Picture this: A nearly empty emergency department (ED) waiting room with virtually no wait time. Hard to imagine? For most of us, it certainly is. In the world of healthcare, there lies an unspoken roadblock when you enter the ED. At first glance, people can usually decipher the status of the room—is the room packed or relatively calm? Then comes the million-dollar patient question, “how long will I wait?” Ideally, when seeking healthcare, each of us would like to hear “how can we help you today?” versus “we will be with you as soon as possible.”
Unfortunately, most of us know that this is not a common case, especially when visiting the ED with a low-emergency or quick in-and-out case. “Access and wait time challenges exist for patients and families—as well as for providers—throughout the nation,” states the Institute of Medicine. Long wait times generate negative effects on health outcomes, patient experience, healthcare utilization, and your organization’s reputation. When there’s no doubt over the drawbacks, why is this a seemingly unsolvable issue?
The root of the triage problem
As we dive deeper into the problem of the traditional ED model, we first must recognize the concept of “triage.” First utilized during the Napoleonic Wars, triage is the process of deciding the order of treatment based on the urgency of the wound or illness. Given the overwhelming amounts of injuries and causalities during battle, it was impossible for military medics to supply enough physicians to meet every soldier’s needs—therefore, doctors had to develop a way to quickly sort and prioritize. However, efficient as triage may seem in today’s healthcare system, many patients end up caught in the middle, with long wait times. As obvious as it may appear, to prioritize treatment, quick in-and-out cases and emergencies go first. Frustration arises for those stuck in the middle because they have the longest wait times—especially when things get hectic.
The legacy of triage is still implemented in today’s ED system. Using triage to the best of its ability is crucial when it comes to the proper ratio of patients to physicians. It’s no surprise that nights and weekends see the highest levels of patient demand, given that this is when most people are off work and have time to seek care. However, this also means these are the least desirable times for ED doctors to work due to other commitments and wanting to spend time with friends and family. This results in a high patient volume and high stress environment for everyone. In fact, according to the Centers for Disease Control and Prevention (CDC), today’s patients spend an average of two hours in the ED. These longer wait times may be associated with poorer health outcomes and financial burden from those seeking non-network care. Despite the many challenges, the opportunities for the ED to improve remain endless.
Staffing to demand.
Hospitals should run continuous assessments that monitor and realign patient supply and demand ratios. Although the patient volume is higher during nights and weekends, the demand is nonetheless predictable. According to Med Page Today’s Kevin MD, the problem is staffing adequately in order to keep up with the high demand.
For example, your staff to patient ratio during the weekdays may suffice, however, higher volumes at night and weekends call for more caregivers to balance out the ratio. Though the triage model helps to fluctuate patient demand, an overflowing waiting room can be dangerous. “Overcrowding the ED has been associated with increased patient mortality, increased length of stay, and increased costs for admitted patients,” states Health Catalyst. Poor staffing greatly affects the patient’s safety and negatively impacts the patient experience. Due to low supply and high demand on night and weekends, these are relatively unfavorable times to work for all departments, not just physicians.
Chaim Bell, a physician and researcher at Mt. Sinai Hospital in Toronto, knows this problem well saying. “…virtually no allied health professionals over the weekend means that there is often a delay in discharging patients over the weekend.” It’s important for healthcare institutes to maintain strong physician and employee engagement, so offering incentives to physicians who work these less desirable shifts can help keep them on board and highly engaged.
24/7 scheduling access.
By its emergency nature, the ER cannot operate like a deli counter where it’s first come first served. And although triage aids the ED’s effectiveness, there’s always ways to improve. Offering online check-ins improves both the registration process and the process of triage by getting a step ahead. Online booking becomes more practical for those who may not need urgent assistance, but still need timely assistance. Because of digital communication constantly expanding, EDs without online booking can fall behind. Online booking should also offer the health assessment questions that the doctors are already going to ask. Sharp Healthcare Medical Group, for example, began their online check-in journey in 2013. According to their reports, their patient satisfaction ratings reached 96 percent. Online booking is Sharp Healthcare Medical Group’s preferred way of booking over calling to make an appointment because of the efficiency and timely assistance it allows. In urgent situations, calling to make an appointment works, but online booking is a more effective use of time for both the patient and physician because it allows the staff to more efficiently triage the patient.
Of course, an empty waiting room is great to see, but the real benefits of efficient ED include timely care for those who need it and a better patient experience and satisfaction. “We are the leaders in a new era of advanced predictive analytics for population health and value-based care,” states Health Catalyst. It’s important for hospitals to identify their possible barriers that slow down the efficiency and address the problem. It’s time to hear more of “how can I help you today?” and less of “we will be with you shortly.”
Sources and further readings