Posted tagged ‘emergency medicine’

Stanford researchers find a better way to predict ER wait times

August 20, 2017

Need to go to the emergency room, but not sure where to go? There’s an app for that. A growing number of hospitals are publishing their emergency department wait times on mobile apps, websites, billboards and screens within a hospital.

But according to researchers at the Stanford Graduate School of Business, these estimates aren’t that accurate.

The trouble with most wait time estimates is that the models these systems use are often oversimplified compared to the complicated reality on the ground, said study author Mohsen Bayati, PhD, an associate professor of operations, information and technology at Stanford, in a recent news story. The most common ways of estimating a wait time is to simply use a rolling average of the time it took for the last several patients to be seen, but this only works well if patients arrive at a steady rate with similar ailments, he said.

Bayati and his colleagues studied five ways to predict ER wait times using data from four hospitals, including three private teaching hospitals in New York City and the San Mateo Medical Center public hospital that primarily serves low-income residents.

In particular, the researchers focused on wait times for less acute patients who often have to wait much longer than predicted, because patients with life-threatening illnesses are given priority and treated quickly. At SMMC, they found that some patients with less severe health needs had to wait more than an hour and a half longer than predicted using the standard rolling average method, according to their recent paper in Manufacturing and Service Operations Management.

The researchers determined that their new approach, called Q-Lasso, predicted ER wait times more accurately than the other methods — for instance, it reduced the margin of error by 33 percent for SMMC.

The team’s new Q-Lasso method combined two mathematical techniques: queueing theory and lasso statistical analysis. From queuing theory, they identified a large number of potential factors that could influence ER wait times. They then used lasso analysis to identify the combination of these factors that are the best predictors at a given time.

The authors were quick to qualify that their method was more accurate, but it still had errors — between 17 minutes to an hour. However, they said that it has the advantage of overestimating wait times rather than underestimating them, which leads to a more positive experience. Bayati explained in the news piece why this is important:

“If a patient is very satisfied with the service, they’re much more likely to follow the care advice that they receive. A good prediction that provides better patient satisfaction benefits everyone.”

This is a reposting of my Stanford blog story, courtesy of Stanford School of Medicine.

FemInEM blog facilitates conversations about women in emergency medicine

July 14, 2017

Photo by LIOsa

As a female PhD physicist, I was often the only woman in the room as an undergraduate and graduate student and as a research scientist. I faced sexism, unwanted attention and personal criticism — particularly early in my career. So I can relate to the gender equity issues that prompted Dara Kass, MD, an emergency medicine physician at New York University, to found FemInEM.

FemInEM is a blog that explores a variety of issues centered on the development and advancement of women in emergency medicine. Kass said their overarching goal is to make it easier for women in medicine to stay at work, despite conflicting priorities like family commitments, career objectives and personal health issues.

“I started FemInEM because I wanted to build a community amongst the women in emergency medicine,” Kass told me. “I had seen so many women solve their own problems around the expected life changes — like maternity leave, lactation and promotion — but they weren’t talking to each other. FemInEM seemed like a way to solve that problem. I didn’t want others to have to figure it out on their own, like I did.”

In addition to the blog, Kass said they use the power of social media — Facebook, Twitter, Instagram, and Snapchat — to amplify the conversation. “There are about 12 to 15 thousand women practicing in emergency medicine in our country, and we probably reach about half of them on a regular basis. The coolest part is that we reach all levels of learners from all over the world,” Kass said.

Kass explained that the online medium is important because it is “extraordinarily accessible and inclusive.” She emphasized that when discussing something like gender equity and the careers of women in medicine, it can never be only about the women. The conversation has to include men and allow them to reflect on their careers as well.

“We do this in a very inclusive way, so it’s really never about ‘us verses them,’” said Kass. “We’re talking about things like parental leave or salary equity. We base our discussions on data, but more importantly we focus on needing to all work together towards real solutions. Men are cool with it.”

Given the goal of inclusion, the blog uses an open-access submission process. “We take submissions from men, from people not in emergency medicine and from people around the world who have very different issues,” Kass said. “Anyone that wants to write for us just needs to submit an interesting piece that somehow speaks to the issue around gender equity in medicine.”

