Canada
United Kingdom
Something’s not right this Thursday morning. Your heart seems to skip and you are a little short of breath. But that’s about it. Best to do what your doctor told you before; go to the hospital to get checked out. It’s noon before the Emergency doctor sees you and after supper before they diagnose you with Atrial Fibrillation and insist you be admitted and started on a Heparin I.V. for anticoagulation. There is no bed available so it’s a long and anxious night ahead on an ER gurney waiting for TEE and cardioversion tests to confirm that there is no atrial thrombus. Sleep doesn’t come because of the narrow stretcher you’re in, and the noise and bright lights that amplify the ER hallway.
By Friday noon you are wheeled up to a bed, exhausted and scared, only to be told a couple of hours later by the visiting cardiologist that your admission has been delayed and that your tests will now not be done until Monday. So you remain on your Heparin I.V. and are also given Oral Warfarin. A day later, you have a massive embolic stroke. Now you get action.
You are rushed to the operating room where a neurosurgeon prepares to remove the embolus. But the procedure has torn your carotid artery and because of the anticoagulants you have been on for two days, you now have a bleeding brain which has resulted in a herniated brain stem. You are now brain dead in ICU where your family pleas for life support for another day until funeral preparations can be made. Sunday night, you are taken off life support, 112 hours after you did what your doctor has told you to do if you have any funny symptoms – go to the hospital.
Poor Operational Efficiencies
Nobody wants this healthcare nightmare to be true. We have to believe that our Healthcare systems do what it takes to prevent these scenarios; yet, unfortunately, they do happen. Patient outcomes are indeed affected by the baffling wait times patients endure to get satisfactory treatment. One of the key reasons for this is that a critical case of operational inefficiency has infected our hospital systems.
Poor bed management has increased wait times and cut into accepted standards of quality patient care. Wait times are measured by Alternative Level of Care (ALC) which exposes the number of hospital beds occupied by patients who no longer need acute care and are waiting to be discharged to more appropriate settings. When acute Emergency patients cannot get timely admission to a hospital because there is a discharge backlog due to an inadequate alternate care placement system, something is broken.
The overcrowding that results in the Emergency Department leads to heightened anxiety, the potential for medical error and other adverse events, and patients leaving without being seen. When a patient leaves without receiving adequate medical care because the wait is too long, their initial medical condition often worsens – resulting in return Emergency visits in increasingly more fragile states which leads to more serious consequences. At the other end, there may be “pressure” to discharge patients early which can also lead to poor patient outcomes and return visits to Emergency if alternate care is not appropriate.
Solution
So the solution appears to be obvious. Discharge patients earlier. Not so easy unless there is a robust system in place that better manages patient flow and the processes by which patients are transitioned from one level of care to another – sophisticated IT systems that can use matching algorithms to identify the right patient to the right care destination at the right time. The answer is data-driven systems that can analyze wait times at every interval of the total patient journey and provide the information that is needed to improve communication and patient navigation processes through the healthcare system. This is where actionable strategies can be developed and where performance management is delivered. This is where the real improvements are realized.
Healthcare systems are in place to help, not hurt us. Being patient-centered means ensuring that positive patient outcomes are tied directly to the level of safe and timely care we receive. This can only happen when high levels of efficiency within a healthcare system exist. Wait times are endemic to our healthcare systems. It doesn’t matter where the patient flow is within the system – acute care to community, acute care to mental health, community to acute care, GP to specialist or chronic services, or community to home – we have to put up with unreasonable wait times. There are eReferral solutions that can help healthcare systems achieve big efficiencies to reduce wait times. The boomers are coming. This is why Patients Shouldn’t Wait.