Patients can text EDs for wait times

Average door-to-provider time also posted

EDs at a number of Hospital Corporation of America (HCA) hospitals in the Southeast are using "new media" to inform patients of their average wait times over the past several hours. These times have been posted on hospital web sites, digital billboards, and most recently, via text messaging.

"The copy on the web site [www.egulfcoastmedical.com] says these wait times represent a four-hour rolling average taken every 30 minutes for the time from arrival to the time patients are being met by a health care professional," explains Scott Pennington, RN, the ED education coordinator at Gulf Coast Medical Center in Panama City, FL. The copy also states that the times are given for informational purposes only.

"Part of our message is we want to give the patient as much information as we can so they can make an informed decision before they ever leave for the ED," says Pennington. "Of course, we also tell them that if there is a medical emergency, they should call 911."

Sheila Bradt, BSN, director of the ED at Gulf Coast, says this approach has engendered several significant changes. "We've seen an uptick in our census of between 10% and 20%," Bradt says. "We have a unique situation here where our competitor owns the ambulance services, so we have seen the growth exclusively from walk-ins, not EMS."

Anecdotal evidence indicates a connection between the wait time texting and the census increase. "We've seen patients who sat waiting in our competitor's lobby text our wait times, come here, and never go back," says Bradt.

In addition, she says, patient satisfaction rates have risen, according to surveys taken by The Gallup Organization. In 2007, 51% of the ED patients surveyed said they were "always" satisfied with their treatment; in 2010, that figure had risen to 61%

Finally, says Bradt, these new processes have had an impact on the staff in terms of their commitment to meeting targeted flow times. "There's a lot more sense of urgency on the part of the staff since our performance is being measured and the public can see it," she explains.

Laying the foundation

Changes like these cannot occur in a vacuum or without extensive preparation, the ED leadership explains.

"In preparing for our wait times to be out there for the public to see, we looked at what processes we needed to improve on — what we were already doing, and what we could do better," Bradt notes.

So, for example, the department instituted "immediate bedding with triage." A quick registration is done in the front by the RN greeter, who also conducts a rapid triage. Full registration is conducted in the back in a fashion that is consistent with EMTALA guidelines.

"We've also changed our staffing patterns after studying historical data," Bradt says. "And we don't just look at the previous year. We review it every couple of months, so we are constantly changing staffing to meet flow demands."

HCA has several key measures its EDs seek to meet, and Bradt is pleased with the performance of her ED since the process improvement began. "Two years ago our arrival to triage time was 45 minutes, and it's down to three minutes," she shares. "Time-to-physician was greater than an hour, and now it's down to 30 minutes."

Sources

For more information about making ED waiting times available through electronic media, contact:

• Sheila Bradt, BSN, ED Director, and Scott Pennington, RN, ED Education Coordinator, Gulf Coast Medical Center, Panama City, FL. Phone: (850) 747-7900.

Education precedes publicized wait times

Before the ED at Gulf Coast Medical Center in Panama City, FL, could begin informing the public about its wait times, the public and the ED staff had to receive targeted education, says Scott Pennington, RN, the ED education coordinator.

"We had to educate the public on wait times and what they stood for, so they understood it represented time from sign-in to providers, which was averaged over the previous four hours," he explains. "We wanted to give prospective patients a realistic idea of what the time meant. We wanted to be clear."

Pennington worked closely with the marketing department to accomplish this goal. There were notifications through print and broadcast media outlets. Media representatives also were brought on-site to see and hear from staff and physicians. The staff and physicians also appeared on local radio and TV news programs. In addition, the hospital's advertising campaign addressed the new notification processes.

Pennington adds that Gulf Coast Medical also has an active community health educator. Regardless of the announced topic, he says, the educator would always include an explanation of the ED wait time as part of the presentation.

Digital billboards were placed in the ED waiting room to remind people what the wait time actually was. "I think this is very valuable because it answers some questions the patient may have," says Pennington. "An educated patient is definitely the way to go."

In addition, Pennington educated the nurses about the key Hospital Corporation of America (HCA) flow measures they were to strive for, to help ensure positive performance numbers when they were shared with the public. "The key was to let the nurses know what the times were and to encourage them to find out what they could do reduce the waiting times," he says.

Sheila Bradt, BSN, director of the ED, says, "There was also new staff scripting. If a patient calls and asks for the waiting time, their response is always, 'the average wait time in the last four hours has been . . .'"


Clinical Tip

Faster flow means better quality

The faster you work on patients who initially present in your ED, the better care they are likely to receive, says Sheila Bradt, BSN, director of the ED at Gulf Coast Medical Center in Panama City, FL. "The best place to treat patients is in the back," Brandt says. Placing patients in a care area improves satisfaction, reduces medical "surprises," and allows diagnostic testing and treatment to begin more quickly, she notes.

Programs such as LEAN have tools that allow reduction in processing times, Brandt says. "If you cut out wasteful steps, you improve your quality and customer satisfaction," she says.