Real Time Emergency Department Patient Wait Times on the Web

Session
Potpourri

Authors
Joseph Guarisco, M.D.
Chairman, Department of Emergency Medicine/System Chief Emergency
Ochsner Health System

Jason Clement
Net Programmer
Ochsner Health System

Les Strikmiller
Project Consultant
Ochsner Health System

Denny Juge
Website Producer
Ochsner Health System

Description
This presentation will lay out a unique approach to providing patients with information regarding emergency room waiting times. As we all know, most patients arrive to the emergency department with expectations of being seen within a reasonable amount of time. However, in reality most people end up being disappointed in that their expectations are usually not met. The Ochsner Health System launched an innovative solution by posting its waiting times on the web for all five emergency departments in its system for patients to ascertain which Emergency Department may have the shortest waiting time at that moment. Not only can patients choose the shortest waiting time, expectations are created in advance and patients buy into that waiting time before their arrival greatly improving patient satisfaction. Additionally these waiting times are posted on a large plasma screen in each emergency department. This presentation will discuss the technical issues, waiting time calculations and expected and unexpected experiences for patients and staff and administrators.

Abstract
The Ochsner Health System is a multi-hospital healthcare organization with five emergency departments within the region four which or within 10 miles of each other. There was a significant load imbalance from one emergency department to the other in that one or two emergency departments at any given time were overloaded with high-volume and the others underutilized. A second issue had to do with patient's ability to ascertain this information in advance of arriving to a specific emergency department.

The Ochsner Health System felt that he could resolve a number of issues by posting ED waiting times on the web. It was believed that if patients had access to waiting times in advance of going to the emergency department they would choose the ED with the shortest waiting time. It was presumed that the benefits would be immediately greater load leveling and that the less busy EDs would get busier and busier EDs would be avoided achieving better balance across the system. Additionally posting the waiting times on the web would provide patients with full disclosure and unique transparency to one of the most aggravating issues facing patients in healthcare today&. long emergency department waiting times. An additional benefit (and very much a nuance) was that patients knowing the waiting time in advance would buy into that waiting time prior to arriving to the emergency department therefore in some way creating and meeting their expectations. It was thought that the outcome would be a great deal more patient satisfaction.

The first step in achieving any success with this project required that each emergency department electronically track and time stamp key patient events such as "time of arrival" and "time of doctor" encounter. This had actually been achieved over a number of years as each emergency department became fully electronic. The second step involved help from IT in extracting that data to a program that could be used to run a series of calculations. In actuality these two steps were fairly straightforward. Once these two requirements were met the task then became one of choosing an appropriate calculation that would emulate patient waiting time. Several calculations were tried and all resulted in a failure to predict the next patients waiting time. As it turned out a surprisingly very simple calculation was derived which turned out to be the best model and emulated the patient's experience and the next arriving patients approximate waiting time.

Once the data was obtained, extracted and calculations applied, the next major step was determining how to get this information to the Web and this is where our web engineers went to work. Displaying this data on the Web was accomplished and as it turned out, these first three steps would be in the long run the least complicated.

The issues that became problematic involved legal concerns as to liability for diverting patients or suggesting that patients not go to the nearest emergency room but rather to the one with the shortest waiting time. Marketing had a viewpoint that there was probably very little marketing value to this project and those patients most likely would not choose an emergency department in advance and as a consumer would not seek out that information. Administration had concerns that access to this information may cast our healthcare system in poor light if waiting times were felt to be excessive. Individual emergency departments with high volumes were concerned that they would lose their volume and emergency departments with low-volume were fearful that they would be overrun potentially with the new patients.

The actual outcome of this project revealed that everyone in the end was a winner. Patients have access to valuable information that allowed them to seek emergency care in a timelier manner. The medical legal division was able to work out a disclaimer that actually provided additional educational opportunities to the patient. Marketing was very surprised when the project received recognition in 84 countries with 23 million web hits the first month of operation. And indeed there has been a great deal of load leveling with patients seeking out the shortest wait times providing better balance within the system and more appropriate utilization of resources. We feel that the most important outcome were improved patient service, improved patient satisfaction and hopefully improved patient safety in that door to doctor times became shorter and critical time-dependent medical illnesses are discovered sooner.