Patients Have No Fury Like a Wait in the Emergency Room

ER wait times were the most frequent and vigorous complaint I received when I was in the hospital C-Suite. Most of the calls I got at home after hours and even in the middle of the night (my home phone was in the admission kits) were either about patients seeking opioid pain medications or wait times – and sometimes both. The research found that - no surprise - longer wait times were also linked to lower patient satisfaction.

Wait Times Skyrocket After Hospital Merger

My colleagues and I became interested in ER wait times when we read an article critical of Ballard Health, a 20-hospital system in the southwest and northeast corners of Virginia and Tennessee. Six years ago, legislators in both states waived anti-monopoly regulations to create Ballard Health. In that time, wait times have tripled, exceeding standards set by state officials.

In its annual report, Ballard Health states the median wait time is 11 hours; the data excluded patients who left the ER without receiving care. According to 2019 federal data (the last year the metric was applied before being retired), the system ranks among the country's slowest ERs. However, according to 2022 Joint Commission data measured at 250 hospitals, the average ER wait time is shy of six hours. A Ballard spokesperson blamed the long times on the nursing shortage and fewer patients being admitted to nursing homes.

Long Waits are Linked to Worse Outcomes

A 2021 study found that:

Prolonged waiting times are associated with worse patient experience in patients discharged from the emergency department (ED)… Prolonged door-to-doctor time was significantly associated with worse patient experience in discharged patients and patients with hospital length of stay ≤4 days. Prolonged ED waiting times were significantly associated with worse patient experience in patients discharged from the ED and in inpatients with short stays. Door-to-doctor time seems to have the highest impact on the patient's experience of these two groups.

Other studies have concluded that wait times – in the ER and doctors' offices– influence patient satisfaction. I did note a bit of good news:

A development that is likely decreasing emergency room and doctors' office wait times is the increase of alternative healthcare facilities. For non-emergency after-hours issues, patients can use an urgent care clinic. If they're unable to get to their doctor at a convenient time, they can turn to a walk-in clinic. Walk-in clinics and retail facilities showed patient wait times of 30 or fewer minutes without an appointment… According to the 2018 Vitals study, there's a strong correlation between how long a patient had to wait and the star rating of the healthcare facility. Physicians with the highest rating had an average wait of just over 13 minutes, while those with the lowest had average wait times of more than 34 minutes.

The Key is Effective Communication

While serving as servant-leader CEO of a 90-bed, rural, regional hospital, reducing ER wait time was a top strategy in reversing the hospital’s fortune. Upon starting in the position, I outlined with managers what the data revealed as opportunities for the hospital, which included reducing ER wait times to improve both outcomes and patient satisfaction. I advised staff that I wasn't going to figure out the solutions; they would rely on the LEANprocess to make changes. These staff solutions included:

Making rounds in the ER waiting room: An informed patient is more satisfied. The ER staff created a protocol that every 30-40 minutes, a staff member – sometimes a nurse, sometimes a tech, and sometimes myself when making rounds – would go into the ER waiting area during heavy volumes. We would make an announcement: "I'm sorry you have to wait; I know you don't feel well. Several severely ill or injured patients have arrived by ambulance, and the doctors and nurses are working as quickly and safely as possible to get you seen." This interaction was greatly appreciated by patients/families and calmed them down as they felt heard and respected.

Setting up an “in-between” unit: To open beds, the CNO and his managers opened a waiting area in the nearby old ER to move patients ordered admitted out of the ER while they waited for a bed on the floors. The unit was compliant with billing regulations.

Posting patient satisfaction scores: Monthly patient satisfaction scores were posted on all units where both patients and staff could see the results. Teams were set up to act on low scores and authorized to recommend changes in service protocols, which the C-suite almost always approved.

The results were that in about 18 months, the hospital saw its Medicare/Medicaid payer mix decline from about 70% of the payer mix to less than 60% some months as commercial insurance patients in the community quit driving to another hospital 45 minutes away. When the mix dropped to closer to 60%, this hospital would achieve a $1 million or more net revenue per month. Reducing ER wait times is a win-win. - John W Mitchell, MS blogs at https://healthcarecsuite.com/