Sometimes a Problem needs a Radical Solution

1n the 1990’s, Cook County Hospital (of ER fame) had a problem.  The Emergency Department had to deal with 250,000 patients a year. 

One of the biggest claims on their limited resources was heart attacks.  About 30 people a day came into the ER with chest pains.  Diagnosis was often inconclusive.  Patient’s answers were often unclear, and ECG tests far from perfect.  The only sure tests took hours – the one thing they didn’t have.  So the doctors had to make an estimate.  The trouble was that different doctors made different estimates – no matter how trained or experienced they were.  Add to this the risk of malpractice, and the doctors admitted people just to be sure.  Unfortunately, they had neither the beds nor the money to deal with them.

An incremental change would not be enough, they needed something radical.

The head of the Department of Medicine turned to a cardiologist who was involved with some  mathematicians who were interested in using statistics for identifying subatomic particles.  The cardiologist had developed an algorithm that identified three of the critical risk factors for diagnosis in conjunction with the ECG.  These were;

1. Is the pain unstable angina?
2. Is there fluid in the patient’s lungs?
3. Is the patient’s systolic blood pressure below 100?

These three tests were the works of years of research, but it was only research, no testing had been done.

Eventually, they trialled the algorithm at the hospital, after two years they compared the results with the doctors usual estimates.  The new method was 70% better than the doctor’s usual method.

The point is that even with the best training and experience, severe conditions can undermine even the best practice.  Sometimes something new is required.  Because conditions at the hospital were so demanding, they had to try something radically different.


The full story can be found in Malcolm Gladwell's book "Blink, The Power of Thinking without Thinking"