Kass particularly enjoys writing and reading posts on the struggles of having “multiple personalities.” One of her favorite posts is titled, “They call me #badassdoctormom.” “The #badassdoctormom post was written by a woman physician who talked about her daughter,” she told me. “This woman saved a guy at a train accident by cutting off his leg in the field, which is extraordinary. Her friend called her a bad ass. That night, during a bedtime story, her daughter asked whether she should call her doctor or Mommy. In her mind, she thought ‘How about bad ass doctor mom?’ In reality, her 5-year-old daughter now calls her a real-life superhero — that’s a really cool story.”

However, Kass told me that this blog post and others have gotten backlash from the female spouses of male physicians. This may be because the wives feel like they are being judged if they don’t work outside the home. Kass hopes this will change. Her advice to all women: “Just be who you are. Be happy. Our goal is to make people feel centered about the life they have in front of them and the choices they’ve made.”

Today Kass is spreading her message on how to support women in medicine when she gives grand rounds to Stanford’s emergency medicine residents. She is also expanding beyond online conversations to an in-real life event called the FemInEm Idea Exchange. Kass said this conference, being held in October in NYC, will make in-person conference networking more accessible to help develop women’s careers quickly and provide motivation.

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Bringing innovative education to emergency medicine: A Q&A with a doctor/filmmaker

March 23, 2017

What do immersive simulations, filmmaking and emergency medicine have in common? One answer is Henry Curtis, MD, a Stanford clinical instructor in emergency medicine who’s using innovative tools to educate medical students and residents about emergency medicine.

Curtis’s latest endeavor is a class called EMED 228: Emergency Video Production, which teaches students how to impact emergency care through film by “telling a story that matters.” I recently spoke with him about his use of filmmaking and simulation games.

Why do you use simulations and filmmaking as education tools?

“Both simulation and filmmaking serve different purposes for emergency medicine education. Immersive simulation is an arena. It’s a place where learners can experience a medical emergency in a safe environment. They make medical decisions, perform procedures and communicate with the patient and their team. When it is all over, they reflect on what happened. Aside from real life clinical experience, there is no better educational technique.

Filmmaking imagines and documents life. Video based learning has many advantages, not the least of which is reproducibility —a final cut is independent of individual human factors that could affect quality on any given day. It is fascinating to bind the experiences unfolding in a simulated medical emergency with videos. For instance, engagement videos can function to more powerfully immerse the learner into a given clinical scenario. Information videos can relate valuable educational cues more effectively than a photo, announcement or text flashed on a screen. Video based debriefing allows playback of the important moments in a scenario.”

What inspired you to create the EMED 228 course? What does it entail?

“I’ve been pursuing a master of fine arts in directing for the last few years at the Academy of Art University in San Francisco. I wanted to give back to Stanford and share the filmmaking skills I’ve acquired with students.

EMED 228 is open to undergrads, grads and medical students. We were fortunate to have a nice mix of students of all different educational interests and filmmaking experience enrolled. They were exposed to an overview of filmmaking. We began the first day with theory. The class then quickly progressed to understanding and implementing the practical aspects of creating a final product — using a robust array of equipment, including multiple high-definition DSLR cameras, GoPros, drones, remote focus pulling devices and gimbals.

The entire class culminated in a screening and Q&A session of the documentary that we created titled, Care Flight in the Golden Hour. We aimed to provide insight into the process and people delivering care to critically ill patients in Lake Tahoe requiring air medical evacuation. These caregivers provide a service, which oftentimes will make the difference between life and death of healthy people who are having a tragic day. We chose to film on location in Truckee, California. Hannah Rasmussen, a first-year medical student, acted as a teaching assistant. Her efforts were invaluable in organizing our remote and on-site collaborations.”

As a child, did you want to be a film director when you grew up?

“I did not always know that I would be so drawn to the storytelling art of filmmaking or that I would prefer to be in the role of directing. I did know that I preferred film to photos when creating memories. In fact, I have many more short videos than photos in the memory closet. During the last year of my emergency medicine residency, I chose to concentrate on the use of film in disaster medicine education and this is where my filmmaking life really began.

Stanford University is a rich world of opportunity. It has encouraged me to chase my interests and carve out a niche in the medical humanities. The department of emergency medicine is fully supportive of my journey. With such resources and encouragement offered at so many levels, I encourage everyone to seek out their passion in this environment.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.


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