Sunday, September 18, 2005

Bottlenecks and Traffic Flow

Excellent article from the Connecticut Post Online, excerpted below:

"Hospital emergency departments are the ultimate safety net for the public"

Against the backdrop of years of double-digit increases in medical insurance premiums, the managed care industry pitched itself as a savior of the nation's ailing health-care system. "Managed car comparison, over an even shorter timespan, Connecticut's hospital emergency rooms treated 1.4 million patients last year — 27.2 percent more than they did in 1996 when they saw 1.1 million.

Meanwhile, hospitals increasingly face bottlenecks transferring patients from emergency departments to hospital rooms. Sometimes there just aren't enough nurses to oversee the beds.

To observers, untrained in the ways hospitals funnel patients through their system, none of this makes any sense. It's hard for them to square seemingly crowded emergency rooms, with vacant beds elsewhere in the hospital.

Initially, hospitals triage patients in their waiting room to ensure that the most critical see doctors first. Once inside the ER, doctors examine the patient and order diagnostic tests if warranted. Then they work to stabilize the patient, either for discharge or transfer to a hospital bed. In some cases, patients end up waiting on gurneys in an ER's hallway hooked up to monitors. This happens for a couple of reasons: their condition may require very close monitoring; the nurse-to-patient ratio may be too low to adequately supervise all of them on a regular floor; or there just isn't an empty bed available.

It's all about traffic flow. And while hospitals everywhere lament the balancing act they must conduct, trying to forecast how much nursing staff they will need to treat the patients they expect to be admitted, the exercise has a steep downside.

According to the American Hospital Association, when hospitals allow logjams in their ERs that delay transferring patients to critical care units and force sick or injured people to wait longer for treatment, that inefficiency costs each hospital on average $1.74 million annually in lost revenue.


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