If your neighbor mentions that they had to make a trip to the emergency room, your second question after “what happened?” is likely “how long did you have to wait?” The ER generally ranks right up there with the local Department of Motor Vehicle office as a place that imposes miserably long waits on users. There also seem no easy solutions to reducing those waits. The whole point of an emergency room is that literally anyone can walk in at any time. Putting would-be patients on an appointment schedule just is not feasible. Adding more resources is also likely difficult. An emergency room is unlikely to be a big money maker. In an emergency, there is an obligation to treat first and ask for insurance cards later so many of those coming through may be uninsured making collecting the full cost of the services provided difficult.
So why not provide information? Many of those coming into an ER have some discretion in where to seek service. A broken wrist is an appropriate reason to go to an emergency room but does not necessarily demand going immediately to the nearest facility. A network of hospitals in Scottsdale, Arizona, is now exploiting this flexibility (Advertising emergency room wait times gains popularity, Dec 21, LA Times). Scottsdale Healthcare has three hospitals and when you walk into any of them you are greeted by a TV screen with the current wait time at the hospital you are at plus the times at the other two. The differences in waits can be dramatic. The example given in the article is 2 hours and 55 minutes at one but only 4 minutes at another. Needless to say, many people with less pressing concerns are willing to spend an added 15 minutes in the car to shave nearly three hours off their wait. Other hospitals are trying different schemes to provide patients with wait information. Methodist Stone Oak Hospital in San Antonio tweets about waiting time (see here).
While one cannot directly attribute decreased waiting times to publicizing waiting times, both Scottsdale Healthcare and Stone Oak have seen improvement:
At Scottsdale Healthcare’s hospitals, the overall length of stay for patients — from walking in the door to discharge — is less than three hours, a one-hour decrease from that of the previous year, said Nancy Hicks-Arsenault, emergency services systems director. Administrators there are aided by the proximity of their facilities, two of which are located 16.5 miles apart, with the third splitting the distance. Prospective patients whose emergencies aren’t life-threatening can log on to the Internet from home and choose which emergency room to visit based on the wait time. Or, like [patient Len] Balon, they can arrive at one facility, check out the monitor and then head to another hospital. If they have registered and decide to move, all their intake information is transferred for them. …
At Stone Oak in San Antonio, [chief operations officer Jeannette] Skinner, said the staff so closely monitors wait times that personnel try hard to resolve delays when the number ticks up. “It bugs them,” she said. “They don’t like seeing that number get higher and higher . . . so they start to self-assess very quickly.”
It is not surprising that providing a little information can go a long way here. When the wait time differential between nearby hospitals is north of two hours, clearly telling people that can shift a lot of patients to where more resources are available. It helps that the three Scottsdale hospitals are under one corporate umbrella but this seems like something that should work even among hospitals that are ostensibly in competition. No one wins when an ER is backed up. It is obviously bad for patients but it has got to add to the stress on staff who are already in a stressful job. At some level, Stone Oak is already forcing hospitals in San Antonio to play this game. Presumably when they post that the current wait is high, those in the know try a different area hospital instead. The two difficulties here would seem to be to get people to check their Twitter page and to keep the information up to date. Glancing at the Stone Oak’s Twitter feed, they are not exactly providing real-time information. There is also a question of context. If I am fortunate enough that I don’t go to the emergency room often, how do I know what is a bad wait? I understand that 5 minutes is short but is 90 minutes high for local ERs? The Scottsdale approach may therefore be better; people are certain to see it when they are in a position to make a decision (although one suspects that more than one patient has left the ER wishing that he could have been told where the short wait was before driving to the wrong hospital) and getting multiple wait times presides a relevant yard stick.
Two points to note before leaving this topic. First, not everyone thinks that advertising ER waiting times is a great idea (although their complaints seem a little paternalistic):
Dr. David C. Seaberg, an American College of Emergency Physicians board member and dean of the University of Tennessee College of Medicine in Chattanooga, said he worries that it may be sending the wrong message to patients. “Frankly, my opinion is that it’s a very bad idea to put waiting times up on a billboard,” Seaberg said. “When you get seen is a very complex process. . . . To put out a number can be misleading.” Any hospital’s emergency room can change at a moment’s notice if there’s a serious crash or other multiple-injury event. … Some conditions should move people to the front of the line, no matter what, Seaberg said, but posting wait times might cause people with chest pains, for example, to drive farther when any emergency room would make them a priority. “That’s a real problem,” Seaberg said. “If you’re really acutely ill, we’ll see you right away. It doesn’t matter how busy we are.”
Second, someone is already trying to make a dime on this issue:
Some hospitals are going a step further and contracting with an outside company to help ease the flow of patients. InQuickEr allows people to register at a hospital emergency room on the Internet and hold their place in line. It projects the time that the patient should arrive at the hospital and guarantees that the person will see a doctor within 15 minutes of that time or the visit is free. The service, which costs $2.99 to $24.99, depending on the market, is currently available only at three hospitals in Georgia, Alabama and Florida. But founder Tyler Kiley said that by next year, the goal is to be in 30 emergency departments. “At this point, I think it’s all about efficiency,” Kiley said. “There are so many ways that technology — even relatively simple technology — can be applied to basic customer service issues in healthcare.”
I have to admit that I am a little dubious of this. Running an emergency is a little more complicated than, say, running a Sizzler. A casual restaurant can give out spots on its wait list and provide a fairly accurate wait time. An ER is just much more susceptible to disruption. They may be giving away a lot of free visits.