April 2007

all about undoing delays in healthcare

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Presenting queueing theory as a general method for modeling patient waits in healthcare, the book dwells on the topic of rapid delivery of medication in a catastrophic event, such as a pandemic or terrorist attack. The importance of optimizing care when patients transit from one care setting to the next care setting is duly emphasized by tracking the good results in clinical outcomes and the business side.

'PATIENT FLOW: Reducing Delay in Healthcare Delivery' probes the delays in healthcare delivery to patients and explicates some methods to cut possible delays normally experienced by patients. The book talks about improving the flow of patients, and the need to avoid unnecessary waits in the course of their flow through a healthcare system. Providing a hands-on discussion, the book looks at methods for solving a variety of problems that inhibit prompt and swift health care delivery.

Taking into account the highly interdisciplinary and practitioner nature of this book, the chapters have been appropriately written by doctors, nurses, industrial engineers, system engineers and geographers whose perspectives have succeeded in providing a comprehensive view for addressing the lacunae of 'patient delay.'

The book targets an audience of the researchers in healthcare, practitioners and administrators by trying to familiarize a set of techniques and strategies to motivate clinicians and administrators, thereby making them try out initiatives that can substantially reduce delays in healthcare delivery.

A significant aspect highlighted in the book is about ensuring services that are closely synchronized with patterns of patient demand. Another notable aspect is about ensuring ancillary services, such as housekeeping and transportation; fully coordinated with direct patient care.

Effective management of healthcare delays can produce dramatic improvements in medical outcomes, patient satisfaction, and access to service and reduce the cost of healthcare. With this objective in mind, a slew of breakthrough strategies is discussed in the book that use 'real-time' monitoring systems for continuous improvement, with techniques for scheduling staff to match the patterns in patient demand. This reduces predictable delays. It utilizes simulation-modeling techniques for both healthcare design and process improvement and provides methods for forecasting the demand for healthcare on a regionwide basis.

Presenting queueing theory as a general method for modeling patient waits in healthcare, the book dwells on the topic of rapid delivery of medication in a catastrophic event, such as a pandemic or terrorist attack. The importance of optimizing care when patients transit from one care setting to the next care setting is duly emphasized by tracking the good results in clinical outcomes and the business side.

The book also provides project management tools to guide the implementation of patient flow projects. It may not be out of place to say that this may be the first book having sole focus on reduction in patient delay, and showcasing the brewing aspirations among hospitals towards positive changes. The book can be an eye-opener in facilitating healthcare.   

Reducing Treatment Delay Among Patients

An estimated 13 million people in the United States have coronary heart disease (CHD), peripheral vascular disease, or cerebrovascular disease. The risk for subsequent myocardial infarction (MI) and death in these patients is fivefolds to sevenfolds higher than for the general population. Many effective therapies are now available for patients with unstable angina, acute myocardial infarction (AMI), potentially fatal arrhythmias, and cardiogenic shock if they seek and receive care expeditiously. However, delays in accessing and receiving care are a continuing problem, threatening the effectiveness of available treatments. Patients with previously diagnosed CHD, including a previous MI, have the same or greater delay times as those without prior MI or CHD. Because of the high- risk status of these patients, combined with the problem of delay in seeking care, the working group of the National Heart Attack Alert Program Coordinating Committee advises physicians and other healthcare providers of their important role in reducing treatment delay in these patients. The working group recommends that primary care clinicians in the office and in inpatient settings provide these patients and their family members or significant others with contingency counseling about actions, to take in response to symptoms of an AMI. The counseling should address the emotional aspects (e.g., fear and denial) that patients and those around them may experience, as well as barriers that may be associated with the healthcare delivery system. Assistance from other healthcare providers (e.g., nurses) should be solicited to initiate, reinforce, and supplement the counseling. A patient advisory form is offered as an aid to providers in counseling their high-risk patients about these issues. Other materials and aids should be considered as well. Physicians' offices and clinics should devise a system to triage patients rapidly when they call or walk in; seeking advice for possible AMI symptoms.

Further research is needed to learn more about effective counseling strategies; symptom manifestation in high-risk groups, and healthcare delivery systems that enhance access to timely care for patients, with prior CHD or other clinical atherosclerotic disease.   

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