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Unlocking the secrets of patient demand

In a telling scene from the Yes Minister show, departmental head Sir Humphrey Appleby advises his political master that the nation’s best performing hospital was able to achieve its goals because it was not hampered by having patients. It is often seen as inevitable that busy public hospitals will have emergency wards clogged with patients and an enormous backlog of surgery – not least because the number flocking to their doors for treatment ebbs and flows as the prevalence of disease and illness in the community waxes and wanes. But, according to a leading Commonwealth Science and Industry Research Organisation researcher, Dr Sarah Dods, the peaks and troughs of patient demand are not entirely random.

11 Mar 2013

In a telling scene from the Yes Minister show, departmental head Sir Humphrey Appleby advises his political master that the nation’s best performing hospital was able to achieve its goals because it was not hampered by having patients.

It is often seen as inevitable that busy public hospitals will have emergency wards clogged with patients and an enormous backlog of surgery – not least because the number flocking to their doors for treatment ebbs and flows as the prevalence of disease and illness in the community waxes and wanes.

But, according to a leading Commonwealth Science and Industry Research Organisation researcher, Dr Sarah Dods, the peaks and troughs of patient demand are not entirely random.

In fact, Dr Dods and her team believe they can, with a reasonable degree of accuracy, predict rises and falls in the number of cases coming through hospital doors – a major breakthrough in helping hospitals manage their workload and lift their performance.

“People working in hospitals often have a gut feel for when things are likely to get busy, but they can’t quite tell you why,” Dr Dods said. “But with our research, we have been able to provide an evidence-based explanation.”

Working with 27 major Queensland hospitals, the CSIRO team led by Dr Dods has been able to examine the peaks and troughs of patient demand, pinpointing choke points and blockages that have delayed treatment and caused hospitals to miss performance targets.

At Gold Coast Hospital, for instance, they were able to identify a spike in demand for emergency department services during Schoolies Week.

In response, the hospital set up an external clinic during that period that helped treat many Schoolies-related incidents, reducing the pressure on the emergency department.

At each hospital they worked with, the CSIRO team was able to identify patterns in the flow of patients, depending on the time of day, the day of the week, the time of the year, and associated with special events.

“What we can say is that arrivals at hospital emergency departments are not random. We can account for about 90 per cent of the variation,” Dr Dods said.

Many public emergency departments are dogged by slow throughput times, perceived long waiting times, limited surge capacity, efficiency bottlenecks, and challenges integrating new technology.

An Australian Institute of Health and Welfare report found that last year just 65.5 per cent of emergency department patients nationwide were seen and admitted or discharged within four hours – well below the 90 per cent National Emergency Access Target (NEAT) set for 2015.

But Dr Dods said emergency departments were often carrying the can for broader systemic problems within hospitals that helped slow down and block the processing of patients through emergency care.

“Meeting performance targets such as the NEAT is not solely the responsibility of emergency or surgery departments,” she said. “Instead, whole-of-hospital engagement is essential in ensuring obstacles to effective patient flow are removed.”

Her analysis is backed by AMA President Dr Steve Hambleton, who earlier this month told radio 3AW that emergency departments were frequently hampered by an inability to get sick patients transferred to other departments within a hospital.

Dr Hambleton said this created a logjam that often caused long delays in treatment, and underlined the need to ensure that all departments in a hospital had sufficient beds.

Dr Dods said that, in addition to more beds and medical staff, hospitals would benefit greatly from system evaluation and redesign.

For instance, her team found that treatment times for emergency department patients blew out in the early hours of the morning, and during periods of low emergency department occupancy, often while patients were waiting for beds in other specialties to become available.

Dr Dods said many problems with hospital capacity stemmed from the practice of admitting most patients in the morning but leaving the main discharge period to the afternoon.

She said a simple swap in processes – discharging most in the morning and admitting most in the afternoon, could help smooth peaks in demand for beds.

Dr Dods said that, after doing their initial work in Queensland – including the development of the Patient Admission Prediction Tool – the CSIRO was now extending its work to hospitals in other states, including Victoria and South Australia.

AR


Published: 11 Mar 2013