Last night on the EMS Garage there was the return of a voice that has been absent for a while – Buck Feris, so the podcast is titled The Prodigal: EMS Garage Episode 132.
Some of the topics discussed were ones that I feel are important. First – The use of wait times, or Press Ganey satisfaction scores to claim that we are assessing quality.
Wait times do not tell us anything. What does an 8 minute wait time mean?
AP Photo/Julio Cortez
The wait time at the Bayonne Medical Center’s emergency room is seen on a billboard on Tuesday, April 12, 2011 at Journal Square in Jersey City, N.J.[1]
According to the article, this is what the posted wait time means –
the average time it takes from entering the door at the ER to seeing a medical provider.[1]
They do not define medical provider. Could that mean someone from security or registration, who may be required to have some medical training (CPR, First Aid, . . . ) and therefore someone considered to be a medical provider – at least as far as not violating truth in advertising laws?
Is the medical provider a triage nurse, who provides a triage assessment of the patient and then decides that the patient can wait a few hours to be brought to the back and placed in a bed, where other medical providers will further assess and treat the patient.
What about a patient with chest pain?
Is registration or security going to recognize someone who looks bad and call someone to assess this patient ahead of every other patient waiting to be assessed?
What the wait time does not tell us is what the wait time means.
We need to educate people about the use of emergency departments and about the use of 911. In stead, we try to dumb everything down to satisfy the What if . . . ? people – the people who are trying to prevent all of us from thinking.
Last week on EMS Office Hours, I was not one of the guests, but the discussion was about what we are doing to educate the public about EMS for EMS Week. Go listen to that discussion, too.
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“With these billboards, we have reaffirmed our promise to provide our patients and the residents of Hudson County with quality care without having to wait in an emergency room for hours,” said Daniel Kane, President and CEO of Bayonne Medical Center, in a prepared statement. “Were dedicated to providing our patients the best possible care close to home.”[1]
This is not even close to true.
Should anyone with a minor complaint be encouraged to go to the emergency department because Daniel Kane, President and CEO of Bayonne Medical Center says they won’t have to wait for hours?
If I have a minor complaint, there is no good reason I should not expect to wait for hours. One of the reasons for the long wait times is that there are too many people there with minor complaints.
Daniel Kane, President and CEO of Bayonne Medical Center appears to be encouraging longer wait times.
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Bayonne Medical Center says it is the first hospital in the tri-state area to publicly post its emergency room wait-times, highlighting improvements since it was saved from bankruptcy in 2008.[1]
How do we know that similarly misguided sales pitches were not the cause of the reported near-bankruptcy?
How do we know that publicizing their documented wait time has anything to do with the appearance of not currently facing bankruptcy?
Since we do not know what the wait time means, how can anyone claim that a change in the documentation of wait time means any kind of improvement?
Where is the research to show that shorter documented wait time, using the same methodology, leads to better outcomes?
Some more on this later in EMS Garage on Press Ganey – Should We Reward High Scores?
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Footnotes:
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[1] N.J. Hospital Debuts Wait-Time Billboards
Posted: Friday, April 15, 2011
Updated: April 15th, 2011 03:45 PM CDT
EMS World
Article
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I am a paramedic in Baton Rouge Louisiana. We have an electronic billboard system around town and 2-3 of our 6 hospitals in the metro use these boards as stated in this article. We have one large hospital here that has the reputation as being the hospital to go to. When I run a call and ask a patient where they want to go, if they don’t have a preference, they will normally state this particular hospital even over saying lets just go to the closest facility.
I have noticed a couple of the smaller hospitals here in town are using the system as noted in this story. My opinion is the goal of this is a marketing ploy to drive customers to their facility. I have found as well the stated wait times are completely un-true in one case. I was holding the wall at one of these facilities the other day and the computer that enters the information to the billboards was open for me to view. It stated 2 minute wait time to get into the ER. It was never updated or even looked at. I held with my patient against the wall for an hour.
The other hospital that uses this system advertises “Average Wait Times” to get into their ER. They have a clerk/tech that monitors the board and provides consistent updates. Even though they advertise “average” wait times, it appears that they are fairly accurate. They also provide a rapid triage clinic and those that are not needing an ER bed are evaluated, treated, and discharged by an MD or PA. There are very rare ER holds for EMS units at this ER even though their patient load has had a huge increase in the past 3-4 years.
So, what’s your opinion? Is it to better patient care and streamline the process or is it merely a marketing ploy to drive more patients to their ER that normally go to the “name” facilities? In my community I am finding it to be a bit of both. I am finding that my transports have vastly increased to these facilities that are using these boards to advertise. Particularly to the second mentioned facility that is right down the street from the quoted “name” facility. With the increased call volume to these facilities I have noticed additional services have been added to both of these facilities. This is much better for the citizens of my community. As said, I notice on facility using mainly to drive patient volume up with no regard to the times they post and the other facility working hard to honor their advertisement. I guess though if in the end the patient care at the facility is top notch, it is all worth it.
Steven Murphy BS NREMT-P,
I don’t deny that it can be effective advertising. I don’t think that it provides important information.
If I have chest pain, what is my wait time going to be?
If I have been to the ED three times this month, what is my wait time going to be?
If I have a twisted ankle, what is my wait time going to be?
All three patients may be concerned about wait times, but wait time is only expected to affect the outcome of the first patient and then only if it is a serious medical condition, rather than a mimic of a serious medical condition. Whether the chest pain turns out to be one of many serious conditions will not be known for a while.
I am shocked.
Next, I will be told that the big juicy burger in the ad is not an accurate representation of what will be sold to me.
I suspect that they have someone in management who understands staffing that is appropriate for the volume 80% (or 90%) of the time and does not have a cow about the extra staffing when things are slow.
I do not know the details of what is being done inside the hospital in Bayonne, but I have assumed that it is mostly marketing.
I am glad to read that there are some places that seem to be trying to improve the patient flow at these facilities. If this does turn out to be an improvement, then I am wrong, but I have seen a lot of examples of hospitals and EMS just making changes to affect appearances, rather than outcomes. I hope I am wrong.
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