By Michael Saxe, M.D., Chairman, Department of Emergency Medicine, Middlesex Hospital
Emergency room wait times are an ever-growing concern both for patients and doctors. It is no surprise that studies show that the longer a patient waits in the emergency department, the lower their satisfaction with the visit. According to Press Ganey’s Emergency Department Pulse Report 2009, the national average total visit time for a patient in the emergency department in 2008 was four hours and three minutes. Overcrowding and long wait times can be fueled by many things, but regardless of the cause, the challenge for emergency facilities is to combat long wait times while continuing to provide top patient care.
At Middlesex Hospital in Middletown, CT the goal is to establish an average “door-to-doctor” time of less than 30 minutes and to also significantly improve patient satisfaction. They’ve made major strides toward achieving these goals due in large part to technology.
Middlesex’s emergency department sees approximately 45,000 patients annually. In March, 2008, Middlesex opened a new emergency department to better meet the needs of an expanding patient base.
The most significant changes were the establishment of three zones designed to increase efficiency and the implementation and expansion of technology. In the new ED, patients are triaged into three zones: the Acute Care Area which serves traditional emergency medical patients; the Express Care Area, a new feature reserved for the treatment of minor illnesses and injuries; and a greatly expanded Emergency Crisis Area that better serves patients in need of behavioral health and substance abuse evaluations. The three zones help to reduce the risk of exposure to infection while allowing for increased, efficient care. The system also helps to keep overcrowding down by getting patients through the ED and to the appropriate floor of the Hospital or discharged and on their way home faster. Plus it helps to avoid overtaxing of any one of the ED’s resources.
The new emergency department offers more privacy, better patient observation capabilities and, most importantly, additional technologies that were not available in the old ED. These new technologies include bedside ultrasound, computerized physician ordering (CPOE), computerized patient tracking, computerized x-ray viewing and an increase in beds with cardiac monitors from eight to 30. These technologies have resulted in more efficient care, expedited test results, improved patient privacy and a more efficient work environment.
While the technology itself is largely the stimulus behind the improvements, without the support and deep involvement of emergency department doctors and nurses, any technology upgrades would have failed. Doctors and nurses were heavily involved over a nine-month period with the development and refinement of the CPOE system before it was fully installed throughout the hospital. The short-term results have been an amazingly smooth implementation period and excellent acceptance of the system. The long-term results have shown an increase in patient satisfaction.
Since the opening of the new emergency department, Middlesex has seen a 45% decrease in wait times, to a current “door-to-doctor” average of 36 minutes. Three years ago, the average emergency department wait time was 60 minutes. Again, not surprising, the decrease in wait times has a direct correlation to the increase in patient satisfaction. Press Ganey patient survey results show a 40% increase in patient satisfaction, which surpassed the hospital’s goals for the first year. The ED’s new goal is to see an increase in patient satisfaction from the 80th percentile to the 95th percentile. During the past three quarters, the goal was exceeded.
Technology continues to be at the heart of improvements made in the emergency department. This Fall, Middlesex became one of four hospital systems in the country and the first in the Northeast U.S. , to launch a new website wait time clock for all three of its emergency department sites, www.MiddlesexERtime.com The computerized tracking system, implemented last year, made the creation of the online wait time clock possible. The new tool allows patients with non-life-threatening emergencies – roughly 75% of the ED patients – to go online to determine how long they can expect to wait in the ED. The online clock helps to better prepare and manage patient expectations upon arrival at the hospital. Many of our patients live within easy commuting distance of two of our emergency department sites. They can check the waiting times and may decide to go to the emergency department with the shorter waiting time. Patients with non-life-threatening emergencies understand that they will have to wait to be seen and helped when they come to the ED. But keeping them informed can aid in ensuring they remain calm which can have a big impact on the perception of their visit.
There is no silver bullet to reducing wait times and increasing patient satisfaction. However, the impact of technology, combined with a dedicated and flexible staff, cannot be denied. Emergency facilities that are committed to reducing their wait times and providing the best patient care need to focus on infrastructure improvements. Technology can absolutely help curtail emergency department wait times and, in turn, shorter wait times will lead to higher patient satisfaction.
Middlesex Hospital is part of the Middlesex Health System, an independent, not-for-profit, community-based health network of inpatient, outpatient, diagnostic, emergency, and rehabilitation facilities. In addition to Middlesex Hospital in Middletown, Connecticut, Middlesex Health System has freestanding satellite emergency departments in Essex and Marlborough. It serves more than 250,000 residents in Middlesex County and beyond.
