Emergency Clairvoyance

By Jim McVeagh 23/11/2009


One of the hallmarks of emergency departments is the unpredictable nature of the throughput. Accidents, in particular, are relatively unforeseeable although certain types do tend to cluster. Cuts with knives seem to congregate around mealtimes (for obvious reasons) and minor traffic-related injuries have an obviously predictable flurry at rush hour. I recall analysing the data from a year of presentations to Invercargill’s Emergency department and getting some reasonable idea of the expected flow throughout the day and the week. It therefore does not surprise me that someone has devised software to make these predictions more efficiently and with more complete data.  I am also pretty sure I can guess where it will be useful and where it will be useless.

The biggest hospitals will undoubtably find it is very good at predicting inpatient loads at least a day or two in advance, allowing hospitals to open beds at a more leisurely rate than the normal “mad panic” mode that accompanies bed block. This alone will make the software worthwhile as it will greatly alleviate the bed block experienced in EDs as well as reduce the stress on overcrowded wards. The software may also be helpful at predicting theatre usage, enable elective surgery to avoid being bumped off by emergencies. It is also possible the software may be helpful in planning rosters, although this is less certain. Doctors and Nurses like reasonably set hours (don’t we all!). Staggered shifts, split shifts and short shifts simply do not appeal to anyone, let alone tired doctors and nurses.

When it come to accurately predicting ED throughput, however, I suspect that the software will not be particularly helpful. While you may predictably get four lacerations between 5pm and 7pm on a Thursday, it will not be possible to tell the extent of those laceration, nor the amount of time spent by doctors and nurses on them, except in the more general terms. I also suspect that the software will become increasingly useless , the smaller the hospital. The throughput of small EDs is vastly less predictable than the throughput of the larger ones.

It would seem that the software in question, CapPlan, will be a worthwhile addition to resource planning efforts. However, I do not imagine it will be particular helpful at rural level unless it has a built in clairvoyant capability.

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