I attended an interesting presentation today, where a problem of APQ was presented. As I understood the presentation, it is challenging to effectively implement APQ without over penalizing the more urgent classes. Using a healthcare example, it would mean an emergency department choosing a CTAS 5 patient (lowest acuity/urgency) with too short of an extra wait over a CTAS 4 patient. While I followed the concerns with standard APQ, I saw new challenges created with the proposed solution.
The presentation demonstrates delaying the accumulation for lower priority groups until a determined period has concluded. I see several related challenges:
- If another lower priority patient arrives within the delay window, the priority alone would not be enough to sort/prioritize. We would have to include arrival order to sort, or wait until one began to accumulate.
- This is only a problem if they end up at the front of the queue before accumulating.
- This is further exacerbated by increasing numbers of categories. Would each group get a progressively longer delay? Then we could be faced with many, all in the case of no arrivals of top priority, zero priority patients.
- CTAS 1-5
- The solution requires an extra complication of tracking time before accumulation.
- This may seem inconsequential, but I would argue it is more pronounced when comparing to the proposed solution.
To keep all of the benefits of delaying, without the 2 challenges, we simply need to flip the intervention. Rather than delaying the accumulation, start the lowest acuity at 0, while each higher acuity group gets a progressively higher starting acuity:
Depending on the context, starting priorities may be enough to allow standard accumulations between categories. With CTAS, such a change would allow matching to the goals for Physician Initial Assessment (PIA) times:
To close, I wanted to show an example, with the same context as above, to further validate the presenter’s concern of early overlap with priority scores of lower acuities: