Tag Archives: emergency room

Hospital sends ER wait times via text

Edward Hospital in Naperville, Ill., has taken the art of making ER wait times available to prospective patients to the next level, the Chicago Tribune‘s Julie Deardorff reports. The hospital, which markets itself as “For people who don’t like hospitals,” has worked to decrease “door to doctor” wait times and are now making it as easy as possible for patients to know just what those wait times are. Folks can get up-to-date wait times online, over the phone or by text message.

A sign in the ER at Beth Israel Deaconess Medical Center in Boston. Photo by kbrookes via Flickr.

According to the hospital’s site, these wait times are “the average time from when a patient arrives and checks-in at our ER to the time when they are placed in a room and treatment begins. The times are updated every 15 minutes based on actual times from the preceding 30 minutes.”

When I tested the service, texting “ERwait” to 41411, I got the following response:

Edward ER Wait Times: Naperville ER 2 minutes/Kids’ ER no wait, Plainfield ER 1 minute, visit us at www.edward.org/ERWaitTimes

It seems effective enough, though I have to wonder just how many people in need of emergency medical attention are going to have the number and requisite text handy.

You might recall that HealthLeaders Media wrote in January about the increasing number of hospitals that post wait times on their websites.

Why ER wait times are all-important

In a recent and conveniently relevant blog post, veteran South Carolina ER doctor Edwin Leap (bio) described how lengthening wait times can bring an emergency room to a “screeching halt.”

At that point, a helplessness descends on the nursing and physician staff. Wait times creep from two hours to four, four hours to eight, eight hours to ten. Only those who are obviously the sickest come back for care. Remarkably, on some of the busiest shifts ever, I discover that I have seen the fewest patients. If the pace were like normal, I could burn through ER visits like crazy; so could my partners. But when the numbers waiting climb, when the patients being admitted and held grow to legions, then speed is dead.

These are the dangerous times. These are the times when the sickest sometimes give up and go home. And the times when overwhelming amounts of data crush clear thinking.

It’s an evocative picture and one that Leap characteristically blames on the mission creep suffered by ER departments around the country. His laundry list of the extra responsibilities crushing today’s emergency rooms — “chronic pain” sufferers shopping for pills, constant chest pain and cardiac care, and basic primary care — should be familiar to anyone familiar with emergency medicine issues, but there were a few that stood out. The most telling was his rant about ERs as mental health facilities.

Mental health holding centers. A private, nationally known chain of mental health centers used to advertise: ‘if you don’t get help here, get help somewhere.’ That is, the ER. Call a suicide hot-line and you’ll be directed to an ER. It doesn’t matter that many facilities (like ours) don’t have psychiatrists or even counselors (except by tele-psych). It doesn’t matter that they take up beds, languishing in line for commitments (which seem to be growing exponentially in number). It doesn’t matter that the law requires us to pay one on one observers (and if they are RN,’s they get RN pay to read novels at $25/hour). It doesn’t matter that we don’t have the security to manage it. We are the last common pathway, so that someone, somewhere can feel good that ‘at least he’s finally getting the help he needs.’ No, he isn’t. He’s getting observed and largely ignored until we can send him somewhere else.

Leap always writes with a chip on his shoulder, but it reaches a crescendo when he decries the role of ERs as “guilt assuaging centers” for fellow physicians.

Call any doctor’s office. ‘If this is an emergency, hang up and dial 911.’ All you need to do, to do the right thing, is send someone to the ER. No matter how many stretchers are lined up in the hall, or how many schizophrenics or arrested drunks are screaming and terrorizing the little children with fevers.

Even when taken with a grain of salt, Leap’s writings bring across the chaos and urgency of the emergency department and highlight the way that it all revolves around that one magic number: The wait time.

Posting ER wait times online: Gimmick or service?

Writing for HealthLeaders Media, Cheryl Clark looked at the growing number of hospitals that are posting their emergency room wait times online.

Clark describes the practice as a “marketing strategy” that may help hospitals snag market share and improve the patient experience, and quotes physicians calling it a “gimmick” that may actually hurt patients by encouraging them to delay ER visits until the line gets shorter. Clark also spotlights a more disturbing version of the system, one which allows patients to pay online to reserve a spot at the head of the ER waiting line.

waittime
Sacred Heart Medical Center in Eugene, Ore., uses a system of infrared tags to monitor ER wait times and post them online.

(Another system) allows patients to buy, for $24.99, the ability to register online for a place at the head of the emergency room wait line at participating hospitals. The concept, called InQuickER—”Skip the ER Waiting Room”—was developed three years ago as a customer service program.

The patient prints out a confirmation number with instructions for what time to be at the hospital so they don’t have to wait.

So far, three hospitals have signed up: Emory-Adventist Hospital in Smyrna, GA, Florida Hospital Waterman in Tavares, FL, and Infirmary West in Mobile, AL.

22 percent of kids’ hospital visits sports related

The Agency for Healthcare Research and Quality has sifted through the numbers in the 2006 report “Sports Injuries in Children Requiring Hospital Emergency Care” and come up with some interesting observations.

Photo by emrank via Flickr

  • Twenty-two percent of kids’ hospital visits came on account of sports-related bruises, scrapes and broken bones
  • Three times more boys than girls needed hospital treatment for sports injuries
  • Teens were five times more likely than younger children to need sports-related emergency room treatment
  • In almost 99 percent of sports-related emergency room visits, the children were treated and released without hospitalization

Two vaccines keeping kids out of ERs

Maryn McKenna writes in Annals of Emergency Medicine that the impressive recent success of rotavirus and pneumococcus vaccines has caused emergency room doctors to ask “Where have the kids gone?”

The vaccines, Prevnar and Rotateq, were introduced earlier in the decade, and their effects are beginning to be felt across the country.

The benefits of such sharp changes in incidence include not only reduced burden of disease but reduced health care utilization and cost; one 2007 study found that, thanks to Prevnar, annual hospitalization and ambulatory expenditures for children younger than 2 years shrank 45% between 1999 and 2004, from $688.2 million to $376.7 million.3 There are more subtle effects as well, some as simple as reducing the stress on a child and his parents because less blood work means fewer needle sticks during an ED stay.

Interestingly, McKenna found physicians worrying that colleagues who entered the profession after these vaccines hit the market would be underexposed to cases of the now widely prevented diseases, and may thus find it difficult to recognize them if or when they do occur.

Physicians who have been in the specialty long enough to have experienced the introduction of Hib vaccine in the mid 1980s, with its extraordinary suppression of bacterial meningitis, and the subsequent introduction of Prevnar, caution that success brings its own risks as well. The lower the incidence of a disease, the less likely younger physicians are to experience it in their training — and thus the more careful medicine must be to make sure certain procedures are still taught.