Diagnostic, Therapeutic and Allied Health Services

Introduction and Context

Diagnostic, therapeutic and allied health services are the clinical support systems through which hospitals identify disease, guide treatment, restore function and promote safe continuity of care. Although these services may not always be the first point of contact for patients, they strongly influence diagnosis, length of stay, treatment outcomes, patient safety, hospital expenditure and public confidence.

Diagnostic services include clinical laboratories, radiology and imaging, pathology, cardiology diagnostics and other investigative units. Therapeutic services include pharmacy, blood transfusion, dialysis, operating-room support and services that directly contribute to treatment. Allied health services include physiotherapy, occupational therapy, speech and language therapy, respiratory therapy, nutrition and dietetics, medical social work, psychology and rehabilitation.

Hospital administrators must manage these services as interconnected clinical processes rather than isolated departments. A delayed laboratory result can postpone surgery; an unavailable medicine can prolong admission; an incorrectly labelled blood sample can create a life-threatening transfusion risk; and inadequate rehabilitation planning can increase readmissions. Effective administration therefore requires coordination of people, processes, technology, equipment, information, supplies and quality systems.

Learning Objectives

By the end of this chapter, the learner should be able to:

1. Explain the roles and interdependence of diagnostic, therapeutic and allied health services.
2. Describe the workflow of laboratory, radiology, blood bank, pharmacy and rehabilitation services.
3. Apply turnaround-time, capacity, utilization and quality indicators in service management.
4. Explain equipment, inventory, infection-prevention, documentation and patient-safety requirements.
5. Coordinate multidisciplinary services with medical, nursing and administrative departments.
6. Analyse an operational problem and design an appropriate improvement intervention.
7. Discuss ethical, legal, regulatory and digital-health issues affecting these services.

1. The Service System and Its Clinical Relationships

A hospital service can be understood as a transformation system. Inputs include patients, specimens, requests, medicines, blood components, equipment, staff time and information. Processes include reception, identification, assessment, testing, interpretation, treatment, monitoring and communication. Outputs include valid results, administered therapies, functional improvement, discharge plans and patient outcomes.

A useful management principle is that the clinical value of a service depends not only on technical accuracy but also on accessibility, timeliness, safety, continuity and communication. A technically perfect test that reaches the clinician after a treatment decision has already been made may have limited clinical value.

1.1 Major service groups

These services operate through a referral-and-information network. The clinician requests a service, the department verifies the request and patient identity, performs the intervention, validates the result or response, communicates it and records it in the clinical record. Each handoff is a potential point of failure.

1.2 The three phases of service workflow

Most diagnostic workflows have three phases:

• Pre-analytical or pre-examination phase: ordering, patient preparation, identification, specimen collection, transport and acceptance.
• Analytical or examination phase: testing, imaging, treatment preparation or therapeutic intervention.
• Post-analytical or post-examination phase: validation, interpretation, reporting, critical-value communication, documentation and follow-up.

Therapeutic and rehabilitation services have comparable stages: referral and assessment, intervention, monitoring, evaluation and transition or discharge. Errors frequently arise before or after the technical procedure, so quality management must cover the complete pathway.

2. Laboratory Services Management

A hospital laboratory may include clinical chemistry, haematology, microbiology, immunology, histopathology, molecular diagnostics and blood-group testing. The administrator must balance clinical demand, operating hours, staffing, equipment capability, reagent availability, biosafety and financial sustainability.

2.1 Request and specimen pathway

The laboratory pathway begins with an authorized request containing the patient’s identifiers, clinical information, requested investigation, priority, requesting professional and relevant collection details. The patient should be identified using the institution’s approved identifiers, normally by asking the patient to state identifying information rather than relying only on bed or location.

Specimens should be collected in the correct container, at the correct time, in an adequate volume and under required conditions. They must be labelled at the point of collection and transported within the specified temperature and time limits. Rejection criteria should be defined for problems such as missing identification, leakage, wrong container, insufficient volume, clotting where it is not expected, haemolysis that affects the test, or excessive delay.

A rejection policy must be applied consistently. However, urgent or irreplaceable specimens may require a documented risk-based exception approved by an authorized professional. The laboratory should record the reason, notify the clinical unit and arrange recollection where possible.

