If you want to achieve the best wait times in the province, you need to know your hourly wait times, in minutes. Averages wait times, or wait times at specific times in the day, will not work. You need to know how your department functions every hour, down to the minute. (We had the best time to physician initial assessment in 2013-2014 at <1.5 hr 90th percentile.)
Clinicians need a thermometer
Managers need an operations report
Board members need a budget
You need hourly wait times reports
Instantaneous Wait Times
To drive change, you need live data, like a thermometer. Patients benefit when providers change their behaviour based on feedback from data about immediate circumstance.
Sure, yesterday’s information helps, if clinicians can remember what they did yesterday. Invariably, horrendous cases or surges in volume stick out in our memories from yesterday. The thousands of banal decisions made that truly impacted performance never get remembered. They reside in the background of our thinking, safe from examination.
Change happens when data becomes available in the moment. Hour by hour data can pinpoint who was working at a particular time and what care was being given.
Real time data allows leadership to query performance and address it immediately.
To get the best wait times in Ontario, we had to ask decision support to report hourly waits in minutes. Hourly reporting supported, or corrected, hunches we had about when wait times lagged. Once we had the right data, we could start trying creative solutions to improve.
Average Wait Times
‘Average’ causes pain and suffering. Reporting averages in healthcare is like reporting the average number of parachutes required for passengers jumping out of a plane.
Average wait times, average patient volumes, and average provider work speed mean nothing to a patient standing in line with tearing chest pain. Leaders should get a bit upset when they hear averages reported, or at the very least, ignore them.
What do you think? When you ask about wait times, are you getting performance from the last quarter? Are you asking for the right kind of data?
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(photo credit: carp.ca)
Shawn…wait times are the bane of thousands of patients. Of the hundreds of patient calls we recd ( mostly orthopedic pts) most told stories of waiting over 12 months to see a specialist. Their lives turned up side down …some off work, some retired and could no longer continue their life styles, some who cried but all extremely upset and frustrated with our health system. They are not impressed with this socialized medicine that only works by rationing care….they can certainly testify to that. Those that had the affordability to self pay went to physicians we suggested in the US…they knew their bundled costs before having surgery….no surprises . OHIP payed nothing. So along with ER wait times those waiting for a specialist suffer both physically and mentally
They advocate for themselves, or friend or family attempt to move them into the line faster. Most have no success in that process so they wait and wait.
There are better models out there that you and your associates write about and champion but the wheels turn very slow.
Great topics and insight…thanks
Thanks again, Don!
We need more stories about people travelling out of province to find care. Maybe we need to create a registry of the crowds that are forced to seek care outside of Ontario?
Sure appreciate you reading and commenting!
Shawn
I cannot WAIT to get our new EDIS that will have live data streaming, physician order entering from touch screen and so much more. Did you achieve your results the same way?
Hey Nick!
Great to see you commenting here. I hope you find your ED information system useful. If you can, try to figure out ways to demonstrate for the board how your EDIS adds value for them. If we frame it as only adding value for patients, EDIS gets lumped into all the other urgent patient needs that scream for help.
Sometimes, the biggest challenge is getting your data people excited about reporting meaningful data. Averages are so much easier than hourly data, but averages are just about useless.
No question, great data from an EDIS and elsewhere, drives results.
Great to hear from you!
Cheers
Shawn
Hi Shawn, love your PIA piece. However, what troubles me is the almost non existent movement on the other P4R markers. We managed to move ALL of our markers into positive territory with a comprehensive approach. The main influencing factor in our ED was added physician time. Imagine that! More physician coverage helped move more people through and improved time to physician assessment. However, we also had to add corresponding support in RN time, DI time and lab time. Our constraint now is physical space. Now we are faced with going to our community and the Ministry for a new ED and OR, to be operated with the same operating budget. It can be done if our space was designed to maximize our efficiency in physician work load.
Cheers
Ozzy
Thanks for commenting, Ozzy.
I agree we need to improve all measures of waiting: length of stay for low and high acuity patients discharged home, time to inpatient bed, and time to physician initial assessment (PIA).
EDs own PIA entirely. No one else controls PIA, so EDs should demonstrate excellence there, first, to establish credibility when trying to move the other indicators.
Looking at the other P4R indicators, the length of stay for discharged patients gets impacted by other hospital services like lab and imaging. We chopped 2 hours off length of stay by slaying our PIA dragon, but gains slowed as we work to engage the rest of the hospital on their performance. Admitted patients waiting 30 hours for a bed suffer the most egregious waits, and this metric has not improved at all.
Having said that, I have a hard time interpreting your note. Are you criticizing our best-in-province performance overall? Are you suggesting out department, with 100,000 visits per year, should model yours, with less than 1/3 the patient volume and a lower overall performance? LOL. I suspect you are giving a friendly jab. If so, I appreciate that you consider us close enough to do so!
Thanks again for commenting. Congratulations on the improvements at your site, too!
Best Regards,
Shawn
Hi Shawn, no jabs at all my friend. What I’m getting at is that our PIA time was improved as well in conjunction with the other P4R markers, thanks to our hospitalist program. Our rate limiting factor now that we have more physician coverage is physical space! We need a larger ED as ours was built fifty years ago to handle seven thousand visits. Our problems are those of scale. We see 30,000 patients per year with 32 hours of coverage per day. Let’s see what we can do with 34 hours.
Cheers
Ozzy
Hey, Ozzy. Thanks so much for writing back!
You guys have done some great things…even greater considering what you have to work with. Thanks for sharing about the hospitalist program. Can you get them to stay late, work holidays, etc? I think hospitalists are great; I just haven’t seen any programs that are anything other than pure salary without incentive pay.
I wonder what Europeans think about our space requirements for EDs? They seem to accomplish more with far less space.
Thanks again for writing back! I know you are busy.
Cheers
Shawn