Efficiency Paradox

Dr. Joe Bormel wrote an interesting blog recently titled, "Efficiency: Paradoxical Impacts of Technology - Southwest Airlines gone awry."

In his blog, Dr. Bormel describes his recent experience with what is called the Braess's Paradox. Very briefly, Braess's Paradox implies that adding extra capacity to a network can in some cases reduce overall performance.

I, too, have experienced this paradox. During a recent Rapid Response Team alert in the hospital, I needed to emergently treat a patient with an IV medication at the bedside. Previously, this medication was stocked in the code carts on each floor. However, after implementing the bar coding system at our facility, it was decided that for the overall good of the institution and patients (safety, cost, etc.), this medicine would be available only from the pharmacy via the an pneumatic tube delivery system.

During this emergency, I asked the nurse for the medicine. I was then told that we had to get it from the pharmacy. A few seconds later I was handed an order sheet to hand write the order so that it could be faxed to the pharmacy. It was then added to the patient's electronic medication record. After that, the pharmacist was able to dispense the medication and place it in the tubing system for delivery. After it arrived to the floor, the nurse needed to scan the bar code system in order to administer the medication to the patient. Finally, after a total of 5 minutes, the patient received the medication. The patient survived.

To the patient and me, the process felt like an hour. I understood the decision to keep the medication in the pharmacy as this medication is seldom used on each floor. Stocking each floor could create medical waste. In years past, I would have been able to grab the medicine and give it myself if needed. But that brings its own inherent risks (stocking, expiration dates, a physician administering a medicine normally administered by a nurse, etc.).

In summary, as we build systems to be more robust and safe, let's not forget that the extra steps in the process may very well slow us down and may possibly have worse outcomes. Being proactive by including clinicians and health informaticians in the research, development, and implementation of such products is key.

Jonathan S. Ware, MD