Hospitals try to improve emergency wait times

Vernon Lyon has some experience with emergency rooms. He has four kids.

So when his daughter Sydni recently slipped on the stairs and hurt her foot, he thought he was in for some serious time in a hospital waiting room. But the Parkville dad went to St. Joseph Medical Center, where officials have been working to cut "door to doc" time.

The community hospital in Towson is one of several in the area — and one of many across the country — working to reduce wait times for patients who come in with less-than-deadly conditions. It's also among those advertising the results: St. Joseph posts the anticipated wait time on its website.

Harbor Hospital in South Baltimore has put up billboards and handed out brochures door-to-door to tell residents about its "quick" emergency room experience. Hospitals in Arizona, Florida, Illinois, Iowa, Maine, Michigan and Tennessee are texting and e-mailing potential patients, posting real-time waits on billboards and taking other steps to tout their speedy service.

Some hospitals are changing because they view the emergency room as a "front door" to the hospital and a link to future — and more lucrative — business such as elective surgery.

More fundamentally, supporters of health care improvements say emergency rooms have become the primary doctor as well as the urgent care center for many Americans. And the overcrowding has forced the hospitals to find new ways to treat patients more efficiently.

"About 80 percent of our patients walk in, as opposed to come by ambulance, and you'd be amazed at how many call ahead and want to know how long the wait will be," said Dr. Gail Cunningham, head of St. Joseph's emergency department. "We've been able to shave at least 25 percent off the patients' emergency department stay. And it's now about a 14-minute wait."

Some critics warn that the ads can be gimmicks in a competitive market like Maryland's, where there are 48 emergency departments to choose from. Some hospitals may have made no improvements in their emergency rooms and others may have not done enough to handle extra patients from successful marketing.

The U.S. Centers for Disease Control and Prevention says the average wait time to get care is pushing an hour. And a November report in the journal Archive of Internal Medicine found one in four emergency department patients in 2006 waited longer to see a doctor than recommended for their condition, up from one in five in 1997.

According to a 2009 report based on patient surveys from Press Ganey Associates Inc., a health care information provider, patients in Maryland spent an average of 4 hours and 23 minutes in the emergency department, or 14 fewer minutes than the year before but still 20 minutes longer than the national average. Baltimore-area hospitals did have one of the highest rates of patient satisfaction.

The Maryland Institute for Emergency Medical Services Systems, which oversees emergency policy in the state, reports that there has been a decrease in recent years in yellow and red alerts, or the time that overcrowded hospitals declined to accept all but the most urgent patients. There also has been a slight decrease in the time it takes emergency workers to return to the field after delivering patients to emergency departments.

Lisa Myers, director of special programs for the system, said the statistical improvements could be attributed to fewer sick people during the peak cold months. There was little flu last winter, for example. But she said the hospitals, health departments and others have been working to cope with overcrowding.

Still, there may be overcrowding and waiting, for those who walk in with non-urgent needs and for those who come by ambulance. And emergency departments that haven't begun looking for efficiencies will need to, said Dr. Jon Mark Hirshon, an associate professor at the University of Maryland Medical School who is board-certified in emergency and preventive medicine.

Almost 60,000 patients a year visit the UM Medical Center's three emergency departments, including adult, pediatric and Shock Trauma, and the number is growing. The Maryland Shock Trauma Center, one of the region's main trauma centers that is currently being expanded, served more than 7,000 patients in fiscal 2009 but was designed two decades ago for 3,500.

Hirshon cited a poll conducted for the American College of Emergency Physicians that found more than 70 percent of doctors surveyed nationally and in Maryland believe emergency departments will become more crowded, even with the newly passed health care reform law. About half believe conditions will worsen for patients.

About 120 million people went to one of the nation's emergency rooms in 2006, up a third from a decade before. And Hirshon said that after Massachusetts passed universal health care in the state that year, emergency departments saw a 7 percent uptick in patients.

"We're already pretty dizzy in the emergency department," he said. "This means we'll all have to figure out more of what's working and what's not."

Many departments, including those in the UM Medical Center, are responding by changing protocols to get patients who need to be admitted into hospital beds faster, rather than "boarding" them in the emergency department, Hirshon said. Hospitals are also adding staff in peak hours.

St. Joseph employed the "Lean Method," adapted from the auto industry. The idea is to view the system from the customer's perspective and cut unwanted service and waste, said Dr. Jody Crane, an emergency medicine faculty member at the nonprofit Institute for Healthcare Improvement and an emergency room doctor in Virginia.

He offered some examples: Don't have patients tell their story to a triage nurse and then again to a doctor. Don't conduct unnecessary tests.

Crane said hospitals that advertise but don't make such changes will quickly become overwhelmed if patient volumes increase, and that will ultimately cost future business in other parts of the hospital where insurance reimbursements are far higher – not to mention patient care.

"In the last five years there has been some really good new models developed from manufacturing and other operations and things are really starting to change," he said. "But the movement has been slow. It'll take another five or 10 years before you see dramatic change in the way emergency departments are run. ... All the marketing now — on websites and billboards, iPhone apps and tweets — is because the technology is available and cheap."

At St. Joseph, where 50,000 patients a year visit the emergency room, officials didn't know how many people would check the new website service. But Dr. Cunningham said real changes were made because hospital officials realized that about half of the hospital admissions were coming through the emergency department. Patients not only needed to be more efficiently treated, but they needed to have a good experience so "they consider St. Joe's for anything else," he said.

Lyon, the dad who was waiting for his daughter's foot to be X-rayed, said the effort was appreciated.

"You always think about how long you'll be there," he said of the emergency department. "With four kids, I've been through it. I've waited. I think it's great they're paying attention to the patients. Our time is valuable, too."

At Harbor Hospital, Dr. Michael Silverman, chairman of the Department of Emergency Medicine, said hospitals, including his, are changing the protocols and also the culture, especially when it comes to treating patients with less urgent conditions such as a sprained ankle, poison ivy or a sports injury.

"In a perfect world you're seen and you don't have to wait, but the world isn't perfect and sometimes we're overwhelmed," he said. "But ultimately, patients need to recognize that most of the time they have a choice and shouldn't accept long waits because that's what their experience has been."

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