Sometimes the most helpful patient services are the simplest to develop. At least that was the case for Edward Hospital & Health Services, an integrated health system in the Chicago suburb of Naperville, Ill., when it developed the “Text Click Call” project that allows patients to see ED wait times via mobile devices or the Internet. The project required no dedicated budget and only took two months of time to develop.
The “Text Click Call” project earned Edward Hospital recognition as a finalist in the 2011 Healthcare Informatics Innovator Awards program. That program recognizes leadership teams from patient care organizations—hospitals, medical groups, and health systems—that have effectively deployed information technology in order to improve clinical, administrative, financial, or organizational performance.
Bobbie Byrne, M.D., Edward's CIO and a pediatrician by specialty, says the impetus of this project was two-fold. Foremost, was for patients to see Edward's short ED wait times compared to its competition. “Our emergency department really works hard on their door-to-doc time,” says Byrne. “They wanted to make sure that people who could choose between competitive hospitals that may have long waits in their ER would know that this is something that Edward is focused on and typically has very short waits.”
Another reason to implement this project was the close proximity between Edward's two emergency department locations, one in Naperville and one in Plainfield, which are about 12 miles apart. Naperville has an adult emergency department and a pediatric emergency department. About 30 percent of the Edward Hospital service area lives either in between the two facilities or within a 15-minute drive of either facility, so knowing which ED has the shorter wait is helpful to patients, says Byrne.
The challenge the project tackled was to balance volumes and wait times between the two locations, as well as indicate the expected wait time for the three sites of care: Naperville Pediatric ED, Naperville Adult ED, and Plainfield ED. Patients could then choose which site to receive care and understand the expected wait time.
Mining Treatment Times from the EHR
The "door to treatment" wait time, which is the average time it takes for a patient to begin treatment, at both Edward facilities is often less than 10 minutes. The quality of the patient experience is very good in both EDs, says Byrne, with Edward Plainfield ED having the highest overall Press Ganey patient satisfaction score of more than 1,000 hospital EDs in the spring of 2010.
The wait times are updated every 15 minutes based on actual times from the preceding 30-minute period of time for patients who were assigned a room during that 30-minute span. Edward uses the Magic electronic health record from the Westwood, Mass.-based Meditech in the emergency department. The time calculation is performed from the Magic ED Tracker Board. Both locations are tracked separately, and the turnaround time between the patient’s arrival and patient’s room assignment is captured and averaged across the number of patients in the population for that 15-minute interval. For each location, the pediatric ED and main ED are tracked separately, based on patient age. This is because in overflow situations they may place an adult in a pediatric bed and skew the true wait times. This data is then moved through a file transfer protocol (FTP) from the EHR to a database server. An active server page then queries the database and displays the times via three methods:
- Via Text: patients can text “ERWAIT” to the number 41411 and receive a text message back with the current wait times.
- Via Phone: patients can call a dedicated phone number and listen to a message.
- Via Internet: patients can click on the Edward Hospital website to see the wait times. The website also delivers information on when to receive emergency care and the locations of urgent care facilities that might better serve their needs.
Budget Neutral Programming
The actual project development took no dedicated budget and only about two months of off-hours work by one Edward programmer. “For motivating technical individuals,” says Byrne, “when they have to do a bunch of boring stuff, [for them] to have a project that they think of as fun and interesting serves both purposes—we get a great project, and they can be challenged technically.”
Since the ED wait time project was launched in March 2010, response has been enthusiastic both in the comments received from patients and in actual usage of the information, says Byrne. In the first six months it was available, there have been 4,780 text requests from 1,892 phones and 732 call-ins from 532 phones. The ED wait times are posted on the front page of Edward website, which gets 57,000 visits per month. Of those visitors, 9,529 individuals have clicked through on the ED wait time button for more information. For those that present for care in the Naperville EDs, an average of 2 to 3 percent of patients claimed to have used the service. For the Plainfield ED, a much higher 13 percent of patients used the service.
Further Applications of the Technology
Edward has this used this technology in another way to monitor and communicate internally the hospital bed capacity, as swings in census impact staffing. “It’s a good communication tool and the health supervisor based on the census can check the status, and then it goes out on digital signage all over the hospital in the physician and surgeon lounges, so they know how busy the house is,” says Byrne.
Since the project was submitted last fall, Edward Hospital has created an iPhone app, so patients can check ED wait times on their smartphones, and Edward’s plans to get its four urgent care facilities online with this technology next.