Charging a Fee

This article appears in the May 2012 issue of HealthLeaders magazine.

The wait times for patients for the 14 ED beds at the 121-licensed-bed Sycamore Shoals Hospital, a rural hospital in the mountains of Elizabethton, Tenn., often reached two hours, and sometimes four. A hospital leadership quality committee saw those numbers and knew they had to make changes, says Melanie Stanton, RN, chief nursing officer. The hospital system decided to charge patients for use of the ED if they didn't really need it.

Under the hospital's program—approved by Mountain States Health Alliance, which owns Sycamore Shoals—a qualified medical practitioner, either a nurse practitioner or physician, determines if a patient's condition was considered nonemergent based on a medical screening exam. If the medical team decides in a preliminary evaluation that the patient's condition is not urgent, the hospital gives patients the option of staying in the ED to see a physician for treatment and paying a $250 fee, or gives them information to see an urgent care clinic or have a follow-up visit with a family physician.

"We do a qualified medical screening exam," she says. "We have very specific criteria and [patients] are assessed as nonurgent. We do provide pamphlets of all area clinics with a more cost-effective rate."

The hospital's performance improvement team proposed changes to the ED after having concerns about wait times and the need for process improvements, says Stanton. The performance improvement team included a multidisciplinary group composed of "hospital leadership and medical staff and front line from all inpatient nursing units" as well as lab and radiology representatives, she says.

A similar plan  is being considered by several facilities across the nation to improve patient flow and reduce ED wait times.

This article appears in the May 2012 issue of HealthLeaders magazine.