A Systemic Approach to the ER Congestion Problem

10+ hours wait times should be a thing of the past

In recent years, I have been brought to talk with a hundred stakeholders who work in emergencies. In the course of these discussions, I understood that the major problem that explains, in large part, the poor performance of our emergencies is the fact that they communicate and cooperate poorly or very little between them.

Last year, for example, the Jewish General Hospital made local improvements to its emergency, and very successfully. All the lean and agile processes prescribed by Taiichi Ohno, father of the Toyota Production System, were there. However, just when we shouted victory and where everything seemed possible (we were promised waiting times under 45 minutes), emergencies spilled over again when several media seized the good news. This had the effect of creating a craze such that the urgency of the JGH is still packed and waiting times are similar (albeit slightly lower) than the Montreal average of 16 hours 42 minutes. Unfortunately, this case is not an exception but an example of so many local improvement initiatives that have not been enough to relieve Quebec’s emergency system.

The problem with congestion is that when it reaches a critical capacity threshold (around 80–90%) the wait it causes for its users becomes exponential. According to the queuing theory, the servers (in our case the emergency physicians) are not enough and the workload (the patients) increases incessantly. The problem quickly gets out of control and the story repeats itself day after day and night after night.

Patient-Balancing System

The solution I would like to propose is to divide patients through the health system as a whole. When we know that 60% of patients who go to the emergency are categorized as non-urgent, it is clear to me that we would improve the situation of Quebec by setting up a system, similar to what we call load-balancing and that has the advantage of spreading the load of Internet users wishing to access a web resource simultaneously.

Patients go to the emergency room where they are sorted by a sorting nurse. When they are categorized as non-urgent (according to the Canadian sorting scale, P4 and P5), they are referred to the next morning at the medical clinic, at the CLSC or at the pharmacy, if their need corresponds to the 7 types of medical procedures that can be provided by pharmacists recently.

At the same time, patients can be referred to hospitals in the periphery if they need it, and they will receive care faster (eg Saint-Hyacinthe Hospital which is less busy).

Political Challenge

All this is logical, possible and desirable. The biggest challenge will be managing the issues related to political aspects of this and actually getting the job done. This does not pose a technological challenge.