Emergency departments are often viewed as stressful, chaotic environments where for clinicians, there never seems to be enough time, and for patients, time seems to drag on. Many hospitals are attempting to change this perception by streamlining patient flow. Swedish Medical Center–Issaquah (Wash.), for example, designed an ED that did not include a formal waiting room and brought patients directly to exam rooms. Other facilities, including Loma Linda (Calif.) University Medical Center, are shifting the waiting room from the hospital to the home for some patients, freeing up space in the ED and creating more efficient care.
LLUMC is using a program called InQuicker that holds a patient's place in line in the ED, allowing the patient to wait at home until a time projected to be less crowded. Robert Steele, MD, emergency medicine physician at LLUMC and CMO of InQuicker, says this system boosts patient satisfaction and efficiency by granting physicians some control over the ED traffic rate.
Efficiency
Using the software, the hospital can predict when peak visits will occur and schedule non-emergent patients who use the wait-in-line service during non-peak hours. "We can provide more services to more people with the same resources," Dr. Steele says. In addition, if the ED faces a surge in volume due to a car accident or other emergency, the hospital can block off certain hours to patients waiting at home to allow physicians to manage the emergency cases first. The hospital can thus "smooth the supply and demand curve," Dr. Steele says, which can improve efficiency. "The more discrepancy between supply and demand, the less efficient we are."
Furthermore, giving patients an estimated time to treatment encourages physicians to meet that projected time. The place-in-line service can thus create a cultural change in the ED, Dr. Steele says. "The healthcare workers now begin to understand that just because someone has an ankle sprain doesn't mean we don't need to hurry up." For example, he says the standard of care is to begin treating heart attack patients within 90 minutes. Non-emergent patients, however, are often not provided a similar type of expectation for the timely delivery of care. Setting an expectation via the software gives physicians and staff an incentive to meet patients' expectations and speed care for even low-acuity patients.
Patient satisfaction
Waiting time at the hospital has an inverse relationship with patient satisfaction — in general, the longer a patient waits, the unhappier the patient is. Allowing patients to wait in the comfort of their home instead of at the hospital thus improves satisfaction, which can in turn improve the delivery of care. "When patients are happy, conversations with them are better. You don't have to walk into the room and say, 'I'm sorry for your wait,'" Dr. Steele says.
In fact, patient dissatisfaction from long waiting times may deter them from seeking care. The place-in-line service "removes the fear of the waiting room," Dr. Steele says. One patient came in to LLUMC's ED for abdominal pain only because he could use the place-in-line system and avoid a long wait at the hospital. This visit ended up saving his life because physicians were able to detect cancer early and remove the tumor, according to Dr. Steele.
In addition to eliminating the need for non-emergent patients to wait at the hospital, the ability to set a realistic expectation of when the ED can treat the patient and deliver on that expectation also contributes to increased patient satisfaction. Traditionally, ED patients have no expectation or idea of when they may be seen. "It could be one hour, three hours…you have no idea. You can't go to the bathroom, you can't go outside, because God forbid they call your name and you miss your opportunity," Dr. Steele says. "You're in a constant state of readiness. It's psychologically very difficult for anybody."
Streamlining patient flow in the ED can not only improve the satisfaction of individual patients, but also improve a hospital's image in the community. "The ED is the front door of the hospital," Dr. Steele says. "That's what the community sees. Yes, you can do a lot of surgeries, yes, you can have a lot of other great aspects of the hospital, but the average person is going to use the ED as the front line and front door to the hospital."
Access
While the place-in-line service facilitates non-emergent patients' ability to be seen in an ED, Dr. Steele does not believe it will encourage patients to go to the ED when an urgent care clinic or retail clinic may be more appropriate. For one, when patients go to the website to check into the ED place-in-line service, hospitals can provide patients the option of going to an urgent care clinic instead.
Dr. Steele also points to the importance of the increased access to care provided by the service. "Any time you improve access to care, you improve the patient's ability to seek care in the right environment. Is it perfect? No. But it's going to improve access to care. Any time you improve access to care, I think that's a good thing."
