It is widely known that long emergency room wait times are a persistent challenge for hospitals and health systems across the country. The median wait time from the point of arrival in the emergency room to the time a patient sees a medical professional, or what’s called door-to-doctor, is about 30 minutes, according to 2014 data from the Centers for Medicare & Medicaid Services (CMS). However, the CMS data tracks average wait times by state and the times vary from 46 minutes in Maryland to 16 minutes in Colorado. Data from the U.S. Centers for Disease Control and Prevention (CDC) published in 2014 indicates that the median treatment time was more than 90 minutes. The CDC data also indicated that 41 percent of patients waited 15 to 59 minutes, 27 percent waited fewer than 15 minutes and 13 percent waited one hour but less than two hours.
Data from ProPublica’s ER Wait Watcher site, which uses Google data, estimates the national average ER wait time as 24 minutes, but the site also estimates the average time, nationwide, that patients spent in the ER before being sent home is 135 minutes, or two hours and 15 minutes. With patient volume in emergency departments expected to increase in the next five years as sicker, more complex patients drive up ED care, it is anticipated this challenge of long ER wait times will only grow.
Physician leaders at Milwaukee, Wis.-based Aurora Health Care are familiar with this challenge and this past year the health system deployed a telemedicine solution with the aim of improving patient flow in its emergency rooms with the overall goal of enhancing patient care and providing a better patient experience. The ED technology solution, a tele-triage approach, was deployed first at Aurora Sinai Medical Center last December and the health system recently expanded the technology to Aurora West Allis Medical Center and Aurora Medical Center in Kenosha.
Aurora Health Care is a health system with 15 hospitals and 159 clinics serving areas of eastern Wisconsin and northern Illinois. Aurora Sinai Medical Center is a 177-bed general medicine and surgical hospital located in downtown Milwaukee, and like many other urban emergency departments, the hospital has seen a steady increase in ED volumes, according to Paul Coogan, M.D., president of Aurora Emergency Services and an emergency department physician at Aurora Sinai.
“We now see over 60,000 patients a year, and just a couple years ago, we were under 50,000 patients a year. So we were seeing a gradual increase in our door-to-provider times, and our overall length of stay, so we needed to come up with a solution to help address our increased demand,” he says.
Paul Coogan, M.D.
Coogan continues,” For a period of time, as they’ve done in other ERs, we put a provider out in triage and had that person interact with the patients in triage, and that was pretty well received. But the problem was, you can only cover one site, and that person was putting in orders, but the idea that we could cover multiple sites through a telemedicine product was exciting.”
Michael Rodgers, director of strategic innovations for Aurora Health Care, says implementing a triage approach in the emergency room served as a springboard for the development of the technology initiative.
“We didn’t start thinking that this was the solution that we would end up with. We started with a provider on triage and we’re getting a lot of benefit from that. We actually just thought, ‘how can we actually replicate that?’” Rodgers says.
Aurora Health Care leaders saw an opportunity to work with a local health IT startup company, EmOpti, Inc., based in Brookfield, Wis., on a technology solution that would replicate the triage approach.
“So we used a Lean startup methodology, just like a startup company would use, to quickly figure out what would work the best and we’re continuing on that path as we go forward, with features, functionalities and a road map that we have set up to even take this initiative to the next level,” Rodgers says. “At the end of the day, this is actually what we came up with. Telehealth wasn’t the goal; it was more the outcome to solve a problem, and the opportunity to enhance the care to our patients.”
And, he adds, “One reason we went with this solution is that, to be honest, we didn’t find anything else out there. I know other healthcare systems are starting to dabble in this area, but there’s not a solution out there that we found that could really help with tele-triage and that would really help to build out a system that would enable us to expand beyond just one site, and really make it effective in multiple different areas.”
EmOpti was founded by Edward Barthell, M.D., an emergency physician, and the company develops acute care optimization solutions that utilize command center, analytics and telemedicine technology to enable physicians in support centers to securely interact with multiple acute care facilities simultaneously.
The tele-triage technology solution allows patients who seek care at an emergency department at Aurora Sinai, Aurora West Allis or Aurora in Kenosha to be seen by an Aurora physician via video when they arrive, with another caregiver right at the patient's side. The offsite physician can serve multiple Aurora emergency departments at once.
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