Jigsaw puzzle
Over the past few months I've been thinking a lot about the delivery of healthcare in the emergency room or the emergency department (ED). One one hand I've been looking at various aspects of the literature - definition and measures of ED overcrowding, causes and effects of ED overcrowding, interventions and models to alleviate overcrowding, and modeling and simulation of patient flows in EDs. On the other hand, I've spent 10 months 'in the field' interacting with healthcare workers associated with the ED - the first seven months were spent conducting focus groups with EMS and ED staff and the last three months have been spent observing work in the ED.
I've also been involved with various research projects between my department and the ED at [Teaching hospital] examining patient flows, information flows, decision-making in mass casualty incidents, use of information technology tools, resource management, and eliminating waste in processes of care. I've spoken to academicians and doctors, engineers and nurses, paramedics and registration staff and gained interesting and widely varying perspectives on what "providing care in the ED" means and the challenges associated with it. I hear the terms 'queuing', 'pyxis', 'charge nurse', 'order set', 'diagnostics', 'length of stay', 'shift', 'rooms', 'trauma call', 'waiting', 'attending', 'hallway bed', 'scheduling', 'chief complaint', triage', 'ETA', and 'medical command' everyday. I dream about interarrival distributions, discrete-event modeling, NEDOCS (National Emergency Department Overcrowding Scale), surge capacity, bed management, and patient flows.
And now after 10 months of immersing myself completely into studying this problem it feels like I'm trying to put together a big, colorful, jigsaw puzzle. And I'm missing a piece.
Inspite of the various different perspectives I've been exposed to and inspite of the different medical, clinical, academic, and technical terms used to describe the problem, I feel like there is something we are all missing. Maybe we need to question the basic assumptions underlying the model of care delivery in the ED, maybe we need to take a totally different perspective. Its almost as if we are trying to calculate the speed of light given the speed of the source and the observer without realizing that the speed of light is constant in vacuum.
I've also been involved with various research projects between my department and the ED at [Teaching hospital] examining patient flows, information flows, decision-making in mass casualty incidents, use of information technology tools, resource management, and eliminating waste in processes of care. I've spoken to academicians and doctors, engineers and nurses, paramedics and registration staff and gained interesting and widely varying perspectives on what "providing care in the ED" means and the challenges associated with it. I hear the terms 'queuing', 'pyxis', 'charge nurse', 'order set', 'diagnostics', 'length of stay', 'shift', 'rooms', 'trauma call', 'waiting', 'attending', 'hallway bed', 'scheduling', 'chief complaint', triage', 'ETA', and 'medical command' everyday. I dream about interarrival distributions, discrete-event modeling, NEDOCS (National Emergency Department Overcrowding Scale), surge capacity, bed management, and patient flows.
And now after 10 months of immersing myself completely into studying this problem it feels like I'm trying to put together a big, colorful, jigsaw puzzle. And I'm missing a piece.
Inspite of the various different perspectives I've been exposed to and inspite of the different medical, clinical, academic, and technical terms used to describe the problem, I feel like there is something we are all missing. Maybe we need to question the basic assumptions underlying the model of care delivery in the ED, maybe we need to take a totally different perspective. Its almost as if we are trying to calculate the speed of light given the speed of the source and the observer without realizing that the speed of light is constant in vacuum.
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