Operations and the Emergency Room

Who would have thought that I would be "listening" to the Celtics vs. Lakers 6th game of the NBA finals in an emergency room. As they say, most accidents happen close to home. After thousands of miles of travel recently to give talks in Hawaii and then in Argentina, with no injuries or illnesses, I tripped last night while taking an evening stroll and landed sidewise on the asphalt road with blood gushing out of my face.

My husband rushed me to UMass Amherst Health Services where no doctor was available and I was told to go to the emergency room (ER) at Cooley Dickinson hospital in Northampton, MA, despite my appeals to be at least looked at locally, but to no avail.

As anyone who has been to an ER can tell you, the experiences in such a setting are not exactly pleasant memories. As one who researches and teaches operations management and operations research / management science and specializes in network flows in systems, I am a stickler for efficiency and for improving processes from those in business and transportation and logistical systems to those in healthcare.

We arrived in the ER shortly before 9(cr)PM (and the TV in the waiting area was set to the Celtics vs. Lakers game). The folks in the waiting area looked pleasant enough and I thought that within an hour I would be "served" and released. After a while my vital stats were taken, I was given an ice pack to apply to my head, which soon got spotted with the red stuff. Then a new patient joined me in the waiting game who had just been in a barroom brawl and his friend had brought him in for treatment. His facial injures resembled mine, but, then again, his arms were covered with tattoos. He also got an ice pack to apply to his head.

I told my husband, who is the pinnacle of patience, that if I was not seen by a doctor by 11:30PM that I would just self-treat myself back at home and live with any scars that materialized.

At 11:25 PM, I was called in to the area where the patients are placed on beds. I was treated to a nicely warmed set of sheets, since I was freezing, and marveled at the activity there, so I asked where did all these patients come from? I was told that they arrived by ambulance and that (as we were waiting for hours in the waiting room) several of the cases, according to the doctors, were very complicated. (I had been asked earlier as to how severe my pain was, and believe that if I had been less of a martyr and had emphasized the acuity, I may have been treated earlier. Perhaps better service is also achieved by arriving in style via ambulance).

There is a "happy" ending to this experience. The doctor that treated me is Dr. Khama Ennis, who not only is a fellow alum of Brown University, but she trained in emergency room medicine under Dr. John Nagurney, at Mass General Hospital. This Dr. Nagurney is a relative of my husband's and is also an instructor at Harvard Medical School. Dr. Ennis treated my daughter several years back on her only trip to the ER and we found all of these wonderful connections. Dr. Ennis' young daughter shares my birthday so talking and being treated by her this time around made the benefits almost outweigh all of the costs. One of her best friends lives in LA and is a big Lakers fan so she was awaiting a teasing text message on the Celtics loss.

Several years back, a group of my undergrad students in Operations Management in my FOMGT 341 class, Transportation & Logistics, did a project on patient flow in this specific hospital and on how to improve operational efficiencies. One of the students, Selena Kaplan, was a nurse, and another one, Maxfield Raynolds, had worked for me at the Virtual Center for Supernetworks at the Isenberg School (and went on to receive a 21st Century Leaders Award from UMass Amherst). Their project, along with Bria Gottschalck, can be accessed here.

Interestingly, my colleague, Professor Jim Orlin of the Sloan School at MIT, has written several posts on healthcare issues, from a personal perspective, including his experience with the ER at Mass General Hospital and has also highlighted the work of Professor Litvak of Boston University on hospital patient flow, whose work has been featured in The Boston Globe.

Hospitals are processing flow networks, with congestion, and patients as well as caretakers and medical professionals can all greatly benefit from optimization. This my undergrads figured out back in 2004 and, hopefully, optimization will be the paradigm for hospital networks. As patients, we care about user-optimization (just as drivers do in transportation networks) since we want to be processed from our arrival until discharge as promptly as possible. Healthcare and hospital administrators, on the other hand, may be focusing on system-optimization, that is, routing the flow so that the total cost in the system is minimized (in transport parlance, think of a controller routing the freight flows in an optimal manner from origins to destinations).

And, yes, to add insult to injury, as my previous updated blogspot stated, the Celtics lost to the Lakers last night.