No one likes to wait, but in healthcare, waiting can lead to issues beyond just frustration—it can lead to serious consequences, from quality of care to the increase of adverse events. The effects of adverse outcomes on patients can include: delay in being assessed and receiving appropriate required care, increasing frequency of the possibility of medical errors, reduction of patient satisfaction, proper outcomes, and overall mortality. [1] To figure out how to reduce patient waiting time, we need to examine several factors and implement a well-rounded strategy.
Most people feel that they spend more time waiting on receiving care than they actually spend with their physicians to get the care they need. Emergency rooms (ERs) are a prime example of extremely lengthy wait times. The average hospital ER patient in the United States waits more than an hour and a half to be taken to his or her room and about two hours and 15 minutes before being discharged. Even more alarming is when a patient arrives with a broken bone. They may wait a painful 54 minutes, on average, before receiving any pain meds. [2]
Many people that come to ERs do not fully understand the reasons behind the wait. There are a number of different reasons for ER wait times:
#1: Triage Process & Overcrowding
Since upwards of a third of ER visits are estimated to be “nonurgent,” the triage process pulls the team away and slows down the triage process. [3]
#2: Access to Inpatient Beds
When the hospital has no available beds for a sick ER patient, that means the patient will wait in the ER until a bed becomes available.
#3: Poor Documentation for Admitting and/or Discharge
Poor documentation can affect patient care, particularly during care transitions, and may cause delays and errors in patient care. [4]
#4: Admitting Privileges
ERs can be filled by patients whose physicians lack admitting privileges to hospitals. Since the physician doesn’t have admitting privileges and admits the patient directly, they have to send them to the ER instead.
#5: Diagnosis & Specialist Availability
It can take time for an ER physician to properly diagnose a patient, especially if there is the need to run blood tests, CT scans, or x-rays, etc. While emergency room physicians are available 24/7, medical specialists are not. It may take time for the ER to get ahold of a medical specialist for support of a diagnosis or treatment.
How to Reduce Patient Waiting Time Through a Multi-Faceted Approach
These different components, especially if they happen in sequence, can affect the overall wait times at an emergency room for the worse. In order to improve the overall wait times, a multi-faceted approach should be utilized. Here are a few examples of a multi-faceted approach:
#1: Upfront Transparent Communication System
Hospitals can implement both an online appointment and advertising time system. These systems can show a potential patient the current wait time and allow them to set a time to hopefully have a more efficient ER visit.
#2: ED Nurse Flow Coordinator
To reduce the throughput time, implement a nurse flow coordinator whose main duties include identifying and resolving delays for patients who have been in the ER for an extended period of time. Maintaining effective teamwork and communication is also vital for ER teams.
#3: Staffing to Demand
Looking at the EHR data to staff according to “norms” of when patients come in, such as “after work” or on the “weekends,” can help to keep the patient flow moving at a consistent rate.
#4: Medical Scribe Program
Outsourcing a medical scribe program will allow ER physicians in a busy emergency department to focus on face-to-face patient care in the most efficient way possible. Medical scribes can document the encounter and ensure that items like critical care time are not missed.
#5: Modify Physician Staffing
Emergency departments can pair ER physicians with family or internal medicine physicians on a shift. The internal and family physicians can focus on the non-life-threatening illnesses while the ER physicians focus on medical emergencies.
ER wait times continue to be a major concern that can threaten patient safety. Healthcare leaders and team members need to continue to look to innovative ways to determine how to reduce patient waiting time for better patient outcomes.
Written by: Nicole Bramblett, MHA
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6117060/ [2] https://hbr.org/2019/02/to-reduce-emergency-room-wait-times-tie-them-to-payments [3] https://pubmed.ncbi.nlm.nih.gov/26763823/ [4] https://bmcemergmed.biomedcentral.com/articles/10.1186/s12873-018-0188-z