I had never heard the term “throughput” before a meeting at our hospital two years ago. It was used to discuss how the emergency department (ED) could yield greater profits by faster patient turnover. Coordinating various duties (including intake, admitting, and cleaning staff; lab and radiology; nurses and doctors) patients could be shuttled into and out of the ED earning the hospital $2 million more per year.
This strategy was implemented in our ED, but failed to maintain efficiency: Intake floundered obtaining vital signs; admitting incorrectly spelled names and entered wrong insurance information; the cleaning staff was not always available; blood tests were drawn erroneously; nurses were bogged down with expanded computer work; and doctors spent less time with patients. It is still a work in progress.
Faster turnover meant relegation of less interpersonal patient time, a greater tendency for mistakes, and the sacrifice of the most important element of health care: quality.
Throughput is a tool used in business management and generally means “the maximum rate at which something can be processed in a given amount of time.” A good example is the drive-thru line at a fast food restaurant.
Having purged myself of adulterated artificial foods many years ago by reading labels, it is rare I find myself in a drive-thru line. Out of convenience though, it happens.
Our nonagenarian mother lives alone tending her garden and two cats. She is not able to do all household chores, so my brothers and I share specific duties assuring a semblance of cleanliness in her home.
One recent weekend, I prepared myself wearing old shoes and brown corduroy pants to clean, sweep, and dust. Since it was early, I decided to pick up breakfast at a nearby fast food restaurant, but the drive-thru line wrapped around the building. A line inside was also long, but my order was taken quickly, allowing 4 minutes and 35 seconds (yes there was a timer on my receipt!) to watch workers prepare meals.
It was like watching the Los Angeles Philharmonic. Everyone moved in harmony, workers in the back saw computerized orders with take-home containers lined up and filled, and magically I was on my way in less than 5 minutes! For those who have had their french fries forgotten, nothing was omitted from our two deluxe breakfasts.
For me though it was an uneasy adventure, but for my 94-year-old mother who doesn’t read labels, it obviously has had no effect on her longevity.
As a doctor, I ask questions that provide clues to a patient’s problem. Driving to her home, my antennae were up when I smelled the whiff of styrofoam container emanating with the hot food.
Mom agreed the pancakes were very good, and the scrambled eggs not bad. It’s hard to ruin an English muffin, but the next clue was when a blotch of imitation butter landed on the nooks and crannies of my pants permanently removing the brown!
I liked the sausage, but an ominous confirmation of my reticence against this fast-food adventure was shortly revealed. With too much food on her plate, my mother placed a small piece of sausage next to one of her begging cats. He sniffed it, and ran away. Yikes!
Now, throughput is being applied in many other areas of our hospital. Is it good for patients when they are rushed through a conveyor belt of services to maximize profit? Even with our breakfast being provided quickly and efficiently, hospitals applying drive-thru techniques like throughput will effect quality.
In health care, patients should be treated like human beings, not like fast food takeout.
Gene Uzawa Dorio is an internal medicine physician who blogs at SCV Physician Report.
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