wasting time…

I’ve had some time for a bit of deeper reflection recently as I’ve been awake a lot longer, and not really able to *do* anything (birth of second child) other than walk up and down my living room holding something that’s noisy.

I’ve been wondering why whenever a patient complains about ‘their wait’ they always over-estimate, sometimes massively.

Every single person who has worked in an emergency department has had an exchange between an exasperated family member or patient about the wait time.  We’ve also probably used our fancy computer tracking system as a rebuke – ‘ well you’ve only been here for 2 hours 12 minutes ‘ we’ll say.  Now anecdotally I’ve noticed people talking about waiting ‘all day’, or ‘6 hours’ when in reality they’ve not even got to 2 or 3 hours of ED wait time.  This is a relatively common occurrence, now we could assume that all patients have no concept of time, or they can’t tell time, or that they are maliciously somehow inflating their wait time to make us care a bit more about them.  Now I’m sure at some point one or all of these reasons are true, but I don’t think they are true in the majority of cases.

This is because generally speaking people aren’t temporally illiterate, and nearly everyone has a watch of some kind.

Now we start our clock when someone has booked the patient in.

When does the patient start their clock?

Probably when they call 111, 999, or go to their GP.  If you start thinking about things from that perspective you can see where frustration arises.

GP does home visit at 10am, calls ambulance for patient, patient is waiting 6 hours for ambulance, gets taken to hospital, 10 ambulances arrive at once, 1 hour wait to be booked in, another 1 hour wait to emerge from triage.  Wheres the day gone? Patient has to stay as no transport home.  Our wait 3 hours 39 minutes.  Patient wait: 8 hours 39 minutes, plus a pointless hospital admission.

Person cuts finger at 14:00, ANP at GP service at 16:00 assesses, might have nerve damage, can’t book into local plastics/hands clinic remotely so goes to A+E.  Gets there at 17:30.  Seen at 21:00.  Discharged home at 21:15 with follow up clinic for the next day.  ED wait 3 hours.  Patient wait 5 hours 15 minutes, and they’ve still not seen the appropriate specialist!

Father calls 111 at 11:00 about 6 month old’s breathing who has a cold, waits for 1 hour for nurse call back, nurse calls back and upgrades to GP appointment at OOH centre.  GP appointment at 15:30 suggests ED attendance for ‘further tests’.  Taken to ED at 16:00 Seen in ED quickly, and discharged at 3 hours 30 as viral URTI.  Patient wait: 10 hours 30 minutes.

Now those three examples aren’t particularly unusual, or poor examples of care, but example 1 might have gone to an ambulatory frailty unit, example 2 could have been referred to hand clinic directly by the GP, and example 3 could have been seen and observed for a few hours in a children’s assessment unit.

Now imagine if we could measure this patient centred ‘time to care’.  I’m not saying this metric should be a target, and certainly not that it should be 4 hours.  But.  Just imagine if the DoH, trust, and CCG we were able to actually  measure what was moving through our healthcare system with this level of accuracy.  I’m amazed that they don’t or can’t.

In fact the first time I’m aware of someone trying to combine all the disparate A+E, 111, and Ambulance data is work currently being undertaken in Yorkshire by the utterly brilliant Prof Sue Mason.  Expect lots of interesting research to start trickling out soon….

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