2.2 Turnaround time

Turnaround time (TAT) is the interval between two defined events. Because different hospitals define it differently, every indicator must state its start and end points. For example, laboratory TAT may be measured from specimen receipt in the laboratory to result verification, whereas a patient-centred measure may begin at electronic order entry and end at clinician notification.

Here, t_start is the timestamp of the defined starting event and t_end is the timestamp of the defined ending event. Both must use the same clock and time zone. TAT is meaningful only when the measurement definition, patient category, test type and priority are specified.

The mean TAT is calculated as:

where TAT_i is the TAT for case i and n is the number of cases. Because a few very delayed cases can distort the mean, the median and selected percentiles are often more informative. A 90th-percentile TAT is the value at or below which approximately 90% of observations fall. Targets should be clinically justified rather than selected only because they are easy to achieve.

Worked example. Five urgent specimens have TATs of 42, 50, 46, 62 and 50 minutes. The total is 250 minutes, so the mean is 250 ÷ 5 = 50 minutes. After ordering the values as 42, 46, 50, 50 and 62, the median is 50 minutes. The mean and median are equal in this small example, but the 62-minute case should still be investigated if the clinical target is 45 minutes.

2.3 Quality control and assurance

Internal quality control uses known control materials to assess whether an analytical system is stable before patient results are released. External quality assessment or proficiency testing compares performance with an external programme or peer laboratories. Calibration establishes the relationship between instrument response and a reference value; quality control monitors whether the system continues to perform acceptably.

A quality system should include:

• approved standard operating procedures;
• staff competency assessment and continuing education;
• equipment maintenance and calibration records;
• reagent receipt, storage, lot tracking and expiry control;
• internal quality-control review;
• participation in external quality assessment;
• incident, nonconformity and corrective-action management;
• document control and record retention;
• biosafety and waste-management procedures.

Quality control cannot compensate for poor specimen collection or an unsuitable test request. Administrators should therefore monitor pre-analytical, analytical and post-analytical indicators separately.

3. Radiology and Imaging Services

Radiology includes plain radiography, computed tomography, magnetic resonance imaging, ultrasound, fluoroscopy, mammography and, where available, nuclear medicine. Its administration involves patient scheduling, referral appropriateness, preparation, consent, radiation protection, contrast safety, image acquisition, reporting and communication of urgent findings.

3.1 Workflow and capacity

A typical imaging pathway includes request review, appointment or emergency prioritization, patient preparation, identity and examination verification, screening for contraindications, image acquisition, technical quality review, radiologist interpretation, report authorization and communication. The workflow should distinguish routine, urgent and emergency examinations.

Capacity is affected by scanner availability, examination duration, cleaning and changeover time, staffing, reporting capacity, contrast preparation, inpatient transport and equipment downtime. A scanner may appear highly utilized while reporting or patient transport creates a hidden bottleneck.

Utilization can be expressed as:

Busy time includes the defined period during which the resource is engaged in patient care; available operating time is the scheduled time the resource is ready for use. Assumptions must be stated: planned maintenance, breaks and downtime may either be excluded or included, but the same convention must be used consistently. Very high utilization may reduce resilience, increase delays and leave no capacity for emergencies; therefore, maximum utilization is not automatically the best performance.

3.2 Safety and communication

Radiation protection follows the principles of justification, optimization and dose limitation for occupational and public exposure. A requested examination should be clinically justified, the lowest reasonable exposure should be used for the required diagnostic information, and staff and patients should be protected from unnecessary exposure. Special procedures are required for pregnancy assessment, paediatric imaging and high-dose examinations.

MRI requires screening for implants, ferromagnetic objects, devices and claustrophobia. Contrast agents require attention to allergy history, renal function where relevant, pregnancy status and emergency preparedness. Every department should have a protocol for contrast reactions, patient deterioration, falls, fire and evacuation.

Critical or unexpected findings must be communicated through a defined escalation process, not merely placed in a report queue. The record should show the finding, recipient, time, method and acknowledgement when required.

4. Blood Bank and Transfusion Services

Blood-bank administration is a high-risk activity requiring strict traceability. Functions may include donor screening, component receipt or preparation, blood grouping, antibody screening, compatibility testing, storage, issue, transport, transfusion support and investigation of reactions.

The essential safety chain is correct patient identification, correct specimen identification, valid compatibility testing, controlled storage, documented issue and bedside verification. A transfusion should be administered only against an authorized order and after required consent and clinical checks.

