by Hari Balasubramanian
In my first piece for 3QD, I discussed some aspects of the science of queueing. In this essay, I'd like to ground that discussion in the context of delays that patients routinely experience in American hospitals. In 2010, there were around 130 million visits to the emergency departments (EDs) of hospitals around the country. Nearly 23% of these patients waited an hour or more to see a care provider [link]. Many urban hospitals and individual patients do much worse.
The documentary The Waiting Room foregrounds the human stories that underlie these statistical estimates, and lets patients, their families, nurses, doctors and social workers speak for themselves. The film is shot during a 24-hour period at the emergency department of a safety-net hospital: Highland Hospital in Oakland, California. 241 patients come to seek care during this one day. Most of the time the camera is in the waiting room, where patients reconcile themselves to a long wait; this applies even to a man with a gunshot wound, whose body is turning numb – hard to believe but true.
The problem faced by Highland Hospital is by no means unique. I've heard it many times from hospital administrators and clinicians. My own research on reducing delays in healthcare led me to work with a large hospital which sees nearly 300 patients daily — more than Highland — in its emergency department. I was quite familiar with what I saw in the documentary: the look and feel of the waiting area; the small rooms inside the main care section with beds and equipment, curtained off to provide patients and their families some privacy; the additional hallway beds with no privacy, but nevertheless necessary due to the sheer volume of patients in acute condition; the constant buzz of pagers, movement of personnel, calls for lab analyses and diagnostic scans; the flicker of computer screens with way too much information; the difficulties in deciding whether the patient should be admitted to an inpatient unit or discharged; and if discharged where the patient should go, for some psychiatric or substance abuse patients have no home to return to.