A new study from Western University outlines statistics-based solutions to eliminate ‘hallway medicine’ in Canadian hospitals, which was a key talking point during the recent Ontario election. Hospital crowding is always a hot button topic in Canada because emergency room wait times are not getting better.
David Stanford from Western University, his former PhD students Na Li and Azaz Sharif and two co-authors believe mathematics hold the answers to this national epidemic. Their findings were published by the prestigious journal, European Journal of Operational Research.
According to Health Care in Canada, 2012: A Focus on Wait Times, a report released by the Canadian Institute for Health Information, emergency rooms in Canada boast a clinical target for the Canadian Triage and Acuity Score ‘Urgent’ category of 90 per cent of patients being seen by a doctor within 30 minutes of arrival. Based on their dataset from 2012 and 2013, the actual number was only 9.2 per cent.
Stanford says, unfortunately, that actual number is not a typo. He also expects that things have not improved since then, due to Canada’s aging population.
“The current targets are unachievable not only because of limited resources, funds or personnel but because the way we’re calculating physician hours needed is not realistic in terms of patient flow and the varying levels of trauma that come to Canadian emergency rooms,” says Stanford, a professor in Western’s Department of Statistical and Actuarial Sciences. “The current model reflects a lack of understanding of basic queueing principles, which we fully explain in this study.”
The study points out that key performance indicators like the Canadian Triage and Acuity Score (CTAS) specify delay targets and percent compliance levels but again, offer no “best” solution. It also reveals that current emergency room staffing policies, which do a mere accounting-style estimation of expected patient volume, are inadequate because no account of variability is given. This again results in under-staffing of physician hours needed.
Stanford, Li, Sharif and their co-authors propose their own sensible solution, based on statistics, to minimize the expected number of patients that are forced to wait beyond their targeted times. They propose a method that tracks how patients are doing based on their current condition, which will allow them to accumulate ‘priority’ points while they wait.
The beauty of this novel approach, says Stanford, is that it could be implemented quite easily by simply adding an additional field to emergency department (ED) inpatient dashboards, which will assist physicians decide who to see next, subject of course to medical decision-making.
“This approach would basically serve as a tie-breaker,” says Stanford. “It can also minimize an even bigger issue in that hospital wards are almost always full, which blocks patients being transferred out of emergency departments and hospital hallways.”
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