in a great deal of pain. After 45 minutes, he was escorted to an examination room. After a 10-minute wait, the examination nurse took Ron's vital signs and prepped the room for the physician. Ron and Mary were tired and hungry. They were relieved to finally see the attending physician when he opened the door to the exam room 20 minutes later. Mid-way through examining Ron, the physician was paged for an emergency. Another 20 minutes passed before a physician's assistant entered. He announced that he would conduct the examination. After a 5-minute exam, he concluded that Ron had a sprained ankle or a broken bone. He ordered an X-ray to confirm the diagnosis. He entered the order for the test on an iPad in 3 minutes while still in the exam room with Ron and Mary. Fifteen minutes later, an orderly took Ron to the radiology department, where Ron was seen immediately. The tech completed Ron's X-rays in 5 minutes. After another 15-minute wait, an orderly escorted Ron back to the exam room. The physician who had initially examined Ron had checked Ron's X-ray by the time he returned. He came into the exam room with his diagnosis: Ron had a fractured cuboid bone in his foot and a badly sprained ankle. The physician prescribed an air cast and a mild pain medication. The discussion with the physician lasted 5 minutes. The orderly returned 10 minutes later to escort Ron and Mary to the checkout desk, where Ron was to pick up his prescriptions. Unfortunately, the checkout nurse was not at her desk. She returned from break 10 minutes later. During 2020 Walden University 2 the checkout process, Ron asked about his prescriptions. The nurse did not see any prescriptions in Ron's chart. She left Ron and Mary to find the physician. Fifteen minutes passed before she returned, apologizing profusely, and printed out the prescriptions. Ron and Mary waited another 15 minutes while the checkout nurse created the referral paperwork and identified an orthopedic specialist that accepted Ron's insurance. Ron was so disappointed in his experience in United General's ER that he wrote a letter to the hospital administrator detailing his visit. The hospital had received multiple similar complaints recently, and the executive committee decided to take action to address the productivity and efficiency of its emergency department.

Explain and provide an analysis of activities and processes that create inefficiency as follows:

Identify five of the activities or processes from the case study/ included in your dashboard that create inefficiency in the emergency department.

Provide a rationale for your selection of the five activities or processes. Include cited material and References to support your assertions.

Identify any discrepancies and outline reasons why discrepancies exist.