The Irish Medical Times - Is radical thinking the solution to Emergency Department overcrowding?


And what possible solutions could overcome these threats? The government felt they had analyzed facts, it was time to bring in the creatives to speculate through possibilities and start thinking in the subjunctive. Who better to turn a catastrophe into a romcom with a twist you didn’t see coming, than the Hollywood elite. 

I’m not suggesting a regional hospital in Ireland should fly in the cast and crew of Grey's Anatomy to fix their problems, but maybe we need to start putting all our crazy ideas on the table. If the HSE was a slick private company, I could see them bringing in some Solution Consultants to lead a 10x outside-the-box thinking session where no idea is a bad idea. The crazy ideas are whittled down and refined until a realistic option emerges. 

Perhaps the answer is already in front of our eyes. The pull tab, which you see on the top of cans of soda and beer was invented in 1959. This same tab didn’t appear on tins of beans until the 1990s. Growing up, I always thought it was strange that I could open a can of diet coke in a split second yet I had to go routing around in a kitchen drawer for some hardware (a tin opener) to grind its way, at my physical expense, around the top of a can of beans to eventually prise it open. If you were super posh/given to wild abandon/American you had an electric can opener (wow, check you out!). 

I always wondered why the technology from the can of soda could not be transferred to the tin of beans, something to do with the tin pliability and cost of production no doubt. But eventually the beans producers levelled up and got the pull tab. 

What crazy, impossible, impractical, costly ideas could help manage overcrowding in a hospital ED? 

  • Live streaming - Cameras everywhere, beds etc, live streaming the action to encourage accountability from all parties 

  • Three strikes and you're out - Turn up three times with a non-emergency and you’re banned 

  • Group triage - A group of people with similar problems are triaged all at once 

  • Per-person Entrance Fee at the door - Cut back on droves of relatives and people with minor complaints 

  • Mandatory GP letter or proof you called a Nurse Helpline before attending - Obviously this does not apply to folks arriving by ambulance

  • ED-Lite - An outdoor pop-up tent staffed by students for people who are willing to take a chance with some less experienced staff 

  • Battlefield Medicine - When the ED reaches a certain capacity a War Zone is declared and certain mandated disease protocols abandoned in favour of patch ups to try and get more people seen 

  • Emergencies only - Post a list of bona-fide emergencies that will be treated, if you’re not on the list, you’re not getting in 

  • 24 hour imaging - Increase the tunaround for scans, x-rays, bloodtests, there should be a full imaging staff working around the clock everyday, emergencies are not 9-5pm

  • Electronic trackers - The hospital bracelet is an electronic tracker to monitor the serious ill and make sure they don’t languish out of sight  

  • Decision maker involved at the start - Involve a senior doctor early in the patients visit to cut to the chase and rule in/out a patients need to stay

  • Check-in kiosks - Patients register at a computer kiosk 

  • Reverse triage - This is a military concept, treat the lowest acuity combatant first to get them back out on the battlefield quickly

  • Discharge lounge - People waiting to be signed out could be put in a room together

These ideas might seem outrageous and untenable, but sometimes the ideas that were considered crazy at first became a huge success e.g. Airbnb, on paper millions of homeowners agreeing to let strangers stay in their houses with no vetting, no insurance, seems nuts, but it now rivals the hotel industry. We’re already seeing some novel ideas coming into hospitals to deal with overcrowding such as moving recovering patients home to avail of Virtual Wards, freeing up much needed beds for sicker patients coming through the EDs. Also there are plans in the works for the HSE to post live ED waiting times on its website to manage flow. 

There must already be other industries managing forms of overcrowding and queuing in innovative ways that the health service could learn from. 

I’m sure there is a soda company out there, reading about the overcrowding, looking at the tin of beans company (HSE) thinking two words - pull tab.


What would your crazy idea be?