This Harvard Business School paper highlights the nonsensical nature of the United States healthcare system – every advance promises one step forward, yet inevitably results two steps backward.
This is a piece of observational operations research regarding radiology turnaround times. If you’re involved in your ED’s throughput initiatives in any fashion, I am certain this has been a recurring issue. Most conversations probably take the form “If only radiology were faster, patients would flow through the department like quicksilver.” So, what happened in a 100,000-visit academic ED and a 60,000-visit community ED when, through process improvement, an “inefficient” gatekeeping step was eliminated?
Initially, at the hospitals observed, ultrasounds were available only by radiologist approval after 5pm on weekdays and on weekends. Scans could be performed as needed from a technician on-call, but this inconvenient step alone added 10-15 minutes to the radiology turnaround time for these patients. After these hospitals added 24/7 technician coverage and eliminated the approval step, two things happened: length of stay for patients receiving an ultrasound on nights and weekends decreased (huzzah), and the number of ultrasounds ordered increased by 11.5% (oh hmm).
Unsurprisingly, as the number of patients receiving ultrasounds increased, the overall average LOS for a patient with an abdominal complaint went up by 26 minutes. And, with the extra ultrasounds for the radiologists to read, turnaround times for non-ultrasound radiology results were increased by 30 minutes. Furthermore, CT use in those same time windows also increased by 4.5%, while general CT use in both departments decreased by 10%. The authors hypothesize incidental findings on ultrasound were prompting subsequent CT use to follow-up suspicious reads, leading to even greater resource utilization. As you would expect, this congestion extended out to the waiting room, with a predicted increase in time-to-room as well.
So – more tests, more costs, longer waits – no detectable effect on outcomes.
‘Merica.
“Increased Speed Equals Increased Wait: The Impact of a Reduction in Emergency Department Ultrasound Order Processing Time”
http://hbswk.hbs.edu/item/7310.html