A few months ago I rushed myself to the JHMI ED around 2 AM due to prolonged, intense, unexplained pain. I had heard horror stories of 10 hour wait times from friends and family, but always assumed, and hoped, these stories were exaggerated. Unfortunately, they are not. During my time in the ED I realized just how overwhelmed ED staff was with both patients who were in dire need of immediate emergency care and patients who were not experiencing medical emergencies, but simply didn’t know where else to go. In an attempt to distract myself from my pain, I started a conversation with the other patients in the waiting room. The lady next to me had been waiting for 11 hours and there was no end in sight, the man next to her came in for shortness of breath and, despite his pre-existing heart condition, had not been seen after 10 hours. As someone who conceals pain well, and because there were so many other sick patients who had been waiting much longer that I had been, I knew there was no hope that I would be seen by the time I would have to go to work in the morning. Since nobody had come around to monitor my condition or update me on my expected wait time, I went back up to the front desk and asked if there was any hope that I would be seen in the next 6-8 hours. The woman at the front desk replied frankly, “no, there is no chance.” As I turned back towards my seat in the waiting room, I looked back at the people I had been talking with. I saw them look at the clock, and then down at their feet and shake their heads. Another hour gone without news. Another hour passed as they continued to suffer. And another hour spent wondering when, or if, they would ever get the care they needed. I thought to myself, there must be a better way. There must be some way that we can improve the system to ensure that each and every patient that feels the need to come to the ED is given appropriate medical care in a way that prioritizes their overall safety and well-being. Maybe, if we could find a way to re-direct the patients who are suffering from non-emergency conditions to nearby, alternative medical facilities, such as alternative care facilities, ED staff would be more efficient and effective at identifying and treating critical-need patients. Today, in EDs around the country, patients experience enormous amounts of frustration while they wait to be seen by a doctor. They are not guaranteed any information about their status, and may go hours without any interaction with medical staff members while they wait to be seen. EDs are regularly overwhelmed by incoming patient volume, and staff members have no systems in place to help them alleviate some of the patient burden so that they can focus their services where they would be most important for maintaining patient safety and quality of care. As ridiculous as it may sound, 83 million patients check Yelp each month to find out ER wait times (H3 Group, healthleadersmedia.com, 2015). This simply shouldn’t happen. To address this increasing problem of long wait times and overwhelmed EDs, our team has developed an automated triage workflow focused on improving how EDs manage patients to ensure maximum possible efficiency in the ED while also improving standards for monitoring patient condition and overall quality of care.
Americans 3B / year in ER services, 13x rate paid by medicare for same service 4B vs. 898M it should cost, minorities are exploited and forced into ED (cnbc.com, 2017).
What it does
There are two ways to alleviate average ED wait time - get patients out of the waiting room faster, or put fewer patients into the waiting room. We address the latter problem by redirecting patients in ED waiting rooms to urgent care clinics that have shorter wait times. Our automated triage workflow identifies noncritical patients by compiling their symptoms and outputs an estimated wait-time. This wait time is compared to the wait time in several urgent care facilities in the area, and if there is a significant improvement, we will encourage patients to relocate.
How I built it
Used React, Mock.io API to create an automated triage workflow.
Challenges I ran into
We aimed for our product to integrate seamlessly into the current ED patient triage system, so that busy hospital EDs can easily start using the smartER system. Thus, we had to make sure we really understood how ED’s function in present day. Shortening ED waiting times has obvious value for patients, but how do we incentivize hospitals to implement this system? Urgent care centers already send high risk patients to EDs, but the reverse model had not been implemented because of the risk of patient decompensation at the lower-tier center.
Connecting Mock Patient Mock.io API data to our app and making it readable
Accomplishments that I'm proud of
It is a logical plan that could actually bring results As a team, creating a functioning site for our hack Being able to come up with a system that can potentially fill a gap in the current medical realm.
What I learned
Learned about IDN (Integrated Delivery System) What affects ED work efficiency
What's next for smartER
To integrate the system with the ED staff in order to: Link an estimated patient wait time with the doctor that will be available next to treat that patient.
Info & Sources
"60% of doctors state technology can improve the quality of life delivery to patients"
"Americans Overcharged 3 billion a year for emergency room services" -Johns Hopkins School of Medicine.
Emergency medicine charges came to 4 billion over 3 billion 102 million allowable amount of 898 million