U.S. hospitals try to pick up the ER pace

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Interesting article.

U.S. hospitals try to pick up the ER pace

By Carey Gillam

KANSAS CITY, Missouri (Reuters) - It's the sort of promotion you might expect from a pizza delivery chain, not a U.S. hospital system.

Like the pizzeria that picks up the bill for taking too long, a Kansas City hospital offers cinema passes and a Detroit hospital system gives away major league baseball tickets to patients who wait half an hour for emergency room service.

With competition for healthcare dollars tight and complaints about care on the rise, hospitals from California to Virginia are trying to cut wait times. They pitch "quality care at a moment's notice" and "door to doc" treatment in minutes.

For those who do endure long waits, hospitals offer meal vouchers, baseball and movie passes and written apologies.

"If someone has to wait a long time it is less likely they're going to come back," said Deborah White, spokeswoman for Carondelet Health, which owns two acute-care hospitals in Kansas City that launched a "30-minute guarantee" program on June 1, even as a competing hospital chain pledged to see patients within 15 minutes.

More than 113 million emergency room visits were reported in 2003 nationwide, up from 90.3 million in 1993, according to the Institute of Medicine of the National Academies. As visits climb, so do wait times.

In a 2006 report, the Institute said backlogs cause ambulances to be turned away from emergency departments once a minute on average and patients wait sometimes hours or even days for a bed.

Last month a 43-year-old woman died in the waiting room of a Los Angeles-area hospital emergency department after a perforated bowel was not treated swiftly.

'CULTURE CHANGE'

"I'd say one quarter of the nation's emergency rooms are doing this now," said American Hospital Association spokesman Rick Wade. "Over the next five years you'll see this pretty much everywhere except in the smallest hospitals."

A typical urban hospital emergency department handles tens of thousands of patients a year. Doctors and nurses must often juggle patients with life-threatening injuries with those whose ailments include ear infections and sprained ankles.

Patients typically require a mix of services, such as X-rays or blood tests, and medicine from the pharmacy.

Hospitals historically kept track of a progress with handwritten charts passed among care-givers and departments.

But with the new focus on efficiency, electronic tracking boards report on patient status. Physicians type their orders into databases directly, allowing for faster handling of the ill and injured.

"There was a lot of resistance in the rank and file of physicians at first. They thought it was basically a marketing ploy," said William Berk, vice chief of emergency medicine for one of seven hospitals in the Detroit Medical Center system, which saw 300,000 emergency department patients last year and just completed a total system streamlining.

"It was an enormous culture change," Berk said. "But it has had a very real positive effect on patient care."

Some hospitals are moving to eliminate waits altogether. The Adventist GlenOaks Hospital in Illinois promises no waits at all. As of last week, patients could skip the waiting room and go directly to a private room where treatment starts as registration is done bedside.

"Nationwide we are doing poorly with the emergency system and its ability to handle surges. But if hospitals can streamline their information, they can see more patients," said Bharat Sutariya, a former emergency department physician on staff at Kansas City-based Cerner Corp., which develops healthcare technology.

"It helps the patients and can lead to financial gain for hospitals," said Sutariya.

[Guest partyrock]

damn, imagine the size of the ER needed for direct to a room ER's at Jacobi or Lincoln. Monty sends just about every patient right into the ER and thats not a place I would want to be. Every bay is usually 3 deep with stretchers and every wall and counter is lined with beds.

[E58RET 24]

As a retired firefighter/paramedic and present day R.N who has worked inE.Rs for the last 15 years,and has seen the ever increasing patient load over those years I dont know if "freebies "willincrease pt satifactionThe increasing use of Fast Track areas and local urgent care centers helps solve the problem of waiting time sometimes only if it is within thier scope of practice.

Then you have patients who present stating they had a Dr's appointment .but "just could'nt wait" or any of the other minor drama's that show up at triage it becomes apparent that ER's are now the new Dr's offices.Also the advent ofcomputerized charting seems to slow things down a little,you see RN's spending a lot of time at a keyboard ,or checking the tracking board.

[Guest paramedico987]

As a retired firefighter/paramedic and present day R.N who has worked inE.Rs for the last 15 years,and has seen the ever increasing patient load over those years I dont know if "freebies "willincrease pt satifactionThe increasing use of Fast Track areas and local urgent care centers helps  solve the problem of waiting time sometimes only if it is within thier scope of practice.

Then you have patients who present stating they had a Dr's appointment .but "just could'nt wait" or any of the other minor drama's that show up at triage it becomes apparent that ER's are now the new Dr's offices.Also the advent ofcomputerized charting seems to slow things down a little,you see RN's spending a lot of time at a keyboard ,or checking the tracking board.

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FOR SURE! I actually rather feel that those who, let's not ignore the truth here, ABUSE the ED as the solution to generalized laziness and ignorance should be made to wait. It sickens me to see someone who comes in with a minor emergency [e/g laceration needs surgical repair] waiting because there are 10 morons with the flu ahead of them who can't just stay home and suck it up like the rest of the world.

Perhaps if they all have to wait a few hours they'll think twice about coming in with complete BS!

Sorry if this offends anyone, but I'm clearly jaded by exposure to reality...