Vijay

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Cloud Gate,Chicago Myself and my 8th dimensional alter ego from Hyperspace!!! Yes true see how?

Hello! I am Vijay, currently doing my MS in the ISYE Health Systems program here at Tech and hopefully if everything goes well this will be final semester. I have taken this course already last year and i think it is one of the fun courses i have ever been in.

Reflections

class 1.0 I had a chance to read a book called Complications by Dr.Atul Gawande and I have already become a fan of his writings. Dr.Gawande sees all medical procedures as a process and he talks about how some hospitals are able to provide much better quality than the others even though there aren't any major differences in their procedures. He mainly highlights how things could go wrong in a surgical settings i.e how missing one simple step could snowball into a big avalanche of errors. If the errors are so evident in a well planned surgical setting, then what about the ER where things happen suddenly? How do we tackle the errors and mistakes that are done by the providers?? (assuming that the patient finally makes it to the doctor after "n" hours long wait)

Check out the video by Dr.Gawande on errors and complications - he also talks about ER.

This is another link about ER on WSJ

New Confessions of ER Doctor!!

class 1.1 Clearly "wait time" is one of the core issue here. I went back home that night and read an article which advices the patients what not to do in case the case of an emergency. The list goes by - 1. Don't forget to call your doctor on the way to the ER

2. Don't use an ambulance unless you really need it

3. Don't be quiet. Don't get angry, and don't lie

5. Don't forget the phone

This list would have been useful when my roommate broke his leg last year and when he did not have an insurance and we did not know what to do next. For the complete article please follow the link in CNN

class 2.0 - Site visit There were two main design issues which struck me when i navigated through the ER system

Firstly, the wait time in the triage process. It takes around "20-30 minutes" for a nurse to attend a patient in the ER and to come up with an acuity level between 1 to 5. The patients are attended in a sequence which is based these levels. Higher the level more quickly(may vary from 0 to 6 hours) a physician will attend the patient. Why not automate this process and let a computer decide the levels based on a quick questionnaire which the patients could fillout from their home?? Now, this raises the question of correct judgment by the patients themselves and by their family. But by looking at Emory, most of the patients are not that sick and they usually belong the bottom of the acuity curve. By doing this, we are letting the patients before hand how long they should wait in the ER. By knowing the wait times, they may also decide what course of action they could take and decide if they want to goto a different hospital or not.

The second question is the time taken for transferring a patient within the ER. I was surprised to see that each patient had to be transferred aroung 3 - 6 times for each of their checkup. There was one lady around late 50's with an asthma attack who caught my attention. She was transferred from the waiting room using a wheelchair to the nursing station(1). There she was transferred to another chair(2) for the checkup(at this point she was given the nebulizer to stabilize her). After a few hours of wait she was again taken in a different wheelchair(3) to the attending nurse who made sure that she was ok and if her vitals were fine. She was then taken back to the same waiting area (4), taken in a wheelchair to meet the physician (5), transferred to the physician bedside(6) and then treated. So the patient had to go through 6 transfers in the ER, which was time consuming, causing distress for the patient worst of all still not met with the physician and have got a preliminary diagnosis. I think we should think of ways of designing a universal patient transporter which could be used in all settings and avoid unnecessary hassle.