Tuesday, October 31, 2006


Hospitals can drastically reduce waiting times in emergency departments by treating the less urgent cases first. A controversial trial at Sir Charles Gairdner Hospital in Perth resulted in a 20 per cent drop in waiting times for all emergency department patients and an 18 per cent reduction in the average length of stay. Triage nurses usually prioritise patients by the seriousness of their injury or illness, with the most critically ill treated first.

In the trial, nurses triaged patients as soon as they arrived, separating those who were likely to be admitted from those with minor ailments who could be discharged after a quick consultation. The less critical patients were moved to a "fast-track" area, where they were immediately treated by a medical team specifically employed to treat only the minor cases. Waiting times dropped 20per cent over the 12-week trial compared to the same period the previous year, despite a 7 per cent increase in the number of people showing up in emergency.

George Jelinek, professor of emergency medicine at the hospital, said the system required staff to rethink the way emergency departments were run. "All of our training has focused on prioritising patients in the order of how urgent their condition is, and this system seemed to be against the spirit of this," he said. "We had to overcome the philosophical objections we had to treating less urgent patients out of order."

Professor Jelinek said the hospital was initially worried about the impact on sicker patients. "However, it seemed to unclog the rest of the department so they worked more efficiently as well," he said. He said the fast-track system, which has become standard procedure at the hospital, should be implemented elsewhere.



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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