Many organizations know that to improve patient experience, they need to work to reduce Emergency Room wait times. Average emergency room wait times are too long. Everyone has heard horror stories about showing up at an ER and being part of a large crowd waiting to be seen. Invariably, these events occur on a weekend, which certainly adds to the problem. According to KevinMD.com, “emergency department wait times reflect poor planning and weak leadership, not fluctuating patient demand. It’s no coincidence that ED delays and other ER wait time issues are most pronounced on nights and weekends. That’s when patient demand is at its highest and it is also the least desirable time for ED doctors to work” (Pearl, 2018).
The traditional model of ED care involves triage, where a nurse assesses the severity of a patient problem and the patient is assigned a priority status for being seen. It emerged as a battlefield treatment strategy when “it was impossible to supply enough physicians to meet every soldier’s medical needs. Doctors, therefore, had to sort and prioritize patients by the severity of their injuries” (Pearl, 2018).
It leaves patients with low priority care needs waiting until times when the volume of care decreases and all more emergent cases have been dealt with. Before the COVID-19 pandemic upended the normal functioning of many ED’s, “patients [would often] spend an average of two hours in the typical emergency department, according to the Centers for Disease Control and Prevention (CDC)” (Pearl, 2018). The reality is that negative ER experiences like this don’t have to happen, and we really know some of the solutions that can be put in place to improve most visits to the ER. Some of them include:
Match Staff Numbers to Expected Demand – Higher demand occurs at night and on weekends, for multiple reasons. This is something that every healthcare organization expects. But, doctors and nurses don’t want to work nights and weekends, so the department is relatively understaffed at times when it needs the opposite.
Ensure Nurses Are Providing Direct Patient Care – When nurses and doctors are all providing direct patient care, organizations can bolster the how may healthcare professionals are providing treatment. Shunting less emergent patients to lower-cost support staff is another way to free up RNs to handle greater acuity patients.
Staff Physicians Differently – rather than just ED physicians, include “family medical practitioners and internists whose training adequately prepares them for the definitive treatment of non-life-threatening illnesses. This approach enables EDs to increase staffing without increasing budget, and it makes more physicians available to see patients as soon as they arrive” (Pearl, 2018).
Tie Wait Times to Payments – Another way to inspire productive change is to link ER experiences to what is paid for them. According to the Harvard Business Review, “hospitals’ waiting times should be measured (as they are) and benchmarked against the national (risk-adjusted) average waiting time of patients with similar conditions. Hospitals that exhibit shorter waiting times than the average should be financially rewarded, while underperforming hospitals should be penalized” (Savva & Tezcan, 2019).
Clearly, the ER experience in much of the U.S. leaves much to be desired for most people who encounter it. Eventually, we will have moved past the current pandemic situation that has changed going to the ER for everyone, afflicted with COVID-19 or not. This is a great time to rethink much of how we’ve grown accustomed to practicing and receiving healthcare. Too many people have settled for the emergency room wait time issues that are not automatic, nor a cost of providing good care. The ER experience has long been ripe for the restructure that needs to happen now.
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