JFC Man the **** up people

[Guynemer]

Why doesn't triage order the patients by the case complexity to minimize average waiting time?

[regexcellent]

That's what I'm wondering too. The hospital website stated that they try to process patients in 30 min and treat them in a further 30 (which is why I went there). I figured there would be a nurse or PA to take care of routine, basic stuff quickly.

[MikeH]

Uh no? I'm saying the ER should charge prices that make it profitable.

I was told by a doctor, as opposed to a snarky brit on poly who's used to ****ty socialized medicine, that I was right to go to the ER anyway. So being upset that it was going to take 5-6 hours to get seen is pretty ****ing reasonable.

People with more serious conditions than me were getting up and leaving in frustration.

Whatever they charge it's always still going to be more profitable to make minor injuries wait to make sure Doctors are never without a patient to see.

Which is why every system socialised or paid for uses a triage system, none of them want to waste money on underutilised doctors, who are the most expensive labour resource.

[Guynemer]

That's what I'm wondering too. The hospital website stated that they try to process patients in 30 min and treat them in a further 30 (which is why I went there). I figured there would be a nurse or PA to take care of routine, basic stuff quickly.

Depends on the time of day you go, I wager.

But the phrase "Why doesn't triage order the patients by the case complexity to minimize average waiting time?" is just... I mean, one couldn't miss the point more if one tried.

[MikeH]

That's what I'm wondering too. The hospital website stated that they try to process patients in 30 min and treat them in a further 30 (which is why I went there). I figured there would be a nurse or PA to take care of routine, basic stuff quickly.

Complex medical conditions tends to mean more serious or potentially more serious. So it's blindingly obvious that treating the simple stuff first immediately leads to worse outcomes for patients. So you treat the most serious and/or complex first.

Well understood minor complaints like cuts will be last in any system that cares about patient outcome.

[MikeH]

BTW - 5% of patients forced to wait 4 hours in A&E is apparently considered a crisis here.

https://twitter.com/EvidenceUK/status/408964674806247424/photo/1

[regexcellent]

I'm not disagreeing at all with the ordering of patients by seriousness. Obviously stuff that needs rapid treatment to save lives comes first.

I think that the ER would be vastly more efficient if it had one doctor or one PA who handled a bunch of the simple stuff and nothing else, so they can clear trivial cases rapidly. For stuff where they're willing to make you wait a few hours, like getting a couple of stitches, ordering those by complexity would make more sense.

[Ben Kenobi]

I think that the ER would be vastly more efficient if it had one doctor or one PA who handled a bunch of the simple stuff and nothing else, so they can clear trivial cases rapidly. For stuff where they're willing to make you wait a few hours, like getting a couple of stitches, ordering those by complexity would make more sense.

If you're sufficiently staffed to be able to do this, your intake will increase. For the same reason you went to that ER.

[MikeH]

I'm not disagreeing at all with the ordering of patients by seriousness. Obviously stuff that needs rapid treatment to save lives comes first.

I think that the ER would be vastly more efficient if it had one doctor or one PA who handled a bunch of the simple stuff and nothing else, so they can clear trivial cases rapidly. For stuff where they're willing to make you wait a few hours, like getting a couple of stitches, ordering those by complexity would make more sense.

You could call it the Urgent Care Centre.

[Imran Siddiqui]

[dannubis]

Why doesn't triage order the patients by the case complexity to minimize average waiting time?

Not sure what you mean.

The most urgent cases usually take the longest time to fix/stabilize?

[onodera]

Depends on the time of day you go, I wager.

But the phrase "Why doesn't triage order the patients by the case complexity to minimize average waiting time?" is just... I mean, one couldn't miss the point more if one tried.

Why not? When we implemented an electronic queue in our branches our first setup prioritized complex operations, like opening new accounts, first. This lead to longer queues and more complaints from the customers, as the average waiting time went up. We then evaluated several more options:
1) what I had jokingly suggested in my previous post. The problem is that whenever there's a steady flow of simple customers our complex customers may get stuck in the queue indefinitely.
2) a single FIFO queue. Works, the customers understand it. Can get clogged if there are more complex customers than tellers.
3) a single teller that processes complex operations first, the rest process them last. Works if there is more than one teller.

We ended up implementing 3 that switches to 2 if there's only one teller in the branch. If the queue is stuck, the branch manager joins the tellers and the system switches back to 3.

Yes, I know the reason why triage works the way it does, it was a mild trolling attempt. However, my story is not over.

A good internet banking site allows a lot of simple customers to avoid going to the branch altogether or at least determine if they have to visit it.

What if, I don't know, you could call a toll-free number and talk to a specialist who would evaluate your symptoms and direct you to an appropriate facility? Oh, wait, that's how it works in Russia. You call 03 and they tell you what to do:
- wait until morning and go to the polyclinic (an outpatient facility for generic stuff and preventive care, that's where Russian GPs work)
- wait until morning and go to a trauma care unit (where reg should've gone: cuts, broken bones, tetanus and rabies shots)
- wait until morning and the doctor from the polyclinic will come
- stay put, the emergency team will come and examine you at home. They will take you to the hospital if necessary

The first three options can be upgraded to the fourth one if the doctor sees the problem is serious.

[MikeH]

I would have been entirely justified in following that with CASE CLOSED and closing the thread.

I very nearly did.

[Ben Kenobi]

We ended up implementing 3 that switches to 2 if there's only one teller in the branch.

Right, because the primary goal of a teller is the same as the doctor. Different system goals require different queue management. If your primary goal is to increase throughfare and decrease wait times, then yes it makes sense to divide things up like you did. For an ER? Not so. The primary goal is to save the life of the patient. This means that your most difficult and care intensive cases go first, the exact opposite of what you do as a teller.

[Guynemer]

What if, I don't know, you could call a toll-free number and talk to a specialist who would evaluate your symptoms and direct you to an appropriate facility?

Which is precisely what I do when I am oncall for the practice.