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by Yaneer Bar-Yam
Step IV: Accelerate Intake Routing
The best waiting room is the one with nobody waiting.

Individuals who are uninsured, or who do not have a primary care provider, often resort to the emergency room for non-emergency care. Without a PCP to act as a router, and without access to a 24-hour phone support, these individuals' options are limited. If their medical problem occurs at night, or if they can’t make it to a walk-in clinic during the clinic’s hours because of work, childcare, or other responsibilities, the emergency room becomes the only option. This puts a huge strain on the emergency care system, since a large portion of its resources must be devoted to treating or routing these cases rather than on the truly urgent ones.

Even for people with insurance and a PCP, the intake system often doesn't work well. The wait for an initial appointment with a family physician averages 20 days in the United States as a whole. According to a 2009 survey, the average wait time to see a family practitioner in Washington, D.C., was 30 days; in Los Angeles, 59 days and in Boston, 63 days.

This delay in the initial care and routing process indicates that something is amiss with the intake system. The influx of patients seeking initial evaluation and referral to specialists overtaxes the primary care system. What’s more, delays in diagnosis can have serious health consequences.

The initial triage decision falls to the receptionist, who is generally unprepared to properly make such decisions. When the doctor is too busy to see everyone who wishes to be seen, the receptionist is put in the position of deciding which patients must be seen urgently and which can wait for an appointment—an appointment that may be several weeks away.

No matter how good the care is once a patient gets to the right place, delays mean that the healthcare system isn’t working well, not for quality of care, where delays may compromise the patient’s health, and not for costs.

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