In addition, some communities, such as those in rural areas, do not have alternatives to EDs. "We have to make sure that we don't ascribe the big city model to the small cities," Dr. Steele says.
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LLUMC is using a program called InQuicker that holds a patient's place in line in the ED, allowing the patient to wait at home until a time projected to be less crowded. Robert Steele, MD, emergency medicine physician at LLUMC and CMO of InQuicker, says this system boosts patient satisfaction and efficiency by granting physicians some control over the ED traffic rate.
Efficiency
Using the software, the hospital can predict when peak visits will occur and schedule non-emergent patients who use the wait-in-line service during non-peak hours. "We can provide more services to more people with the same resources," Dr. Steele says. In addition, if the ED faces a surge in volume due to a car accident or other emergency, the hospital can block off certain hours to patients waiting at home to allow physicians to manage the emergency cases first. The hospital can thus "smooth the supply and demand curve," Dr. Steele says, which can improve efficiency. "The more discrepancy between supply and demand, the less efficient we are."
Furthermore, giving patients an estimated time to treatment encourages physicians to meet that projected time. The place-in-line service can thus create a cultural change in the ED, Dr. Steele says. "The healthcare workers now begin to understand that just because someone has an ankle sprain doesn't mean we don't need to hurry up." For example, he says the standard of care is to begin treating heart attack patients within 90 minutes. Non-emergent patients, however, are often not provided a similar type of expectation for the timely delivery of care. Setting an expectation via the software gives physicians and staff an incentive to meet patients' expectations and speed care for even low-acuity patients.
Patient satisfaction
Waiting time at the hospital has an inverse relationship with patient satisfaction — in general, the longer a patient waits, the unhappier the patient is. Allowing patients to wait in the comfort of their home instead of at the hospital thus improves satisfaction, which can in turn improve the delivery of care. "When patients are happy, conversations with them are better. You don't have to walk into the room and say, 'I'm sorry for your wait,'" Dr. Steele says.
In fact, patient dissatisfaction from long waiting times may deter them from seeking care. The place-in-line service "removes the fear of the waiting room," Dr. Steele says. One patient came in to LLUMC's ED for abdominal pain only because he could use the place-in-line system and avoid a long wait at the hospital. This visit ended up saving his life because physicians were able to detect cancer early and remove the tumor, according to Dr. Steele.
In addition to eliminating the need for non-emergent patients to wait at the hospital, the ability to set a realistic expectation of when the ED can treat the patient and deliver on that expectation also contributes to increased patient satisfaction. Traditionally, ED patients have no expectation or idea of when they may be seen. "It could be one hour, three hours…you have no idea. You can't go to the bathroom, you can't go outside, because God forbid they call your name and you miss your opportunity," Dr. Steele says. "You're in a constant state of readiness. It's psychologically very difficult for anybody."
Streamlining patient flow in the ED can not only improve the satisfaction of individual patients, but also improve a hospital's image in the community. "The ED is the front door of the hospital," Dr. Steele says. "That's what the community sees. Yes, you can do a lot of surgeries, yes, you can have a lot of other great aspects of the hospital, but the average person is going to use the ED as the front line and front door to the hospital."
Access
While the place-in-line service facilitates non-emergent patients' ability to be seen in an ED, Dr. Steele does not believe it will encourage patients to go to the ED when an urgent care clinic or retail clinic may be more appropriate. For one, when patients go to the website to check into the ED place-in-line service, hospitals can provide patients the option of going to an urgent care clinic instead.
Dr. Steele also points to the importance of the increased access to care provided by the service. "Any time you improve access to care, you improve the patient's ability to seek care in the right environment. Is it perfect? No. But it's going to improve access to care. Any time you improve access to care, I think that's a good thing."
In addition, some communities, such as those in rural areas, do not have alternatives to EDs. "We have to make sure that we don't ascribe the big city model to the small cities," Dr. Steele says.
Related Articles on ED Patient Flow:
No Waiting Room, No Wait? A New ED Model at Washington's Swedish Medical CenterU.S. Hospitals Expand Emergency Departments to Handle Increasing ED Volumes
AHRQ Releases Emergency Severity Index to Categorize Patients' Need for ED Care