Storage equipment must have continuous or appropriately frequent temperature monitoring, alarms, documented excursions and contingency plans. Different components have different storage requirements and expiry periods; local regulations and manufacturer instructions must be followed. The blood bank must maintain traceability from donor or source through recipient and final disposition.

A transfusion-reaction protocol should include immediate clinical assessment, stopping the transfusion when indicated, maintaining appropriate intravenous access, notifying the responsible clinician and blood bank, preserving the unit and administration set, collecting required specimens and documenting the event. Near misses should also be reported because they reveal weaknesses before harm occurs.

5. Pharmacy Services and Medication Management

Hospital pharmacy is responsible for the medication-use system, not merely for dispensing. Its functions include formulary management, procurement, storage, compounding where authorized, dispensing, medication reconciliation, clinical review, adverse-event monitoring, antimicrobial stewardship and patient education.

5.1 Medication-use cycle

The cycle consists of selection, procurement, receipt, storage, prescribing, transcription or electronic processing, dispensing, administration, monitoring and discontinuation. Governance should clarify who is accountable at each stage. Look-alike and sound-alike medicines, concentrated electrolytes, high-alert medicines, controlled medicines and refrigerated products require additional safeguards.

Stock management should balance availability with expiry and financial loss. A simple inventory measure is stock turnover:

Annual consumption cost and average inventory value must be measured over the same period and valued using a consistent accounting method. A high turnover may indicate efficient inventory use, but it may also indicate insufficient safety stock; a low turnover may indicate overstocking, slow-moving items or inappropriate purchasing.

The reorder point can be estimated as:

Demand during lead time is expected consumption while awaiting replenishment. Safety stock protects against demand and supply variability. The formula is a planning approximation; it does not replace expiry monitoring, supplier reliability assessment, criticality analysis or regulatory requirements.

5.2 Medication safety

Medication reconciliation compares the patient’s pre-admission medicines with admission, transfer and discharge orders. Pharmacists and clinicians should resolve discrepancies, assess interactions and communicate changes to patients and caregivers. Discharge information should state medicine name, purpose, dose, route, frequency, duration, precautions and follow-up requirements in understandable language.

Antimicrobial stewardship seeks to use antibiotics appropriately: the right agent, dose, route and duration for the clinical indication. It combines prescribing review, microbiology information, local resistance data, infection prevention and education. The goal is not simply to reduce medicine use, but to improve outcomes while reducing avoidable resistance, toxicity and cost.

6. Rehabilitation and Allied Health Services

Rehabilitation is a goal-oriented process that enables a person with a health condition to achieve optimal independence and participation. It may begin in intensive care or an acute ward and continue through outpatient, community or home-based services.

A rehabilitation pathway usually includes referral, functional assessment, identification of patient goals, formulation of an interdisciplinary plan, intervention, reassessment and discharge or transition planning. Measures should reflect function and participation, not only the number of treatment sessions.

Physiotherapists address mobility, strength, balance, respiratory function and physical activity. Occupational therapists address activities of daily living, cognition, environmental adaptation and return to work or roles. Speech and language therapists address communication, swallowing and related functions. Dietitians assess nutritional status and develop nutrition plans. Psychologists and social workers address emotional, behavioural, family, financial and social barriers. Respiratory therapists, orthotists, prosthetists and other professionals may contribute according to local service design.

The rehabilitation plan should identify precautions, assistance requirements, equipment, measurable goals, responsible professionals and review dates. Discharge planning should begin early for patients with complex needs. A safe transition requires patient and caregiver education, medication and equipment arrangements, referrals, transport planning and communication with the receiving service.

7. Coordination, Information and Handoffs

Clinical coordination is achieved through shared care pathways, multidisciplinary meetings, escalation rules and reliable information systems. Administrators should avoid designing services around departmental convenience alone. The relevant question is whether the whole patient journey is safe, timely and clinically coherent.

Important coordination mechanisms include:

• electronic ordering and result delivery;
• structured referral forms;
• critical-result and critical-value escalation policies;
• daily multidisciplinary rounds;
• discharge and transfer checklists;
• agreed service-level standards;
• patient tracking and queue visibility;
• incident reporting and feedback loops.

