How Hospital ERs are Slashing Wait Times
At New York-Presbyterian/Weill Cornell Medical Center (NYPWC), ER wait times were up to two and a half hours for low-acuity patients.
Longer wait times in hospital ERs contribute to overcrowding and delays in medication administration for patients with mid-level injuries and illnesses like broken bones and infections. Patient mortality rate is also higher when ER wait times are longer, though usually only by a small margin. According to one study, patient mortality rates rose from 2.5% with a wait time under two hours to a rate of 4.5% for patients waiting 12 hours or more.
To combat their consistently long wait times, NYPWC began utilizing telehealth in its emergency department. All low-acuity patients experience the same onboarding experience: triage nurses ask for the primary complaint and take patient vitals and an NP or PA examines the patient to ensure stability. If a patient is deemed to be in stable condition, they are eligible for the hospital’s express service. Express patients are then sent to their own room where they have a video conference with affiliated physicians in other areas of the NYPWC health system.
Fig 1 Data provided by Definitive Healthcare and the CDC.
Since the express telehealth service was launched in July 2016, average hospital ER wait times at NYPWC have plummeted from around 150 minutes to 18 minutes according to Definitive Healthcare data.
Other hospitals are using a more hands-on technique with people in executive leadership positions. A study done at the Oregon Health & Science University (OHSU) studied 12 ER hospitals nationwide: 4 high-performing, 4 mid-performing, and 4 low-performing.
The study found that the hospitals with the lowest wait times had the highest levels of support and involvement from executives. These hospitals also emphasized care coordination between all members of the hospitals’ staff, from clinicians to custodians, and had high levels of staff accountability. Finally, the report found that the top-performing hospitals used real-time data analytics to adjust workflows and direct staff members according to current needs.
Yet another approach to ER overcrowding deals with the hospitals’ floorplan itself. Bon Ku, an emergency physician at Thomas Jefferson University Hospital (TJUH), has sent students with iPads to map the movements of doctors, nurses, technicians, and patients for the past two summers.
The data Ku’s students gathered was then compiled into “heat maps” showing where physicians got caught up. They discovered physicians were spending too much time at computers entering patient data, and not enough time actually seeing and listening to patients face-to-face. With the popularization of EHRs, care providers are spending an increasing amount of time on digital medicine and data entry, decreasing the amount of time they are available to be with their patients.
The care team at TJUH has considered placing keyboard stations inside patient rooms in the ER so providers can enter information in real-time rather than attempting to input all the information after the visit. They have also considered using scribes so providers can focus on caring for their patient while another staff member documents it.
Another potential solution to disruptions in ER workflow could be the layout of the facility itself. A study from the Robert Wood Johnson Foundation found that hospitals with shorter distances between delivery rooms delivered fewer babies by cesarean section. When rooms are arranged in clusters or pods, providers are able to move and work more efficiently than when rooms are set along a hallway. LEAN programs have already begun implementing layout design changes to maximize efficiency, but not all hospitals have the time or money to invest in completely rearranging their emergency departments.
Top 10 Hospital ERs with the Highest % of Patients Leaving Before Being Seen
|Hospital||% of Patients|
|Richmond University Medical Center (NY)||29%|
|UnityPoint Health – Pekin (IL)||17%|
|NYC Health and Hospitals – Lincoln (NY)||15%|
|University of South Alabama Medical Center (AL)||14%|
|UMDNJ University Hospital||13%|
|Culpeper Medical Center (VA)||12%|
|Aurora Medical Center – Kenosha (WI)||11%|
|Texas Health Center for Diagnostics & Surgery Plano (TX)||11%|
|Harbor – UCLA Medical Center (CA)||11%|
|University of California Davis Medical Center (CA)||11%|
|Avg total %||14.4%|
Fig 2 Data from Definitive Healthcare, excluding DOD and VA hospitals
One of the easiest solutions to ER overcrowding could be to educate patients on what constitutes a visit to the emergency department. A study from UC San Francisco (UCSF) found that nearly 3.3 percent of all ER visits over the past seven years led to patients being sent home without any administered care. That is nearly 14 million patients whose visits to the ER were unnecessary and clogged necessary care for other patients.
These visits were primarily due to toothaches, back pain, headaches, throat soreness, and psychosis-related issues. Emergency departments are designed to care for patients with life- or limb-threatening issues, not specialty care. But some patients might not know where else they should go.
For patients, it can be difficult to determine when they should visit the ER or an urgent care clinic. While ERs are for imminent danger, urgent or express care clinics are better equipped to handle fevers, sore throats, sprains, fractures, and other immediate—but not life-threatening—health concerns.
In some areas of the country, patients may visit the ER because they have few or no other choices. In the mid-south, dozens of patients may visit emergency departments between 60 and 80 times per year. For those with chronic pain, an ER may be the only place to get relatively fast relief, especially if their primary care physician isn’t knowledgeable about their particular illness. This new knowledge of “high-utilizers” and avoidable ER visits has alerted care providers to a lack of patient services—particularly surrounding mental health, dental care, and specialty services.
Top 10 Hospital ERs with the Longest Average Wait Times
|Hospital||Avg Minutes Waited Before Being Seen|
|Southern Regional Medical Center (GA)||155|
|Barnes – Jewish Hospital South (MO)||127|
|MedStar Washington Hospital Center (DC)||125|
|Piedmont Henry Hospital (GA)||124|
|MedStar Southern Maryland Hospital Center (MD)||117|
|Sinai Hospital of Baltimore||112|
|Saint Agnes Medical Center (CA)||112|
|Bascom Palmer Eye Institute (FL)||108|
|Mondanock Community Hospital (NH)||107|
|NYC Health and Hospitals – Kings County (NY)||101|
|Avg total wait time||118 minutes|
Fig 3 Data from Definitive Healthcare, excluding DOD and VA hospitals
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