Reducing Wait Times a Disorganized Task

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If you are trying to provoke someone with an otherwise positive disposition, one simple way to do so is to start talking about waiting times for medical care. With few exceptions, the waiting times required to receive medical treatment are longer than they should be. In most cases, they are certainly longer than most of us would like and we patients have little patience in waiting to be treated.

The problem of waiting times is not limited to any specific type of medical care as emergency room visits, referrals to specialists and scheduled surgeries all take notoriously long. Nor is the problem of wait times particularly better in for-profit systems versus public systems. Each system has its strengths and weaknesses. Of course the blatant exception to this statement is for those who have the ability to jump the queue with cash in hand. For the majority of individuals, waiting times are a reality should we need some form of nontrivial treatment.

As times passes, waiting times continue to increase in locations all over the world. In the US, researchers from Harvard University found in a 2008 study that the average emergency room wait time for those suffering a heart attack had increased by 150% between 1997 and 2008. In the same period, the average length of all emergency room visits had increased by 36%. Numbers from Canada showed an increase of 12% from 2009 to 2010 for the time elapsed between seeing a specialist and undergoing elective surgery. Similarly, in Australia waiting times for emergency room treatment increased by roughly 5% per year and elective surgery waits increased by 2.1% per year between 2005 and 2010.

The problem plagues the majority of health care systems.

Beyond just being annoying for patients, long waiting times obviously have an effect on patient health. Short-term delays in treatment can result in prolonged suffering and longer recovery periods. Delays of a longer duration can cause reductions in our quality of life. The delays for treatment of serious conditions can directly affect our long-term quality of life following treatment and even our chances of survival in some situations. Thus, there are important reasons to reduce wait times. Unfortunately, most approaches taken are not proving successful.

One of the common solutions to reducing waiting times is throwing more money at the problem. Public systems are most likely to see this approach applied by politicians eager to gain political points. Hospitals get funding for new staff and new bed space to try to move people through the health system more quickly. In good financial times, this approach does provide some improvement, but it is both costly and it quickly becomes unsustainable when the economic outlook is no longer rosy.

Another approach to reducing wait times has been to impose time standards. In the UK, Australia and some provinces in Canada, governments set a goal that the length of the stay in the emergency room should not exceed 4 hours. Unfortunately, these approaches have also increased the costs of running the health system. At the same time, according to a study of the UK system by the University of Sheffield, they have not resulted in consistent improvements in the delivery of care.

In the private system, US hospitals are keen to promote their attempts to reduce wait times in their emergency rooms with the programs that they are implementing. Hospitals such as St. Joseph Medical Center in Maryland have their wait times online. Others are sending text and email messages to patients to let them know the speed of the service. In other cases, some hospitals are partnering together to solve the problem. However, overall, the solutions are piecemeal in nature.

One significant part of the problem comes down to a lack of central administration and measurement of waiting times. In the UK, different hospitals measured different factors in assessing the duration of their waits. In Canada, the province of Ontario set up its own system to track wait times. Other provinces in the country have different systems or none at all. These differences in availability and collection make understanding the problem of wait times very difficult.

If we really want to understand where the problems are that are driving long and increasing wait times, it is key to set up some standards of measurement across numerous regions. Whether it is the World Health Organization or large-scale medical associations, these groups should work toward a standard set of information to collect and a standard way to report their results. Doing anything else means that understanding the cause of wait times is very difficult and reducing them effectively is all but impossible.

Its hard to say why this has not yet happened, but it seems that in the world of health care, regardless of whether the system is private or public, there are too many chiefs. Each region or facility delivering health care wants to be autonomous and fights to do things their way. Unfortunately, the result is that patient health is being sacrificed both because of the delays and because of the costs that these delays subsequently cause. If we really want to improve patient care while reducing costs, we must force our health care providers to work together in reducing wait times.

Related Links

http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=49830
http://www.nationalpost.com/news/canada/Emergency+room+wait+time+problem+continues+fester/3845544/story.html
http://www.cbc.ca/news/health/story/2010/12/06/wait-times-fraser-institute.html?ref=rss
http://www.aihw.gov.au/publication-detail/?id=6442472405
http://www.hc-sc.gc.ca/hcs-sss/qual/acces/wait-attente/index-eng.php
http://www.commonwealthfund.org/Content/Performance-Snapshots/International-Comparisons/International-Comparison–Access—Timeliness.aspx
http://onlinelibrary.wiley.com/doi/10.1111/j.1742-6723.2010.01330.x/full

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