We know hospital congestion is routinely caused by access block, which occurs when patients are blocked from flowing through the system by a lack of downstream capacity. In Canada, where health care is provided by provinces, British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Québec, New Brunswick and Nova Scotia have all experienced challenges handing over patients in a timely manner.Īustralia has likewise seen long lineups of ambulances queueing at hospitals, and has committed to hiring thousands of paramedics in an effort to combat year-on-year increases in patient handover times.īeyond ambulance handovers, delays and congestion also occur at other areas: the ED, wards and long-term care are some of the pinch points common in health-care systems around the world.Īs an industrial engineer researching and working in health-care patient flow, this raises the question: where’s the next pinch point? Code zero In the United Kingdom, the National Health Service has made eliminating handover delays one of its three priorty reforms for pre-hospital urgent care in its 10-year Long Term Plan. Pinch pointsĭelayed handovers of patients arriving by ambulance is a decades-old problem challenging health-care systems around the world.
They may represent the truest analogy for the canary in the coal mine because they are literally dying and are a clear indicator that the health-care system is congested at a dangerous level.
Routine and prolonged ED congestion has since led to declarations that patients waiting in an ambulance outside the ED are the new canaries in the coal mine.īut when ambulances waiting outside the ED become routine and prolonged, another new canary appears: patients at home waiting for an ambulance. Peter Vanberkel is a professor in the Department of Industrial Engineering at Dalhousie University.Ī hospital’s emergency department (ED) has long been considered the canary in the coal mine for the health-care system: when it’s congested, the whole hospital is congested.
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