As You Were Saying … MGH needs checkup for possible ER bottlenecks — Steven J. Spear

MIT Sloan Senior Lecturer Steven Spear

MIT Sloan Senior Lecturer Steven Spear

From The Boston Herald

Five years after a $500 million expansion, Massachusetts General Hospital’s emergency department is again overburdened, in the words of hospital President Peter Slavin with “delays, dissatisfaction, and sometimes even concerns about quality and safety.”

Before the public, payers, policymakers and donors get on the hook — again — for more staff and more extraordinarily expensive capital expenditures, let’s ask these questions first.

• What’s the mix and volume of patients presenting at the emergency department?

• What portion of discharges occur on time, and of the rest, how long are they delayed?

• From when a patient first presents in the ED, what’s the lag until that patient is examined and treatment begins, the time from “door to doc?”

As to the first question, there are certainly patients with conditions that truly are life- or limb-threatening and arise unexpectedly. Think stroke, heart attack, or aneurysm.

However, we want to make sure there aren’t overlooked opportunities to shift care to more appropriate, less-costly settings in the community — such as with chronically ill patients who, but for a lapse in care continuity, wouldn’t have had an episode. For them, you need to improve the outpatient care in the huge MGH and Partners network. And then there are the patients who didn’t know to try an urgent care or primary care facility first. For them, the solution is not ED spending either, but education.

Read the full post at The Boston Herald.

Steven Spear is a Senior Lecturer at the MIT Sloan School of Management and at the Engineering Systems Division at MIT.

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