Archives for June 1, 2006

Glog Potpourri

Glogging while the cat’s away…


This post will be more like an emergency medicine (EM) potpourri sort of along the lines of “why are
fire engines red?
” You know random associations…

First, I’ve got to get use to the Movable Type interface again—I haven’t used a WYSIWYG editor since my blogging infancy, circa 4.04. I have the same version over at symtym, but it is just for looking at the “nuts and bolts.” So turn off the WYSIWYG editor and use my much preferred AR markup in XHTML.

Second, I try to collect EM relevant abbreviations/phrases/terms—we have a vast wealth of colloquialisms with bad pronunciation, grammar and spelling mixed in. Humor is always a good place to start this “guesting” relationship. Old favorites and a few new ones in no particular order, with commentary (of course):

  1. ground level fall: no one can fall from the ground to the ground
  2. mechanical fall: well of course it is mechanical, the only alternative is virtual
  3. GCS 16: one that calculates his/her own score
  4. 5–point restraints: leathers and a foley
  5. male bed: has a fifth wheel
  6. my child has whelps: are they house broken?
  7. I’m passing clogs: I like Bastad Monet in a 43
  8. penis: OK (actual triage complaint)
  9. vag spots: thousands of exams, but never seen a spotted one…
  10. WAD: weak and dizzy; see WAD panel
  11. WAD II: weak and dizzy and needs a CT
  12. DFO: done fall out, see #1
  13. AEIOU: acute ethnic illness otherwise unknown
  14. VM: vowel movement
  15. DBI: “dirt ball index,” calculated from the BAL × BSA (in tattoos) ÷ by the number of remaining teeth

Enough of that PC stuff…

Third, Press Ganey revving the engine while in park.

‘Patient’ says it all | USAT | 5.31.06

The average length of stay in U.S. emergency rooms is 3.7 hours, or 222 minutes. The state-by-state look at emergency department waiting times was conducted by Press Ganey Associates, which measures patient satisfaction for 35% of the nation’s hospitals.

The report on emergency-room times is based on about 1.5 million patient questionnaires filled out in 2005. And it shows wide state-to-state variations in the time between entering the hospital’s emergency department and being admitted or sent home.

Iowa (138.3 minutes) and Nebraska (146.1 minutes) had the shortest emergency-room stays, while Maryland (246.9 minutes), and Arizona (297.3 minutes) had the longest.

Press Ganey measures the perception of performance (subjective), which is the surrogate for actual performance (objective, if all biases can be truly identified and controlled) and even farther removed from production. If we desire the countries EDs to function like public safety (which is often the expectation)—then they must have a production model akin to public safety. There are worlds of differences between an average response and a percentile response. Take a typical marking ploy for hospitals, stating an average door-to-doctor time in the ER that averages 30 minutes, 50% will see the doctor in greater than 30 minutes (normal distribution). Contrast that with a paramedic ambulance provider that has a contractual requirement to provide an ambulance to the scene within 8 minutes 90% of the time (normal curve skewed markedly to the left). Such a degree of production (moving the whole curve to the left on the time axis) requires tremendous additional cost and infrastructure. Skewing the production to the left (moving the “hump”) will require even more cost and infrastructure. Anyone involved in a high performance EMS systems knows that all components must be at peaking staffing—i.e., to wax biochemical, we’re dealing with zero-order reactions, where production is constant and continuous. This can be achieved in EMS with 90% reliability, but healthcare and the payers have no such commitment or public mandate.

Press Ganey gets to rev the engine—and gets paid very well for doing it. It has very little to do with quality or the offering of credible solutions, but everything to do with the promotion of competition amongst healthcare entities.

Well not to be accused of maundering, that’s enough meandering.