Med-Direct

Problem Space

Problem Statement  

How can we increase patient satisfaction, reduce overcrowding and long wait times at William Osler Health System Emergency departments.

Problem Background  

Emergency departments (EDs) have long struggled with managing patient flow due to high demand, especially as patients seek care in EDs when they cannot access timely services from primary care providers or walk-in clinics. Staffing shortages have further worsened these challenges. Notably, wait times for physician assessments in EDs have increased significantly since the COVID-19 pandemic. In 2022/23, patients waited an average of 118 minutes after triage to see a physician, a 30-minute increase from 2013/14. The longest wait times, for patients in the 90th percentile, reached 257 minutes, up from 183 minutes a decade earlier.

This rise in wait times has led to higher rates of patients leaving EDs without being seen. In 2022/23, 5.3% of patients left without receiving care, with some hospitals experiencing rates as high as 14%. One hospital with an average wait time of 175 minutes saw particularly high abandonment rates. The increase in wait times and patient dissatisfaction has become a persistent issue, highlighting the ongoing strain on the ED system. This problem has worsened over time and remains a significant barrier to improving care delivery and patient satisfaction.

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Research Insights

User Pain Points

Emergency Department Patients

• Long Wait Times lead to frustration and discomfort.
• Some patients leave without being seen, with some hospitals seeing even higher rates, leading to unaddressed health concerns.

Emergency Department Staff (Physicians, Nurses, and Support Staff)

• Staffing Shortages: Increased patient demand combined with staffing shortages results in higher workloads, stress.
• Difficulty Managing Overcrowding: Overcrowded EDs create a chaotic work environment, making it difficult for staff to provide timely and effective care.

Hospital Administrator

• Operational Efficiency: Increased wait times and high left-without-being-seen rates put pressure on administrators to improve patient flow and reduce overcrowding.
• Financial and Resource Strain: Overcrowding and staffing challenges lead to inefficiencies, placing financial strain on hospitals and stretching resources thin.

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Supporting Data

Based on the publication from the office of the auditor general Ontario, 

• In 2022/23, patients waited an average of 118 minutes after triage to see a physician, up from 88 minutes in 2013/14.
• In 2022/23, the average patients left-without-being-seen rate was 5.3%, with some hospitals experiencing rates as high as 14%.
• Staffing shortages have increased pressure on healthcare professionals, contributing to difficulty in managing patient flow.
• Increased patient volumes and longer wait times lead to heightened workloads and stress for staff.
• Operational Strain: The rising wait times and 5.3% left-without-being-seen rate put pressure on administrators to address patient flow issues.

Patient interviewees during the primary research stage also provided supporting data indicating their dissatisfaction and frustrations with long wait times. Some patients even went home and returned at a later time.

Feedback

In order to validate the significance of this problem, we conducted patient interviews and secondary research. From the primary interviews conducted 67% of interviewees were unhappy with the long wait times experienced in the ER. They all acknowledged long wait time to be a symptom of a bigger issue in the ER. 

Both Primary research and secondary research from the office of the auditor general of Ontario agreed that shortage of nurses and physicians to be one of the major causes of long wait times. Other causes mentioned by the office of the auditor general of Ontario include lack of beds and delays in lab and imaging results.

Landing on the Solution

From evaluating the root cause of long wait times, we came up with 4 possible solutions. Which included: providing dynamic wait times to patients in attempt to divert patient traffic, making use of AI enhanced triage system to reduce work load of tirage nurse, making use of an AI transcribing feature to help physician with documentation and making use of AI powered medical directives.

Based on criteria such as safety, impact and feasibility, we decided to work on the AI powered medical directives 

Med-Direct aims to reduce wait time in ER by increasing consistency, safety and reducing delays in receiving lab and imaging results. Which could save between 30 min to 2 hours of wait time. (Typical estimated average times to receive results of medical imaging, and time between nurse assessment and physician assessment).

User Flows/Mockups

User Flow

https://app.mural.co/t/albert3150/m/albert3150/1740023955838/dad811d7dd01f5a19f35221eb8bfff7d5ded1e06?sender=u3aef876b7fca2c8fd42b2096

Mockup

Here is a link to Figma design page: https://www.figma.com/design/F74lEaAq61u9PsFMgpDZyB/Med-Direct?node-id=0-1&p=f&t=JG5xAVGHURtBhDtx-0

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Future Steps

From secondary research, I realised there is still room for improvement with ER triage systems which could reduce wait times even further. The potential of clinical decision support system in the ER is huge. Although I chose to explore medical directives, AI powered Triaging could also provide significant improvement and could be incorporated in the hospital information system to make a bigger impact.  I plan to explore this area in future projects.

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Images 

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