Lucy and Ethel worked on an assembly line and were responsible for wrapping all of the chocolates that came down the conveyor belt. At first, things were easy, but as more and more chocolates came faster and faster, eventually Lucy and Ethel became overwhelmed and the whole process fell apart. The result was a classic comedic moment.
In emergency medicine, things aren’t so funny. The chocolates are our patients. At times, patient flow is manageable. At other times, patient volume becomes so high that we have difficulty providing good medical care. When things get too busy, usually there is a relief valve called “bypass”. Hospitals have to meet certain criteria to go on bypass, but once a hospital declares bypass, no ambulances may bring additional patients, giving the emergency department time to stabilize patients already there and to open up beds to accept new patients.
Massachusetts is pushing the envelope in medical care and, in January, created a statewide policy that hospitals could not go on bypass. According to this article from the Boston Globe, the law seems to be having its intended effect … for now.
By refusing to allow hospitals to go on bypass, the state forces busy hospitals to keep accepting ambulance runs. It is then up to the hospitals to find a way to make room for the additional patients. Kind of like pushing a kid into the deep end of a swimming pool and telling him that he better figure out a way to stay afloat.
Hospitals are now opening up additional units and are hiring additional staff to get floor patients discharged earlier in the day. However, wait times haven’t changed much – still an average of about 5.5 hours for admitted patients and 2.5 hours for discharged patients since the rule went into effect.
So is forcing hospitals to work at above capacity a good idea or not? Is necessity the mother of invention? Or will we start to see a bunch of hospitals floating to the surface at the deep end of the swimming pool?