A while back we posted about Scottsdale Healthcare an Arizona not-for-profit with three hospitals that has been a leader in a movement to post emergency room waiting times. Go to their website and you will see something like the above image telling you the wait in each of their emergency rooms. Thus, if you are dealing with a problem that is urgent but not life threatening (e.g., is that ankle sprained or broken?), you can trade off the discomfort of a longer drive with a possibly longer wait.
These times are updated every three minutes and are based on the wait of the most recent patient. Thus if that patient was the last of a burst of arrivals, a new arrival’s wait could be much less. One can similarly concoct similar scenarios in which what’s on the web gratuitously under-reports how bad the wait is. Still, it is a reasonable first pass at a wait and certainly more information than most people have when deciding where to go for aid.
Now we have a follow-up story from amednews.com (Posting emergency wait times: Good marketing or good medicine?, Oct 11).As the article’s title suggests there are still naysayers on this practice.
But the growing trend could lead to misuse. Patients could self-triage in a dangerous way. There could be inappropriate use of the emergency department. There also might be a misplaced emphasis on door-to-doctor times versus more meaningful measures, such as how long it takes for an ED patient to be admitted or discharged once their care is completed.
So these break down along the lines of people may be stupid and caregivers may be given bad incentives. On the former, the concern is that people will opt for long drives or stay home because they are overly sensitive to waits. While I generally believe that it is never good to underestimate stupidity, this seems a bit much. As I said above, I am not sure that I would think to look at a Twitter feed when faced with a medical emergency. That is certainly clear if the emergency involved, say, chest pains. This really is about sprained vs broken ankles so this concern seems overstated.
Concerns about bad incentives may be more relevant:
If hospitals begin to compete on this and other wait measures, patient care could be compromised, Dr. [Dino] Rumoro [chair of the Dept. of Emergency Medicine at Rush University Medical Center in Chicago] said.
“If you want to just pit a couple of emergency departments against each other and see who has the fastest throughput times, well, you just bypass the ordering of any tests,” he said. “I can get you a throughput time of 10 minutes and you’re out the door — here’s my assessment based on a physical exam only.”
A point here is that you don’t need to publicly publish numbers for this to be an issue. Have the COO get a bee in his bonnet about ER waits and you will likely hear griping that care may be compromised.
But has this played out at Scottsdale Healthcare? So far, no.
The hospitals publicly posting their waits appear to be seeing patients quickly, with times often listed as less than half an hour. However, no peer-reviewed medical study has examined the effects of the practice on patient outcomes, experts said.
Scottsdale Healthcare began posting wait times in April 2008 at its four EDs, all of which are within about 15 minutes’ driving time of one another in the city (two — a general ED and a pediatrics ED — are housed at the same center). Its patient satisfaction scores have improved by 2 percentage points, said Nancy Hicks-Arsenault, RN, the organization’s systems director of emergency services. …
Before the hospital’s four EDs started posting wait times, which reflect the most recent patient’s experience, patients waited the longest at Scottsdale Healthcare Medical Center Osborn, a Level I trauma center and stroke center. Now patients are more evenly distributed among the system’s EDs. … The patient population being served in the organization’s EDs has a similar level of acuity as before the wait-time postings began, Hicks-Arsenault said.
So patients are happier and they are doing what you would hope — moving away from the most congested facility to less used resources. Even better, you are keeping the relative Mickey Mouse cases out of the trauma center that is needed for the most critical cases.
There is, of course, a study here that is begging to be done. I would not be surprised that the results of Scottsdale Healthcare could be replicated if you have one organization controlling multiple ERs. It is in Scottsdale Healthcare’s interest to give accurate data. Yes, they might scare you away from one hospital but they have a very good chance of still getting your business because they are effectively directing you to another one of their hospitals. This may not work as well if only one hospital is reporting wait times.