听is a professor in the Department of Industrial Engineering at听.
A hospital鈥檚 emergency department (ED) has long been considered the canary in the coal mine for the health-care system: when it鈥檚 congested, the whole hospital is congested.
Routine and prolonged ED congestion has since led to declarations that patients waiting in an ambulance outside the ED are the new .
But when ambulances waiting outside the ED become routine and prolonged, another new canary appears: patients at home waiting for an ambulance. They may represent the truest analogy for the canary in the coal mine because they are and are a clear indicator that the health-care system is congested at a dangerous level.
Pinch points
听
Delayed handovers of patients arriving by ambulance is a challenging health-care systems around the world. In the United Kingdom, the National Health Service has made eliminating handover delays one of its three priorty reforms for pre-hospital urgent care in its 10-year .
In , where health care is provided by provinces, have all experienced challenges handing over patients in a timely manner.
Australia has seen long lineups of ambulances queueing at hospitals, and has committed to hiring thousands of paramedics in an effort to combat in patient handover times.
Beyond ambulance handovers, delays and congestion also occur at other areas: the ED, wards and long-term care are some of the pinch points common in health-care systems around the world.
As an industrial engineer researching and working in health-care patient flow, this raises the question: where鈥檚 the next pinch point?
Code zero
听
We know hospital congestion is routinely caused by , which occurs when patients are blocked from flowing through the system by a lack of downstream capacity. This is often rooted in an inability to discharge patients from the hospital, which is often due to lack of space in long-term care.
Naturally, this stalls the flow of patients, causing them to wait in ward beds to be discharged from the hospital, in ED hallways waiting for ward beds, in ambulances waiting for ED beds, and eventually at home waiting for an ambulance.
This last group represents a new pinch point. Although ambulances not meeting targeted response times is not new, it is a relatively new phenomenon that there are no ambulances available to respond to calls in a timely manner 鈥� a situation known as 鈥渃ode zero.鈥�
This new pinch point however, is substantially different from the others. The patients affected have not yet been seen by health-care providers, are not within meters of health-care services, and their urgencies are not known. These patients are at home, in unknown duress, waiting.