What Emergency Rooms Could Learn from IT Help Desks

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After more than twenty years working in many companies, many of them as a consultant often dramatically improving operations, I have received a blessing and a curse:

  • Blessing: I see improvements and benefits potential almost everywhere.
  • Curse: I see improvements and benefits missed almost everywhere.

The other day, I spent six and half hours in a hospital emergency room (ER) with a family member. Fortunately, everything is fine, and they are healthy. Unfortunately, the amount of time wasted was astronomical.

To be clear, the medical care itself was excellent, both clinically and the "bedside manner". But the process from the system was, shall we politely say, pathetic.

Of the six and half hours spent:

  • One hour waiting for test results
  • 45 minutes being treated by medical personnel
  • 15 minutes handling papework

At least four and half hours, or 69.2%, were wasted.

Afterwards, a doctor friend told me that, for an ER, six and half hours isn't too bad!

As a working person, I find the waste of my time offensive. But if I were the hospital administrator, I would be outraged. Not only should I care greatly about my customers and their satisfaction, i.e. the high indirect costs, but my lost direct costs are hurting my ability to deliver care every single day.

  • How much do I pay for extra floor space, beds, power, water, food, plumbing, cleaning, paperwork, directions, security, air-conditioning and all of the additional ongoing costs because people are in my ER instead of discharged?
  • How much unnecessary stress does it put on my staff, beyond the difficulty of dealing with the baby who fell, the person in a car accident, the heart-attack victim?
  • How much staff time is wasted, and stress increased, by patients continually asking where they are, and what is taking so long?
  • How inaccurate are my medical tests because patients are under stress due to long and unknown waits?

Even if most people do not waste 70% of their in-ER time, observation of any ER in the developed world will show the numbers to be not too far off the mark. Even with a conservative 50% average waste margin, the amount of money that could be saved - or better health services provided - with a 50% ER wastage rate is quite high.

What accounts for the inefficiency, and how would we solve it? Coming from the technology world, and especially customer support and help desks, here are several key areas to consider:


In the technology business, and especially IT and help desks, we use ticketing technology to manage prioritized workflows. Each issue is a ticket, and the ticket is handed off from one person or group to the other and back again.

Each ticket follows a pipeline which ensures it gets treated and managed correctly. Further, because each ticket has a priority, there is a built-in ability to pre-empt other tickets as needed.

In a hospital ER, some form of pipelining is done by the patient's file placed in various stands of "drawers" or other organizing rows. Yet, these do not move folders around, and are not integrated into other systems. The number of cracks to fall in and their size makes glacier crevasses look like sidewalk cracks.

For example, blood drawn for tests or tissue for biopsy may be sent to the lab, but lab results do not automatically get added to the file, nor do they cause the file to jump to the front of the similar-priority queue.


In an IT ticketing system, a ticket cannot be closed out until all of its requirements have been met. These are determined by the specific implementation, but often include such items as:

  • Resolution description
  • User location
  • Phone number
  • Problem software

When requirement are enforced, errors due to missing data are fewer.

In a hospital ER, we depend on doctors' notes to know what needs to be done, and a human reviewing them to be sure nothing was missed. It is easy to send a patient out while forgetting to write a prescription, give a test or remove a stitch.

Automated systems review all requirements and give a simple red or green light.


Most important of all, though, are metrics. As anyone who has worked in an IT help desk, customer support group or network operations centre knows, we measure our tickets:

  • How many are open at once?
  • What are the time-to-begin handling the ticket, time-to-resolution, steps-to-resolve and any of a number of other steps? We measure averages (both mean and median), standard deviations and percentiles.
  • How do the time to handle and time to resolve vary by issue, specialty, time of day / day of month / date of year?

Most importantly, how can we use the above information to bring our quality of service up and costs down?


Hospitals work on the manual, human, paper system - even the most advanced - that has been in usage for many years. Even those that have adopted Electronic Medical Records (EMRs) still use them as digital repositories, not digital pipelines. They do not need digital versions of existing medical processes, but medical version of the best IT processes.