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Posted wait times an added advantage to multi-facility systems?
Impact on load-balancing to be studied by system
Given that patients are keenly interested in wait times, an increasing number of EDs across the country are taking advantage of new media to make this information more accessible to the public.
For example, many EDs enable consumers to access wait times online or via text on their cell phones along with a promise that patients will be seen quickly. When done well, such a strategy can boost volume, as well as patient satisfaction, but for health-care systems that operate multiple EDs in a given metro area, it also offers the potential advantage of directing patients to the least busy EDs so that bottlenecks are avoided and patient flow is evened out across the system.
With six adult EDs and one pediatric ED operating in the same region, Memphis, TN-based Methodist Le Bonheur Healthcare is uniquely situated to reap some gains in efficiency from the posting of ED wait times, which the health system began doing in August of 2010, explains David Cummings, RN, CEN, corporate administrator, patient care operations, at Methodist Le Bonheur Healthcare.
"That is why we are looking at our arrivals by zip code to see if there is some load balancing of non-acute patients," says Cummings. "Our EDs are very strategically located in different quadrants of the city, so one of the things we are looking at is to see if there is a shift. People from one zip code might go to a different hospital based on wait times. There is nothing out there really published on this, so we will probably do a case study about our experience. We are trying to look at it fairly scientifically."
In addition to mapping arrival by zip code, Cummings says the hospital will also be tracking market share by payer mix to see if the posted wait times are linked to any changes.
While the impact on load balancing has yet to be determined, one result is already clear: Since the hospital began posting ED wait times at all of its adult hospitals, volume is up by 6% to 10%, says Cummings. Despite the increases, the leave-without-being-seen (LWBS) rate ranges from just 1% to 2.1%. "We have very good processes in place and good throughout upstairs, so we have the capacity to see more patients in an efficient way," adds Cummings.
Get your house in order
It is clear that posting ED wait times can be a good way to win business, but it is important to have your house in order first, emphasizes Marty Carr, MD, the medical director for the health system's emergency departments. "A couple of years ago, we undertook a project to make all of our EDs more efficient, and to get people in and out faster," he says, noting that the initial goal was to get people seen by a provider within 30 minutes of arrival. "Everybody thought that was pretty insane at first, but we time stamp everything [through our EMR], and we can follow the process and see where problems are. We did that, and times started to come down."
With such improvements in place, it was a not big deal to the clinical staff to post the wait times online. "It doesn't change our wait times. It just makes them more available to the public," stresses Carr. "We were already good, and this just shows what we do."
At press time, two of the health system's EDs were offering guarantees that patients would be seen by a provider within 30 minutes of arrival, and the remaining EDs were expected to offer similar guarantees shortly, according to Cummings. However, he says the health system has no plans to post the wait times for its pediatric ED, which is part of the health system's children's hospital.
"We chose not to post our children's ED wait times because we didn't want people to be confused and maybe go to another ED when they really needed to go to the children's center, even if the wait time is a little bit longer," says Cummings. "We take care of kids at all of our EDs, but we really want our kids to go to our designated pediatric, level one trauma center hospital."
Fortunately, since the EDs at Methodist Le Bonheur had already transitioned to an electronic medical record (EMR) by the time the posting of ED wait times was even discussed, there was no need for additional IT investments, explains Cummings. The health system uses an EMR platform developed by Kansas City, MO-based Cerner Corporation, and Cummings had already worked with the health system's IT group to put mechanisms in place to regularly retrieve key performance measures from the EMR.
"Within the Cerner platform, we created a real-time dashboard for people on the front line to proactively manage the ED, and that development gave us the ability to publish the [ED wait time] data," says Cummings. "We had the ability to do this, and it happens automatically. The data get [refreshed] every two minutes."
Differing definitions a marketing challenge
Posting ED wait times makes sense from a marketing standpoint, to be sure, but Cummings stresses that the practice is also in line with the health system's mission and philosophy.
"Our organization is very big about transparency in our quality measures and quality metrics. We post many of our quality measures online already, so to try and continue that transparency ... we wanted to let the community know what they could expect from our EDs," adds Cummings, noting that many people assume that when they go to the ED, they are going to have to sit and wait. "We wanted to help dispel that myth, at least in our EDs, where our patients are seen by a provider in a room. They're not just sitting out in a waiting room."
In fact, one of the marketing challenges that Methodist Le Bonheur has run into is that now one competing health system is posting an ED wait time as well, but it is posting the wait time until a patient is placed in a bed as opposed to the time until a patient is seen by a physician, nurse practitioner, or physician assistant the standard used by Methodist Le Bonheur, explains Cummings. "Patients aren't [in the ED] to get into a bed. They are there to see a provider, but I think [the competing hospital] saw the value of posting ED wait times, and they are responding to our campaign for a reason," he says.
The concern, says Cummings, is that patients may not discern the difference in the two standards being used to describe wait times. "They are not measuring the same thing that we are measuring, and the public probably doesn't know the difference," he acknowledges. "What we are publishing is the average door-to-provider time over the previous hour, but there are lots of ways you can play with the numbers."
David Cummings, RN, CEN, Corporate Administrator, Patient Care Operations, Methodist Le Bonheur Healthcare, Memphis, TN. Phone: (901) 516-2357. E-mail: firstname.lastname@example.org.