Queue management in U.S. emergency departments
Hospitals slash emergency room wait times By Marie-Anne Hogarth
East Bay Business Times
August 11, 2006
Sutter Delta Medical Center in Antioch says it has reduced emergency room waiting times from an average of four to six hours to one to two hours in just two months by adopting a new system for prioritizing patients.
For a hospital that expects to see 54,000 patients this year in its emergency department - the only one in eastern Contra Costa County - those shorter waits represent a big boost in efficiency.
Rapid Medical Evaluation, the new system at Sutter Delta, is not entirely original. It was developed by Emeryville-based California Emergency Physicians Medical Group, which staffs more than 50 emergency departments in the state.
The RME system is one example of a nationwide push for emergency room efficiency. Hospitals are seeking ways to reduce “door to doc” times, which in turn impact patient satisfaction scores. Strategies include using providers earlier in triage, bedside registration and setting up separate areas to treat noncritical patients quickly.
http://www.bizjournals.com/eastbay/stories/2006/08/14/story4.html?b=1155528000^1329775
Comment:
By Don McCanne, MD
Excessive queues (wait times), whether for acute problems in emergency departments or for non-urgent specialized services, are often claimed by opponents of reform to be an inevitable consequence of universal, publicly-financed health systems. The truth is that they are an inevitable consequence of any health care system that is not monitoring patient flow and making appropriate adjustments when warranted.
When excessive queues develop, two approaches may be appropriate. If the system is truly deficient in capacity, minor adjustments in capacity may be required with a very modest increase in marginal costs. Much more often, excessive queues can be moderated simply by application of queue management techniques, often with no significant increase in costs.
This article demonstrates that even the seemingly insolvable problem of excessive emergency department queues here in the United States can respond dramatically to simple queue management (even though other issues such as surge capacity may have complex solutions). Establishing policies to ensure that everyone has comprehensive health care coverage should never be a reason to abandon principles of queue management.
Some countries, but not all, have lagged in queue oversight and management.
The following Canadian website provides links to presentations on queue management. They have acknowledged their problem, and they are addressing it.
http://www.cprn.com/en/doc.cfm?doc=1447