Issue link: https://industrialengineer.epubxp.com/i/826827
24 ISE Magazine | www.iise.org/ISEmagazine A health systems Live in Ward D, the Rolling Stones By William "Ike" Eisenhauer An inpatient hospital visit tends to feel like you are attending a live Rolling Stones concert – without the music. Still, you experience many of the greatest hits: "You Can't Always Get What You Want," "Time Is on My Side," "I Don't Know Why," "Too Much Blood," "One More Shot" and "Under My Thumb." To pen such lyrics, Mick Jagger and Keith Richards must have spent some time in the modern healthcare system at one point. But the encore performance is saved for the key component of every hospital visit: the anticipated and subsequent frustration of over- promised and under-delivered dis- charge timelines. The expectancy-disconfirmation paradigm is alive and well in health- care. It is most clearly evident in the massive uncertainty of the process that likely has the most dramatic effect on how patients perceive the quality of their healthcare. I personally have seen the rollercoaster ride patients are placed on when part of the health- care team sets the patient up, like Lucy with Charlie Brown's football, with the promise of going home to loved ones. Patients think they can begin getting back to the life they had before. This is followed two hours later when, instead of being discharged, they remain hospitalized. Their spirits, much like Charlie Brown after Lucy yanks the football away at the last minute, lie sprawled across the ground. Now, I understand that a lot of things have to take place, and the patient care team really is trying to make sure that the person is going home safely, not too soon, with everything necessary in place. But are we really so bad at pre- dicting this timeline that the only con- sistency in this process is that patients definitely will not be leaving when we said they would? With the vast amounts of data and patient record management that we have, I find it absolutely incredi- ble that we cannot get this process nailed down to within 30 minutes or so of a decent prediction. We have to do better. The personal certainty that comes with delivering on the promise of when a patient goes home is that it touches ev- eryone in the process: providers, family, healthcare team and patient. When it fails to deliver, it places a perturbation through the system that can send it into complete chaos. And it does not need to happen. If everyone is on board and makes it a focal point of quality delivery, a valid discharge time prediction should be able to be made – barring extremely unex- pected developments. However, in practice this panacea given to patients to lift their spirits often turns to bitter vinegar when the expec- tation is not confirmed. There has been progress on predicting the day that discharge will take place. The work done on discharge planning has mostly focused on clinical concepts. While that is good for planning pur- poses at the hospital and ward level, it really does no one any good if the fam- ily expects a morning discharge and at 9 p.m. hunger sets in with weary loved ones who have been told 10 times that it will just be "another hour or so." It is time for engineers to help develop more granular predictive models. We need to do studies to help reduce the causes of variance from predicted discharge times, removing process bottlenecks that lead to delay. The data is there. The focus, however, is not. So instead of patients "doin' this and signin' that," we engineers can start saying "'cause I try and I try and I try and I try." Eventually, success in predict- ing discharge times will let us all leave the singing of "Can't Get No Satisfac- tion" to the Rolling Stones. William "Ike" Eise hauer is a gi eeri g professor at Portla d State U iversity a d atio al director of the Vetera s E gi eeri g Resource Ce ters for the Vetera s Health Admi istratio . His i terests are i tegrati g e gi eeri g a d healthcare professio als to i crease the value of health systems a d ad- va ci g e gi eeri g scie ce to address health- care delivery challe ges. He ca e reached at wde@pdx.edu. Instead of being discharged, they remain hospitalized. Their spirits … lie sprawled across the ground.