Hospital Emergency Rooms

On the 27th of December I spent 4 hours sitting in a hospital waiting room. Why? Because I’d hit my toenail on a door and it had completely split apart from the nailbed. Fun times aside, there was absolutely no need for me to spend longer than 2 minutes there. All that happened, after 4 hours, was that the Doctor poorly bandaged my foot and sent me home.

So why the wait?

A large part of the problem appears to come from two sources:

1. Hospital Staff are set in a pattern of being slow, and instead of working to remedy the situation, the attitude is defensive (hence no waiting estimates are given out).
2. Any interaction with a patient requires spending longer on paperwork than with said patient.
3. There’s no obvious system being followed – anyone can sit wherever they like, and people with clear problems (cut finger) are lumped in with those waiting for a diagnosis (feeling sick, potentially infectious).

Fixing the first point is difficult (although not having 6 people for admin, with 1 nurse on duty would possibly help), but the second has so much potential that I’m shocked it’s still so bad.

Let’s start from the top.

When you first enter the emergency room you’re given a paper form to fill out. The nurses then type this into their system (sometimes asking you to clarify a word).
How about instead we have a keyboard or a tablet through which patients can enter their own information?

There’s a long waiting period, but plenty of time between arrivals. This time is wasted, with people being seated and ignored.
Surely we could spend a few minutes with each patient when they first arrive, making sure we assess the urgency of their status, and give them an idea of what’ll need to happen. 

When, eventually, someone comes to talk to you, they have to log all of this in a notebook (which I imagine gets entered into the system later on).
If McDonalds can use a wireless transfer order system, why on earth can’t the healthcare system do the same? Write notes as soon as the patient appears, and submit an ‘action’ for what happens next. (i.e. if a Doctor needs to see them, send an action to the pool of available Doctors, much like submitting a fast food order).

All of the above would dramatically improve the speed with which people are processed. It would reduce events like people with chest pains waiting half an hour, or having to wait over 2 hours to be offered panadol.

As to the third point – why not set up a queue-type system that the patients can actually see? There’s nothing so frustrating as waiting somewhere without information where nothing appears to be moving.

It would also make sense to separate the two types of people – injured vs ill. It would increase the comfort of people who aren’t sick, just injured, and allow Doctors to straight away know what they’re dealing with.

Above all that though, the most important thing is probably the fear of being sued, and hence of acting.

If nurses were more able to make a diagnosis I could have been sent home immediately. If the staff were less defensive about being asked for a time estimate, people would be happier seeing their wait was shortening. And if people could clearly see the order they were waiting in, they’d be able to visually see the queue decreasing.

But of course, this is the public health sector. There’s none of the competition that forces the private world to improve, and none of the financial factors to act as an incentive. Change here will be hard, and I fear unlikely.

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