Report Documents ER Wait Times in U.S.

Report Documents ER Wait Times in U.S.

News Feb 13, 2013

Feb. 13--Broken leg? Heart attack?

You're probably heading to the emergency department and, depending on the area hospital you pick, your wait to be seen will be as short as 11 minutes or as long as an hour.

The U.S. Centers for Medicare & Medicaid Services has issued new data comparing hospital ER wait times.

The new data set expands on one released in May, when CMS issued a limited batch of measurements from 74 U.S. hospitals, tracking only two metrics -- the time it takes for a patient to move from the emergency room entrance to an inpatient bed, and the time it actually takes to place someone in an inpatient bed following a doctor's recommendation.

The new data track 4,000 hospitals in seven ER-related categories, including the one that patients are most acutely aware of and irritated by -- the average time a patient spends in the ER before being seen by a "health care professional."

Best in the region, according to that metric, is Excela Health Frick Hospital in Mount Pleasant at 11 minutes, followed by Butler Memorial Hospital at 13 minutes and St. Clair Hospital, at 14 minutes. Three UPMC hospitals, UPMC Mercy and the combined (for record-keeping purposes) entity of UPMC Presbyterian and UPMC Shadyside, are next at 15 minutes and 16 minutes.

Some of the longest waits are at Ohio Valley Hospital, at 58 minutes, and Allegheny General Hospital, at 51 minutes, according to the Medicare data.

ER wait times can fluctuate based on the hospital's location (urban vs. suburban or rural, with urban hospitals usually having longer waits), its annual patient volume (the higher the volume, the longer the waits), and its trauma rating (designated trauma centers see more serious cases, forcing those with less serious emergencies to wait longer).

The North Side's Allegheny General Hospital, for example, is a "level one" trauma center, meaning it is capable of treating the highest-acuity patients. The emergency room there sees about 50,000 patients a year.

The 51-minute wait reported by Medicare is "a little higher, but close to what our internal tracking tells us," said West Penn Allegheny Health System spokesman Dan Laurent. "It is something that we have been focusing on."

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In one recent change, he said, the hospital added physician assistants to the patient triage process -- the assistant, working with the triage nurses, can evaluate patient before a doctor sees them, "which is particularly helpful in speeding up the care of moderate- to low-acuity patients."

While AGH may rate poorly against area hospitals' wait times, against other urban level one trauma centers that double as teaching hospitals it is "middle of the pack," Mr. Laurent said. "Our goal, however, is to be much better than that."

For most hospitals, a median wait time of under 30 minutes is a good benchmark. In 2009, according to the Centers for Disease Control, the median ER wait time for all U.S. hospitals was 33 minutes.

They are, in a numerical respect, fighting a losing battle. Between 1997 and 2008, annual ER visits grew almost 31 percent in the U.S., from 95 million to 124 million.

Over a similar period, from 1990 to 2007, the number of urban hospital-based emergency departments in the U.S. dropped by about one-third, or 933 out of 2,814 urban acute-care hospitals.

In other words, fewer emergency rooms, but many more visits.

So hospitals have taken a variety of measures to drive down wait times in the past decade, including the one measure that makes the most practical sense: getting people who don't need to be in the ER out of the ER.

That means routing some patients with non-urgent conditions to other providers or -- if they don't need emergent care or an inpatient bed but still ought to stay in the hospital -- moving them out of the ER as quickly as possible and into an observation unit, freeing up emergency room capacity for the next patient.

Larger systems with multiple hospitals can use real-time tracking to send patients or ambulances from a hospital with a longer wait to one with a shorter one. Excela Health System's "ER Wait Time" webpage, for example, gives visitors the estimated wait at each of its three emergency departments (Frick, Latrobe and Westmoreland), updated every minute.

"Our goal was set at 20 minutes," said Maryann Singley, vice president of patient care services at Excela's Westmoreland hospital, in Greensburg.

Most days, they beat that goal systemwide, but not always.

"During high flu season, we weren't meeting that ... and we weren't alone in that," she said.

Excela has been examining its own ERs, trying to make the emergency room visit more efficient. Many systems -- Excela included -- have addressed the issue by adding capacity and redesigning the ER.

In 2010 and 2011, Excela completed a $4.5 million redesign of its Westmoreland ER, installing new CT scanners and X-ray equipment, adding 3,400 square feet, increasing the number of triage beds and parking spaces, and redesigning the ambulance access.

But only so much efficiency can be wrung from more square footage. Lots of it has to do with rethinking "patient through-put" issues -- discharging patients in other areas of the hospital in a timely fashion, for example, so that the emergency room patient who needs an inpatient bed is able to get one.

"If patients aren't moving throughout the rest of the organization, we backlog the ER," Ms. Singley said.

Westmoreland studied these and other issues by way of participation in the Urgent Matters Learning Network, a hospital improvement venture funded by the Robert Wood Johnson Foundation.

UPMC has been using that same two-pronged approach to manage ER wait times -- adding capacity and "focusing [on] what goes on in the entire hospital," said Rick Wadas, chief of community emergency medicine. Just as ER backups can plague the rest of the hospital, backups elsewhere can affect the ER.

"If people keep coming in the front door, but can't get out of the back door, we eventually run out of space," he said. UPMC, he said, shoots for an initial wait time of under 30 minutes, and all of its area hospitals achieve that.

CMS's "Hospital Compare" website was launched in October 2011, and since that launch date, it has been adding more categories, measurements and statistics by which hospitals can be compared.

Users can select up to three hospitals in a region, to see which one performs best in certain quality categories, including various ER wait times (such as what percentage of suspected stroke victims receive a brain scan within 45 minutes, or how long a bone fracture victim waits for a painkiller, or the total time spent in the ER).

While the wait to see a doctor is often the one a patient notices most, other wait times are just as important.

"How fast can we get the X-ray done?" Dr. Wadas asked. "If that process takes 20 minutes versus 50 minutes, you can see what a huge difference that can make" in terms of total time spent in the ER, from entry to discharge.

The CMS data are limited to hospitals that accept Medicare payments. Certain hospitals -- such as Children's Hospital of Pittsburgh -- don't do business with Medicare, and as a result cannot be compared to other hospitals in the region using this web tool.

Because the data are population-specific (only people 65 and older use Medicare), it may not be reflective of a hospital's true performance across the breadth of its patient load, something that concerns health officials, who worry patients may draw the wrong conclusions when they look at the statistics.

Hospitals also warn that the data are only as good as its compilers, since the wait times (and other metrics) are essentially submitted by the hospitals themselves when they send bills to Medicare.

But patient advocates generally approve of the tool, saying it's a big step toward quality transparency.

Bill Toland: btoland@post-gazette.com or 412-263-2625.

Copyright 2013 - Pittsburgh Post-Gazette

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Pittsburgh Post-Gazette
Bill Toland
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