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Wait Watchers

March 28, 2010
by Kate Huvane Gamble
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Smart organizations are demonstrating that while they can't erase ED wait times, they can leverage technology to keep patients better informed
Ludwig Johnson
Ludwig Johnson

There is an unmistakable trend in healthcare facilities all across the country. Emergency departments (EDs) are getting more traffic, which is leading to longer wait times and frustrated patients.

Research from Waltham, Mass.-based CSC indicates that the current growth in emergency department (ED) visits is significantly affecting patient access, quality, cost and care management. And the end, it seems, is not near. According to authors Kathy Jankowski, R.N., Louann Parker, R.N. and Debbie Jacobs, 67 percent of healthcare executives surveyed expect ED visits to increase in the future.

Smart hospital executives are putting two and two together and realizing that frustrated patients are bound to walk out the door - taking their revenue with them. So to mitigate the issue, a number of organizations are implementing bed management systems and creating fast-track triage programs. But while this may improve turnover and increase efficiency, patients are often still left in the dark as to when they might see a physician. With that in mind, a handful of organizations are going one step further and devising innovative methods of communicating wait times to patients - in some cases before they even arrive at the hospital.

For instance, in Florida, Central Florida Regional Hospital (Sanford) and Osceola Regional Medical Center (Kissimmee) are posting wait times on electronic billboards situated along local highways. With this technology, which has also been rolled out at Akron General Health System in Ohio, patients can quickly learn where they have the best chance of getting treatment in the shortest amount of time.

In Middletown, Conn., it's even easier. Middlesex Hospital, a 275-bed network, recently began publishing the wait times for its three ED facilities on its Web site. Shoreline Medical Center is located about 20 miles south of Middletown in Essex, Conn., while Marlborough Medical Center is about 15 miles north. If area residents need emergency care, they can quickly pull up the site (http://www.midhosp.org) and find out how long the approximate wait times are at each location.

Timing is everything

For Middlesex, the primary goal in rolling out the technology was to help distribute traffic more evenly among the three sites, according to CIO Ludwig Johnson, who says Middlesex handles around 90,000 ED visits per year. “It was part of an effort to improve patient satisfaction while also balancing the load for our staff,” he says.

Unlike many IT initiatives, launching and maintaining the online ED clock has been a minimal effort. According to Johnson, the program was written in Cerner Command Language, Kansas City, Mo.-based Cerner's fourth-generation programming language, and designed to read the triage file, parse the data to determine how long the waits are, and send the information by file transfer protocol to Middlesex's Web server.

The data that is being fed to the Web server comes from the triage and tracking components of Cerner's ED information system, FirstNet, which is utilized at Middlesex. As soon as a patient arrives, a nurse collects basic information such as name and chief complaint, does a quick assessment of what type of care is needed and how soon, and enters the information into the system. At this point, the patient's wait time - or the clock - officially starts, he says, and it doesn't stop until a physician is available. (Johnson notes that patients who present with a life-threatening injury or condition are exempt from the list and are seen immediately.)

How it works is simple. “If the longest wait to see the doctor is 60 minutes, that's what we report on the site,” says Johnson. “As soon as the next person sees the doctor, the number is adjusted to what his or her wait time was.” The clock is updated every five minutes to ensure the most accurate information is available, he adds.

Another benefit of the tool is that it's available in both Flash and HTML formats, enabling users to access it from computers and smartphones. “We set up the site so that it can detect whether the person is using an iPhone or a computer, and customize itself to fit that need,” says Johnson. “We wanted to make it as user-friendly as possible.”

Interestingly, it isn't just patients who are using the tool. ED physicians and executives often use the online clock while traveling to keep tabs on their facilities.

What truly surprised Johnson, however, was the national attention the project has attracted. “I couldn't believe it. It turned out that very few places around the country are doing this, so our story has run in a number of cities, including San Francisco, Chicago and Phoenix,” he says. “We wanted to create a bit of a marketing splash - which we did, much more than expected - but what we really wanted to do was balance out our volume so people could go to a place where the wait is shorter.”

View from the top

At Atlantic Health, a 1,200-bed system based in Morris Plains, N.J., the emphasis isn't necessarily on decreasing wait times, but on communicating them more effectively to patients. According to Linda Reed, vice president and CIO, Atlantic Health's two hospitals have Horizon Enterprise Visibility boards from McKesson Corp. (Alpharetta, Ga.) installed in the emergency and surgical departments, as well as the inpatient area.

Linda Reed
Linda Reed

“It really comes down to what kind of patient and family experiences you want,” she notes. “With these boards, we can keep people updated.”

“It really comes down to what kind of patient and family experiences you want. With these boards, we can keep people updated.”

The visibility boards, which according to Reed have been live in the ED for about four years, provide a “high-level view of where patients are in the care process, how long they've been there, and treatment status.” Using a HIPAA-compliant patient identifier, the board has indicators that light up when lab results are ready or when patients vacate a room.

Similarly, McKesson's Horizon Surgical Manager displays patients' steps from the holding area to the OR and to the recovery room, enabling family members to track their progress. “Families have told us that they really find it helpful because they know how to manage their day. They know if they have time to go grab lunch,” she says. “They also use it to give updates to other family members.”

While the ED and OR boards are targeted more toward patients and their families, Atlantic Health also utilizes an inpatient visibility system that provides information for staff. With this tool, staff can quickly learn what rooms are available, what rooms need to be cleaned, how long a patient has been in a room, and more.

Takeaways

  • Increases in ED visits are significantly affecting patient access, quality, cost and care management - a trend that is expected to continue.

  • A number of organizations are dealing with the increased demand for services by implementing technologies to keep patients better informed of wait times.

  • Publishing ED wait times online offers hospitals a way to communicate information to patients quickly without requiring a significant investment from the IT staff.

  • Hospitals are also utilizing visibility boards to keep both patients and staff updated on patient conditions and room status.

The goal, says Reed, was to have all of that data stored in a central location. In order to make that happen, systems had to be configured so that they could speak to each other. Atlantic Health's visibility boards are tied to the registration system (also a McKesson product), she says, so that once patients are checked in, their data automatically populates the boards. Interfaces were also set up with laboratory and pharmacy systems through an HL7-based engine, ensuring that as patients move throughout through different departments, the information on the boards is always current.

As a result, “the staff has really embraced the boards,” Reed adds. “They feel that we put something in that's helpful to them. It gives visibility as to what's going on in the organization.”

And the organization isn't stopping there. Atlantic plans to work with McKesson to leverage the systems' predictive modeling capabilities to better anticipate staffing needs. “We want to get the most we can out of these tools,” she says. “The boards help drive efficiency because they make the care process more transparent. Getting the right level of care in the right area and the right part of the continuum is what's important. You have to be able to use these tools to become more productive.”

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Healthcare Informatics 2010 April;27(4):30-31

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