By Ronald M. Wyatt, M.D., M.H.A.
The Joint Commission
People hate to wait. They don’t like waiting in line for their coffee. They don’t like waiting to find out the latest gossip. They don’t even like waiting for water to boil.
Coffee, gossip and boiling water – three non-life-threatening things in which the time frame is of little to no consequence, yet we hate waiting for them.
Now imagine how much people hate to wait for something in which the time frame is critical – even potentially life threatening, if delayed.
Unfortunately, it happens in health care far too often.
Sentinel event statistics from The Joint Commission show that one of the top reported events from 2004-2013 is delay in treatment. In 2013, delay in treatment was the third most common reviewable sentinel event.
With increased demands for health care services and clinicians, and a renewed focus on improved health outcomes, there is an urgent need to find ways to prevent these delays.
Whether it be delays in medication, a lab test, physical therapy, or any kind of treatment, these delays don’t just happen, but instead often have proximal contributing factors, such as misdiagnosis, failure to treat, failure to communicate a significant lab result, delay in diagnosis, or misunderstanding of the underlying disease process.
These proximal factors, and the delays they cause, have dangerous outcomes, as an Agency for Healthcare Research and Quality (AHRQ) study found that 28 percent of 583 diagnostic mistakes were life threatening or had resulted in death or permanent disability (Schiff G.D., et al: Diagnostic Error in Medicine: Analysis of 583 Physician-Reported Errors. Arch Intern Med. 2009; 169(20):1881-1887).
Meanwhile, the most common root causes of delays in treatment reported to The Joint Commission include:
- Communications failures
- Failed hand offs and care transitions
- Inadequate staff orientation and training
- Inadequate staffing levels
- Clinician availability
- Failures in the patient-assessment process
So, how to we begin unclogging the timeline and eliminating delays?
One way The Joint Commission is working to help organizations address delays is by increasing patient engagement through its Speak Up program. Started in 2002, the program encourages patients to:
Speak up if they have questions or concerns.
Pay attention to the care they receive.
Educate themselves about their illness or condition.
Ask a trusted family member or friend to be their advocate.
Know the type of medicines they receive.
Use hospitals, clinics and surgery centers that have been carefully assessed by The Joint Commission.
Participate in all decisions about their care.
If you’re looking to diagnosis areas that might be causing delays in your organization, it would be wise to focus your organizational attention on:
- Scheduling processes
- Ordering and reporting test results
- Improving access to care
- Implementing a standardized communications method, such as Situation Background Assessment Recommendation (SBAR)
- Maintaining adequate staffing levels (expect the unexpected)
In 2013, The Joint Commission reviewed 107 sentinel events that were a result of delays in treatment. This means there was either a patient death or permanent loss of function as a result of that delay.
With the combined commitment and efforts of organizational leadership, clinicians and patients, we can reduce that number.
Now is the time to act. Don’t wait.