27 Jun 2012

Essay Topic: Waiting for the [Medical] World to Change

Specific Purpose: To discuss the significance of waiting times in the Emergency Department (ED) and the best management options for the problem.

Central Idea: The worsening problem of patient waiting time in the ED is a multilevel problem and as such requires a multilevel solution that includes elements of Lewin’s model of change


I.Studies have shown that just staying longer than 8 hours in the Emergency Department has been shown to increase your chances of a heart attack or myocardial infarction. This of course only applies to patients that present in the ED with non-ST-elevation myocardial infarction. (Horwitz, Green, Bradley, 2010).

II. Reveal Topic:However this nonetheless highlights the increasing problem of waiting time in the ED, a problem that requires urgent attention and solution

III. Credibility Statement:As a student involved in the healthcare industry, and as a decent human being, I know how frustrating it is to lose a patient in the ED just because of long waiting times, especially since these are patients who in the first were rushed there for immediate care. I would like to share therefore the insights I have gleaned in searching for solutions to this problem.

IV. Relevancy Statement:Prolonged waiting times can greatly increase the likelihood of adverse outcomes and complications and the number of people who leave the ED before being attended to, and can decreases patient satisfaction. Addressing the problem can therefore improve the quality of care that these patients receive.

V. Preview of Body: To help you understand how to best tackle the problem of prolonged waiting times, I would like to discuss first the nature and causes of the problem, and then offer solutions that have been proven effective in research studies. I would also talk about the importance of evaluating the results of interventions through Lewin’s model of change and SWOT analysis


I.The Magnitude of the Problem

A. Growing rates of patient consults at the Emergency Department (Forero, McCarthy, Hillman, K. 2011)

B. The decreasing number of hospitals that meet the recommended wait times for Emergency patients (Horwitz, L. I., Green, Bradley, E. H. 2009)

II. The underlying causes of the Problem (Forero et al. 2011)

A. Access block and overcrowding

B. Three levels of the problem

1. patient-centered factors

2. Hospital factors

3. Clinical factors

III. Fine-tuning the Emergency Department

  1. Lewin’s model of change
  2. The three-leveled approach (Forero et al. 2011)
  3. Triage-related solutions (Oredsson, Jonsson, Rognes, Lind, Göransson, Ehrenberg, Asplund, Castrén, Farrohknia 2011)
  4. Applying Lean Manufacturing Principles in the ED (Ng, Vail, Thomas, Schmidt 2010)
  5. The UK National Health Service example and the importance of reevaluation (Pimlott 2010)


I. Summary Statement: Most hospitals face a challenge to attend to the rising number of patients being brought to the ED and still maintain acceptable waiting times. After going through some of the underlying causes of the problem and possible interventions, it is clear that there is no clear cut solution to the problem. Emergency departments therefore have to adopt appropriate measures while at the same time monitoring their programs to fine tune and optimize patient waiting times.

II. Memorable Closing Statement: At the end of the day, the interventions I just presented are not simply to address long waiting time, but most importantly to offer patients a chance of a long lifespan.


Forero, R., McCarthy, S., Hillman, K. (2011). Access block and emergency department overcrowding.Critical Care, 15(2), 216.

Forster, A.J., Stiell, I., Wells, G., Lee, A.J. and Walraven, C.V. (2008). The effect of hospital occupancy on emergency department length of stay and patient disposition. Academic Emergency Medicine, 10(2), pages 127–133.

Horwitz, L.I.., Green, J., Bradley, E.H. (2010). US emergency department performance on wait time and length of visit.Annals of Emergency Medicine, 55(2), 133-141.

Ng, D., Vail, G., Thomas, S., Schmidt, N. (2010). Applying the Lean principles of the Toyota Production System to reduce wait times in the emergency department.Canadian Journal of Emergency Medicine, 12(1), 50-57.

Oredsson, S., Jonsson, H., Rognes, J., Lind, L., Göransson, K. E., Ehrenberg, A., Asplund, K., Castrén, M., Farrohknia, N. (2011). A systematic review of triage-related interventions to improve patient flow in emergency departments.Scandinavian Journal of Trauma, Resuscitation, and Emergency Medicine, 19(43).

Pimlott, N. (2010). Waiting. Canadian Family Physician, 56(7), 624.

Tidd, J., Bessant, J. and Pavitt, K., 2005. Managing innovation tools: SWOT Analysis. [Pdf] Available at: <http://www.managing-innovation.com/tools/SWOT%20Analysis.pdf>. [Accessed 20th May, 2012]

Filed under: Essay topics — Tags: , — admin @ 5:43 am
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