Waiting Isn't ER Patients' Top Issue
June 23, 2009
In what might be a counterintuitive take on crowded emergency rooms, patients say the time spent waiting is not their top concern, according to a customer satisfaction survey last year of 1.4 million patients.
Though decreasing the length of the visit would improve overall customer satisfaction, the report says, patients’ top priorities are how well they were kept informed about delays, how well the staff cared about them as people and how well their pain was controlled. It also mattered if the waiting room was comfortable.
The study was done by Press Ganey, a consultant for more than 10,000 health care facilities (more than 40% of the USA’s hospitals). For the fifth straight year, customer satisfaction showed a slight increase, to 83.7% from 83.1% in 2007.
The bad news in the report: The average time spent for each visit to an emergency room is 4 hours and 3 minutes, a two-minute decline from 2007. Lengthy stays also were highlighted in April by the Government Accountability Office, which found some waits for emergent patients — those who should see a doctor in one to 14 minutes — were more than twice as long as they should be.
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The strain on emergency departments grew from 1996 to 2006 as 32% more patients sought care while the number of centers dropped from 4,019 to 3,833. Yet the increase in the number of patients seeking care shows the value Americans put on being treated in emergency rooms, says Nicholas Jouriles, president of the American College of Emergency Physicians.
“What I take away from the Press Ganey report is that people have to wait longer than they should, but they love the ER and want it to be an option in their health care,” Jouriles says.
Customer satisfaction declines the longer a patient waits: It’s 89.2% for waits of less than an hour, 81.4% for three to four hours, and 75.1% for six or more hours.
The report calls for addressing crowding in general and decreasing “boarding” in the emergency rooms and getting patients to the appropriate floor faster. (Boarders are patients waiting in the ER for admission to the hospital.) The GAO made the same recommendation, citing “competition between hospital admissions from the emergency department and scheduled admissions — for example, for elective surgeries, which may be more profitable.” Spreading out elective surgeries would help get boarders admitted during peak hours.
“It is a difficult change, but the concept is a good one,” says Jim Scheulen, chief administrative officer of Johns Hopkins’ department of emergency medicine in Baltimore. “How would surgeons react to doing operations on Saturdays to help with this? It is easier said than done.”
Jouriles says boarders are the biggest problems facing ERs, not seekers of non-urgent care, who account for only 12% of ER patients. “Even though boarding occurs in the emergency department, it is really a systemwide problem. If we can solve the problem of boarding, we’ll fix the whole health care system.”
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