Information systems should preserve the source, time, author, status and amendment history of clinical information. Role-based access, authentication, audit trails, downtime procedures and privacy controls are essential. Automation can reduce transcription and scheduling errors, but poorly configured systems can reproduce errors at scale.

8. Performance Measurement and Quality Improvement

A balanced dashboard should include structure, process, output and outcome indicators. Structure indicators assess resources, such as staffing, equipment availability and accreditation status. Process indicators assess whether required actions occur, such as specimen rejection review or medication reconciliation. Output indicators assess activity and timeliness. Outcome indicators assess effects on patients, such as complications, functional improvement, readmissions or patient-reported experience.

Examples include:

A proportion is calculated as:

The numerator must be a subset of the denominator, and eligibility criteria must be explicit. For example, if 96 of 120 eligible discharge records contain documented medication reconciliation, compliance is (96 ÷ 120) × 100 = 80%.

Improvement methods may include the Plan–Do–Study–Act cycle, process mapping, root-cause analysis, Pareto analysis and failure mode and effects analysis. Root-cause analysis should examine system conditions such as workload, training, communication, interface design, staffing and supply reliability rather than assigning blame to an individual alone.

9. Equipment, Facilities and Supply-Chain Governance

Equipment planning should consider clinical need, throughput, compatibility, service support, total cost of ownership, training, cybersecurity, consumables and end-of-life disposal. Procurement should be based on validated specifications and a transparent evaluation process. A cheaper purchase may become expensive if it requires proprietary consumables, frequent downtime or unavailable technical support.

Preventive maintenance reduces avoidable failure but does not eliminate it. Departments need escalation procedures, backup arrangements, loan equipment or referral pathways for downtime. Equipment logs should record installation, acceptance testing, calibration, preventive maintenance, repairs, incidents and decommissioning.

Supply systems must protect the availability and integrity of reagents, medicines, blood supplies, contrast agents, personal protective equipment and rehabilitation devices. Critical items should have defined minimum and maximum levels, expiry controls, supplier alternatives and emergency procurement procedures.

10. Ethical, Legal and Regulatory Considerations

These services involve patient autonomy, privacy, informed consent, equity and professional accountability. Patients should receive understandable information about relevant procedures, risks, alternatives and the use of their information. Consent requirements vary by jurisdiction and procedure; emergency exceptions and substitute decision-making must follow applicable law and policy.

Confidentiality applies to test results, images, medication records, genetic information and rehabilitation assessments. Access should be limited to legitimate care, operational and legal purposes. Results must not be discussed in public areas or transmitted through insecure channels.

Equity requires fair access to diagnostic and therapeutic services. Priority systems should be clinically based and transparent, not determined by social status or ability to exert influence. Administrators should monitor whether rural patients, persons with disabilities, language minorities, older adults or economically disadvantaged groups experience longer waits or poorer access.

Accreditation standards, licensing rules, occupational safety requirements, controlled-drug regulations, blood legislation and data-protection law vary by country. Local law and current professional standards must therefore be consulted before implementation. This chapter provides management principles, not legal advice.

11. Technology and Artificial Intelligence

Digital laboratory systems, picture archiving and communication systems, electronic prescribing, barcode medication administration, automated analysers, tele-rehabilitation and remote reporting can improve access and traceability. Benefits depend on workflow design, interoperability, staff competence and downtime preparedness.

Artificial intelligence may support image prioritization, pattern recognition, workload forecasting, quality checks and clinical decision support. It should not be treated as an infallible replacement for professional judgement. Before deployment, managers should evaluate validation evidence, local performance, bias, explainability, cybersecurity, data governance, liability, human oversight and monitoring after implementation. A model trained on one population or equipment platform may perform poorly elsewhere.

12. Illustrative Case: Reducing Delays in an Integrated Diagnostic Pathway

Background

A 250-bed general hospital reported frequent delays in initiating treatment for patients admitted through the emergency department. The average laboratory TAT for urgent tests was 78 minutes, while urgent imaging reports were frequently completed after clinical decisions were made.

Problem analysis

A multidisciplinary team mapped the pathway from electronic order to documented result. It found three major constraints: specimens waited for transport during shift changes; urgent imaging requests were queued with routine examinations because priority rules were unclear; and critical results were communicated by informal telephone calls without consistent documentation. Equipment capacity was adequate, but handoffs were unreliable.

