Emergency departments offer online updates on wait times

Patients usually assume when they go to the emergency department that there is going to be a wait. Now some emergency departments are letting them know how long it will be.

Several hospitals across the country are developing real-time wait clocks on their Web sites to give patients without a critical or life-threatening injury or illness an idea of how long they can expect to wait to be seen. The hospitals say it can help patients decide where to go for care and could mean that some patients forgo an ED visit altogether.

Michael Saxe, MD, chair of the Dept. of Emergency Medicine at Middlesex Hospital system in Middlesex County, Conn., said he doesn't see a downside to the practice. Middlesex, which started posting its wait times in September, has three locations. Many patients who are equal distance between two of the locations find it useful when determining where to go, he said.

The time that Middlesex displays is based on the longest wait of a current patient in the waiting room. Dr. Saxe said the hospital system decided to go this route as opposed to using median times, as many hospitals do, because half the times would be overestimated, the other half underestimated. This way, the hospital exceeds expectations the majority of the time.

So far, the wait-time reports have been well-received, Dr. Saxe said. "Everyone who hears about it thinks it's a great idea."

Officials at Gulf Coast Medical Center in Panama City, Fla., said the hospital has worked hard in recent years to bring its wait times close to the national standards of 35 minutes and is using the wait clocks as a way of showcasing those efforts.

"We would not post the times if they were four to five hours," said Sheila Bradt, RN, director of the emergency department at Gulf Coast. And because the times are displayed, it helps set the hospital apart from the competition, she said.

The hospital uses the average wait time from the previous four hours and updates the clock every 30 minutes. Times are posted online as well as on a large billboard in town, and can be sent to patients' cell phones.

St. Luke's Hospital in Cedar Rapids, Iowa, has both an ED as well as an urgent care center. It posts wait times for both departments as a way of helping direct traffic to the appropriate place, said Laura Rainey, director of communications for St. Luke's.

Rainey doesn't know how posting the wait times has affected people's decisions on where to go, since the program is still in its infancy. But she does know patients are looking.

In August, about 5,000 people clicked through to the wait clock on the hospital's Web site. By mid-September, the number who clicked through had risen to 6,725 for the month.

"It will be interesting when we get into flu season to see what the number's going to be," Rainey said.

Bret Nicks, MD, assistant medical director of Wake Forest University Baptist Medical Center in Winston-Salem, N.C., doesn't think posting wait times is a good idea.

"Depending on how they present the wait times, it might not behoove the patient to go to those places," Dr. Nicks said. There may be more urgent cases in front of the patient, or they themselves might be an urgent case, and the wait time wouldn't apply.

David Seaberg, MD, an emergency physician with Erlanger Hospital in Chattanooga, Tenn., which doesn't post wait times, agrees that laypeople generally don't understand the complicated process that goes into triaging care. And they may not understand that an average wait time does not mean that is how long everyone who walks in the door will wait.

"It won't be understood, and it could be dangerous" if someone forgoes care based on the wait time, Dr. Seaberg said.

Leigh Vinocur, MD, an emergency physician from the University of Maryland School of Medicine, referred to posting wait times as a "gimmick."

In an emergency department, people understand there is going to be a wait, she said. If they leave with a satisfactory result, they usually consider the wait worth it, she said.

Satisfaction on the line

But a recent study by Press Ganey, a South Bend, Ind.-based health care satisfaction and improvement services company, found that how wait times are handled could make a difference in hospital satisfaction scores.

The report, "Emergency Department Pulse Report," which looked at 2008 patient satisfaction scores, found that hospitals can give a considerable boost to satisfaction scores by keeping patients well-informed about delays.

Of course, keeping patients informed doesn't necessarily mean implementing an electronic wait clock, said Christina Dempsey, RN, senior vice president of clinical operations for Press Ganey.

"If you know that you are the best in the market in terms of waiting times, then by all means, post your waiting times," Dempsey said. "However, I am not sure that as a strategy just to let people know what their waiting times are going to be, it's a good marketing strategy."

The Press Ganey report found that while the average wait time decreased nationally by two minutes in 2008 compared with the prior year, patients still spend an average of four hours and three minutes in the ED.

Dempsey said patients always want to be kept informed. But this can be accomplished just as easily by having intake nurses issue verbal updates to patients in the waiting room.

Posting wait times does nothing unless the systemic problems causing long delays are addressed first, she said.