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Thursday, July 5, 2012

Time Shifting Emergency Department Demand

Om Malek, posting on GigaOM, has an interesting article on a startup which time shifts power consumption of appliances attached to its smart grid system from peak hours to off-peak hours. Unused energy is sold back to a local grid operator, creating revenue, which is shared with the customer.

Managing Emergency Department volume is surprisingly similar to managing electricity demand. There are massive fluctuations in demand at different hours of the day. Both require massive amounts of infrastructure in order to manage peak demand. Both systems have a potential for life threatening consequences if peak demand is not met. Peak demand is affected by weather and day of the week (well documented in ED literature).

In addition to the obvious similarities listed above, what is most important is that total demand is determined by the sum of independent events, which are often convenience choices by consumers: "turn on dishwasher now or in an hour", "go to the ER now for my cough or wait until the morning."

The inherent complexity of managing ED patients makes managing ED volume even more challenging than managing electricity consumption. Whereas electricity use is either "on" or "off", and all the consumer needs is either more or less of one resource, each ED patient may require a multitude of different resources, some very scarce or hard or expensive to perform concurrently, such as ultrasound or CT scan.

And when dealing with complex systems, it is well documented that efficiency often declines dramatically once capacity reaches 70-80% of total maximum capacity.

Therefore, it becomes even *more* imperative for EDs to employ techniques to reduce demand during peak hours, just as power companies are learning to do the same with electricity demand. It is *not* sufficient to just "call in the on-call doctor", because ED patients require more than just a doctor; they require nurses, techs secretaries, beds, x-ray techs, etc. Unless you are calling in additional ancillary staff, your additional doctor is most likely not going to be very efficient. The concept is "don't spend money on increasing infrastructure to meet peak demand; rather, spend resources on smoothing out demand.".

Although we discharge ~80% of our patients, not all of those discharged should have their care delayed (e.g. acute fractures). However, every ED provider will attest to the vast number of patients whom we treat who could have been safely managed either several hours earlier or later.

This leads us to the obvious point: in this era of growing disruptive innovations in healthcare, it is time to develop ways to reduce peak demand on emergency departments. Companies which can assist patients in seeking non-ED based solutions for their medical care, or can safely redirect non-emergent ED patients to return during non-peak hours, will have great demand for their services.
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