Approach and solution

The hospital introduced a defined urgent-testing policy, colour-coded transport containers, scheduled specimen collection rounds, electronic priority fields and a radiology escalation list. Laboratory and radiology managers jointly defined TAT start and end points. A dashboard displayed median TAT, 90th-percentile TAT, specimen rejection, imaging backlog and critical-result acknowledgement. Staff received training, and daily huddles reviewed exceptions rather than blaming individuals.

During the first month, 120 eligible urgent laboratory cases were reviewed. Before intervention, 72 met the 60-minute target. After intervention, 96 met it. Compliance therefore improved from (72 ÷ 120) × 100 = 60% to (96 ÷ 120) × 100 = 80%. The hospital also observed fewer undocumented critical-result communications. The team continued monitoring because a single month could reflect random variation and because faster processing must not reduce analytical quality.

Learning points

1. The main problem was a system bottleneck, not a lack of technical competence.
2. Capacity measures must include transport, reporting and communication, not only equipment hours.
3. Clear definitions are necessary before comparing performance.
4. Timeliness improvement must be balanced with patient identification, quality control and clinical appropriateness.
5. Joint ownership across departments is more effective than isolated departmental targets.

Challenges and Limitations

Service demand is variable and often unpredictable. Emergency cases compete with scheduled work, and staffing shortages may affect both technical processing and communication. New technology can create capital, training and cybersecurity burdens. Performance indicators may encourage undesirable behaviour if targets are used punitively—for example, releasing incomplete results to improve TAT or avoiding complex patients to protect productivity statistics.

Measurement also has limitations. A high utilization rate does not prove efficiency, a low rejection rate may reflect under-reporting, and patient satisfaction may be influenced by waiting conditions outside the department’s control. Indicators should therefore be interpreted with clinical outcomes, risk information and qualitative feedback.

Best-Practice Framework for Administrators

An administrator can use the following sequence when establishing or reviewing a service:

1. Define the patient population, clinical purpose and scope of service.
2. Map the complete pathway, including referrals, handoffs and exceptions.
3. Specify staffing, competence, facilities, equipment and supply requirements.
4. Establish standard operating procedures and safety-critical controls.
5. Define clinically meaningful indicators and data sources.
6. Implement incident reporting, audit, quality control and corrective action.
7. Coordinate with clinicians, nursing, information technology, procurement and infection prevention.
8. Review equity, patient experience, privacy and accessibility.
9. Test downtime and emergency-contingency arrangements.
10. Use results for learning and improvement, not merely compliance reporting.

Chapter Summary

Diagnostic, therapeutic and allied health services form an interconnected hospital system. Laboratory and imaging services provide information that guides diagnosis and treatment; blood banks protect transfusion safety; pharmacy manages the medication-use cycle; and rehabilitation and allied health services support recovery, independence and continuity of care. Effective administration requires end-to-end workflow design, reliable identification, appropriate equipment, competent staff, supply security, communication and clinical coordination.

Turnaround time, utilization, stock turnover, quality indicators and compliance measures are useful only when their definitions, denominators, timestamps and assumptions are clear. Quality management must cover pre-analytical, analytical and post-analytical stages, while improvement programmes should address system causes rather than rely on individual blame. Ethical practice requires privacy, informed participation, equity and regulatory compliance. Digital systems and artificial intelligence can improve performance, but they require validation, human oversight, cybersecurity and continuous monitoring.

Key Terms

Diagnostic service: A service that generates information for identifying, monitoring or excluding a health condition.

Therapeutic service: A service that directly contributes to treatment or management of a health condition.

Allied health service: A health profession or service that supports diagnosis, treatment, function, rehabilitation or psychosocial care outside the medical and nursing professions.

Turnaround time: The elapsed time between defined start and end events in a service process.

Pre-analytical phase: Activities before examination, including ordering, identification, collection and transport.

Analytical phase: The technical examination or measurement of a specimen or image.

Post-analytical phase: Validation, interpretation, reporting and communication after examination.

Internal quality control: Routine monitoring using control materials within a service.

External quality assessment: Comparison of performance with an external programme or peer group.

Critical value: A result indicating a potentially life-threatening condition requiring prompt communication.

Utilization: The proportion of available resource time spent performing defined work.

Blood component: A therapeutic product derived from blood, such as red cells, platelets or plasma.

Medication reconciliation: The structured comparison and resolution of medicines across transitions of care.

