Mathematical Wait Time Solutions

The LARGEST, LOUDEST, across the board complaint I have heard in treatment centers all over from NY to CTown to Boston is the LONG WAIT TIMES.
In BX, I was almost attacked by a marine father who had waited 6 hours for the pediatric EMERGENCY DEPARTMENT to treat his daughter, who had broken her pinky toe a week earlier.
He charged at me because I let in a set of three year old twins with respiratory infections, one of which was experiencing respiratory retractions (when the chest rises unevenly, a clear sign of serious distress).
I tried to explain that an ER is not a restaurant. It is not first come, first serve. It is sickest first, and a broken toe (which there is nothing anyone can fix, except for the person who needs to rest it) that happened a week before (obviously, not an emergent priority) may wait a full day.
Before I could get the word “triage” out however, his face twisted and he lunged at me.
You better believe I slammed and locked that door in his face. That ER pays well specifically due to “occupational hazards” such as this, but not that well.
Yes, a marine was going to attack a twenty-one year old, 100 lb., female nurse over a long wait.
That’s serious.
Emergency personnel, as well as many others in the world, do receive messages from their subconscious which is a culmination of all past experiences and often result in their “gut” instincts to provide care.
I do not undermine the power of gut instincts. I’ve gotten by for a very long time on these, but there is also a personal level in accordance with past experiences and the person’s perception of these experiences, which can be argued as the cause for HUMAN ERROR (See Gary Klein’s Sources of Power or Malcolm Gladwell’s Blink).
My recommended solution for this problem of wait times, as well as minimizing the margin for human error: computerized algorithms.
This idea could also cure time consuming thought processing by professionals.
Problems may be simply be taken out of the equation (Ha, get it. Algorithms. Out of the Equation. It’s a geek joke).
How could this be done?
Maybe, by collecting case files and data from patients around the United States who present with major common symptoms (i.e. chest pain or dyspnea) could be fed into a computer program designed to take the information of presenting symptoms and calculate the final official diagnosis, course of actions and outcomes in each patient to predict, based on previous patient experiences, which subjective symptoms are most ominous and require the most intensive intervention.
Clearly, The presenting symptoms, disease progression, necessary medical intervention and final diagnosis would need to be inputted to receive averages representing a course of action from previous patient experiences.
This task would save both time and money by taking the guess work out of treatment.
The final product, which would be the standardized course of action, should look like a treatment tree.
Think this is genius? I do, but it’s not all me. See “Blink” by Malcolm Gladwell. I’m just explaining the benefits from both views of health care.
The benefits would include less time for stressed Drs/NPs/Pas to make judgment calls based on past experiences susceptible to human error, which inevitably leads to less out of pocket expenses for hospitals per patient treated.
IS anyone following me here? Because I’m not even sure I’m following myself.
Hospitals will spend less money to treat each patient since guidelines will already exist, all that would need to be done would be to take a pertinent health history which includes a set of standard questions that should provide the appropriate information to guide a professional to the tree which would dictate treatment.
Think this is a CRAZY, OUTRAGEOUS idea? Let me give some information, stats, and numbers to back me up.
Cook County Hospital in CHICAGO began this experiment in 1996 under the supervision of Brendan Reilly, who was previously an associate professor at DARTMOUTH UNIVERSITY.
Cook County Hospital in the hood sounds like a world away from the gorgeous, sprawling surroundings of Dartmouth.
Reilly, in “Blink” described the ER as a “system with constrained resources.” Chest pain patients in particular were “resource intensive.”
So chest pain patients were treated as they are in most ERs. Professionals would “gather as much information as they can and make a guess” (Gladwell, Blink, pg. 129). With the system being what it is, professionals err on the side of caution, a very expensive decision.
Reilly began to develop “statistical rules,” feeding cases into a computer to determine commonalities to guide treatment.
The end result, known as “Goldman’s Algorithm” (after Reilly’s idol cardiologist who worked with mathematicians on this idea in the 70s), was proven 70% BETTER than the previous method of checking and guessing (See the study publication http://www.medscape.com/viewarticle/417246)
Professionals “guessed” right between 75-89% of the time. The algorithm guided appropriate treatment more than 95% of the time.
What an algorithm could do is take the stress and sponteinity out of dire situations where judgment calls may be skewed by unnecessary factors (such as a screaming wife or a marine that is about to hit you).
I could go on about this, but basic moral of the story, indentifying an underlying pattern among patients could guide care QUICKLY, EFFICIENTLY, and AFFORDABLY.
It’s a mathematical solution. This is obviously not a cure all, but I do think it would be a sufficient start.
FYI- Brendan Reilly is now in Windy City politics. He says he is a “man of the people.” To read about him see http://www.windycitymediagroup.com/gay/lesbian/news/ARTICLE.php?AID=14090 To contact him go to http://www.reillyforchicago.com/index.php
He is also technologically savvy. He has a profile on LinkedIN, the world’s largest online business network.