Can posting ER wait times be dangerous to patients?

You’ve probably experienced that age-old ritual of cooling your heels in an ER waiting room hoping that it won’t be too many hours before a nurse lets you inside the sliding doors.

Simon Bradley tweeted this to my Twitter Account @WCBADoctorBrian: “My buddy had a deep laceration between the thumb and the index finger – a full layer of skin.  Took 10 hours at (name of hospital withheld), fastest in town.”

A growing number of Emergency Rooms in the United States have taken the consumer-savvy step of posting their wait times in an effort to speed things up.  Scottsdale Healthcare in Arizona operates four emergency departments.  Every three minutes, Scottsdale gives patients a fairly close estimate of how long they can expect to see a doctor, a physician assistant or a nurse practitioner at one its four ER sites. The times are posted automatically on electronic billboard as well as the hospital’s web site.  Henrico Doctors’ Hospital in Virginia posts wait times on a huge billboard located outside the hospital.  A growing number are doing it right across the US.

Hospitals in the US see posting wait times as a way to beat out the competition by boasting they see patients in the ER faster.  In addition, companies that operate chains of Emergency Rooms find that posting wait times smoothes out patient demands for ER services by encouraging patients to visit an ER that has a shorter wait time.  Some Emergency Rooms are posting wait times to embarrass the hospitals in which they’re situated into doing more to shorten the wait.

In Canada, there’s no competition for patients.  Emergency Rooms are a bit behind the curve.  Some loosely keep track of wait times so they can keep patients in the waiting room better informed.  In Ontario, where I practice, the province has set a target of being seen and treated within 4 hours of arriving with a minor problem and 8 hours of arriving with a major medical problem.  In that province, you can log onto a web site and find out how often the hospital ER you go to sees patients within a prescribed or recommended maximum amount of time.

In British Columbia, the provincial government recently announced $22 million in financial incentives for Emergency Rooms that shorten the wait.  So far, I’m not aware of any Emergency Rooms that put wait times on web sites and social media in a way that could influence the behavior of people who are thinking of going to the ER.  However, I am aware of urgent care centers in Canada that do post wait times.

The idea of arming potential patients with information on wait times seems like a smart nod to consumers.  Clearly though, there are risks involved.  No doubt Emergency Rooms that shorten the wait get bragging rights.  But I want to know what they do to shorten the wait.  My fear is that they’ll cut corners.  Just shortening the encounter between patient and health care professional to 5 or 10 minutes can shorten the overall wait, but at what cost to the quality of the visit?

My biggest fear is that posting wait times could lead patients to make inappropriate and perhaps even fatal decisions.  I can well imagine a patient with chest pain checking on the Internet and finding that the hospital closest to him has a 40-minute wait, while the second closest hospital 15 minutes farther away has a three-minute wait.  He decides to drive across town to the farther hospital and suffers a fatal heart attack during the trip.

Patients need to be aware that the ER queue is not ‘first come, first served’.  Life threatening problems get seen right away regardless of the length of the queue.  I’m also concerned that posting long wait times will discourage patients with potentially life-threatening problems from coming to the ER at all.

To me, the posting of ER wait times is emblematic of a larger issue.  Those who work in Emergency Rooms must re-double their efforts to connect with patients.  They need to demonstrate that they care about patients as people, not just as diseases.  They need to understand that wasting patients’ time in the ER is a serious inconvenience to them.

The one thing they should never do is discourage patients from coming to the ER.

Adapted from a blog post that appeared on White Coat, Black Art.

Brian Goldman is an emergency physician and author of The Night Shift: Real Life In The Heart of The E.R., published by HarperCollins.

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