High-alert medicine: A medicine that can cause significant harm if used incorrectly.

Rehabilitation: A goal-oriented process that improves functioning and participation.

Multidisciplinary care: Care involving professionals from different disciplines working toward shared patient goals.

Traceability: The ability to follow an item, specimen, product or decision through its complete pathway.

Root-cause analysis: A structured investigation of underlying system factors contributing to an event.

Proportion: The number meeting a defined criterion divided by the total eligible number, usually expressed as a percentage.

Service-level standard: An agreed expectation for scope, quality, access or timeliness of a service.

Review Questions

Short Answer Questions

1. Distinguish diagnostic, therapeutic and allied health services.
2. What are the three phases of a laboratory workflow?
3. Why must turnaround-time definitions specify start and end events?
4. State two essential controls in blood-bank management.
5. What is the purpose of medication reconciliation?

Long Answer Questions

1. Explain the complete laboratory specimen pathway and identify common points of failure.
2. Discuss the major administrative responsibilities in radiology and imaging services.
3. Describe how pharmacy contributes to medication safety beyond dispensing.
4. Explain the role of rehabilitation and allied health professionals in discharge planning.
5. Discuss how a hospital can design a balanced quality dashboard for diagnostic and allied services.

Analytical / Application Questions

1. A laboratory has acceptable analytical quality but frequent delays in urgent results. Analyse the likely system causes and propose an improvement plan with suitable indicators.
2. A hospital’s pharmacy experiences repeated stock-outs of essential medicines despite high inventory expenditure. Apply inventory-management principles to investigate and correct the problem.
3. An imaging department reports 95% scanner utilization but increasing patient complaints and delayed reports. Explain why high utilization may coexist with poor service performance and recommend corrective actions.

Multiple Choice Questions with Answers

Question 1

Which phase includes patient identification, specimen collection and transport?

A. Pre-analytical phase

B. Analytical phase

C. Post-analytical phase

D. Discharge phase

Correct Answer: A. Pre-analytical phase

Question 2

A laboratory records TATs of 40, 50, 60, 70 and 80 minutes. What is the mean TAT?

A. 50 minutes

B. 60 minutes

C. 65 minutes

D. 70 minutes

Correct Answer: B. 60 minutes

Question 3

Which measure is most directly concerned with whether a scanner is engaged during available operating time?

A. Stock turnover

B. Utilization

C. Specimen rejection

D. Medication reconciliation

Correct Answer: B. Utilization

Question 4

Which practice best supports blood transfusion traceability?

A. Using bed number as the only identifier

B. Recording the complete issue and administration pathway

C. Storing all components at one temperature

D. Removing near misses from quality reports

Correct Answer: B. Recording the complete issue and administration pathway

Question 5

The reorder point is generally estimated as:

A. Annual consumption minus expiry losses

B. Demand during lead time plus safety stock

C. Average inventory divided by annual consumption

D. Maximum stock minus minimum stock

Correct Answer: B. Demand during lead time plus safety stock

Question 6

Which activity is a post-analytical laboratory activity?

A. Specimen collection

B. Reagent calibration

C. Result validation and critical-value communication

D. Patient preparation

Correct Answer: C. Result validation and critical-value communication

Question 7

What is the principal purpose of medication reconciliation?

A. To increase the number of prescribed medicines

B. To compare and resolve medication discrepancies during care transitions

C. To replace all generic medicines with branded medicines

D. To eliminate pharmacist involvement in discharge

Correct Answer: B. To compare and resolve medication discrepancies during care transitions

Question 8

Which rehabilitation practice is most consistent with patient-centred care?

A. Setting goals without patient involvement

B. Measuring only the number of treatment sessions

C. Linking interventions to functional goals and participation

D. Delaying discharge planning until the final treatment session

Correct Answer: C. Linking interventions to functional goals and participation

Question 9

If 96 of 120 eligible records meet a documentation standard, compliance is:

A. 70%

B. 75%

C. 80%

D. 96%

Correct Answer: C. 80%

Question 10

Why can very high equipment utilization be undesirable?

A. It always indicates poor technical quality

B. It eliminates the need for maintenance

C. It may reduce flexibility for emergencies and increase delays

D. It guarantees low patient satisfaction

Correct Answer: C. It may reduce flexibility for emergencies and increase delays