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A urologist colleague of mine recently described the impact of long waiting times on his patient, named Linda*. He had just completed a multi-hour surgical removal of an infected staghorn calculus from Linda’s kidney. An operation, he pointed out, that he shouldn’t have had to do.
Linda had been seen in an emergency department several weeks earlier and treated for renal colic with an outpatient referral to urology. But due to long wait times and relatively low severity of symptoms, she hadn’t received an appointment.
Unfortunately while waiting, her symptoms progressed to the point that she needed urgent surgery. An outpatient procedure that would have taken about an hour had now taken several hours, with a worse outcome for the patient. He described it as a “death spiral of waiting”; an issue that could have been handled quickly was delayed until it become complicated, leading to longer wait times and more complications for other patients.
Linda’s experience with long wait times in Canada are reflected in the research. We not only feel like we’re in a “death spiral of waiting”, we are. Compared to 10 other OECD countries, Canadians have the lowest access to same-day or next-day appointments.
The Institute of Medicine recently reported that the US health system wasted more than $750 billion in 2009. They describe waste due to inefficiency, complexity and resistance to change.
As an example, they describe how it took 13 years for most experts to recommend the use of thrombolytics to treat heart attacks after the therapy had already proven to be effective.
They characterize a continuously leaning healthcare system as having:
- Continual improvement using tools such as Lean
- Incentives to achieve positive outcomes
- Partnership between clinicians and patients
However, they also warn that improvement will be challenging because of the high workload and job stress that many clinicians experience: “Given such real-world impediments, initiatives that focus merely on incremental improvements and add to a clinician’s daily workload are unlikely to succeed.” Continue reading
Parkinson’s disease is a neurodegenerative disorder that often severely limits the functioning of patients in many domains of their lives. An analysis of a multi-disciplinary network for treatment of Parkinson’s patients has shown that costs can be reduced and adherence to evidence-based guidelines increased.
ParkinsonNet is a multi-disciplinary approach that has been active in the Netherlands since 2005, consisting of community-based allied health professionals that, with neurologists, form a referral network. The goal was to develop expertise and improve communication between professionals treating patients with Parkinson’s.
ParkinsonNet has expanded to more than 50 regional networks in the Netherlands. Participating professionals include neurologists, nurses, physiotherapists, speech therapists, occupational therapists, dieticians, social workers and mental health workers including psychiatrists. Continue reading
23 1/2 hours is an engaging video reviewing the evidence for positive health benefits of at least 30 minutes of daily exercise. Dr. Michael Evans hosts an excellent website helping to interpret complex medical issues through evidence-based analysis. His website can be found at http://www.myfavouritemedicine.com/
On the topic of US healthcare, I recently came across this video about the recent boom in hospital construction.
I have spent some time on projects in America recently. It seemed as if every city, no matter how depressed economically, has just completed a brand new, state of the art concrete and glass temple to healthcare. In one newly renovated hospital, standing by the fountain in the luxurious but almost empty lobby, the only thing that seemed to be missing were the patients.