Despite a recession and continued crowding, a new study shows that the average wait time in the nation's emergency departments fell by two minutes in 2008 to 4:03. Even with the long waits, Press Ganey's Emergency Department Pulse Report 2009 finds that patient satisfaction rose in 2008, continuing a five-year improvement trend.
Leigh Vinocur, MD, on the emergency physician faculty at the University of Maryland School of Medicine, says she's not surprised that patients leave the ED satisfied.
"First of all, they probably can't get in to see a primary care doctor," says Vinocur, who is also a national spokesperson for the American College of Emergency Physicians. "And when you go to a doctor's office, he decides you could need a CT scan or a neurologist and you're waiting another few weeks for a referral.
"So, even though people are waiting four and five hours in the ER, they have an idea they are going to have a diagnosis when they leave. That doesn't always happen. But we can do a lot of procedures and things while you are there to get closer to the diagnosis," she says.
Vinocur laughed when told that two minutes had been trimmed from a four-hour wait, but she noted that it at least reverses a trend that Press Ganey says has added 27 minutes to the nationwide average ED time since 2002.
The ACEP has long maintained that ED care is actually efficient and cost effective, especially because of the dearth of primary care physicians and a lack of alternatives. Press Ganey President and CEO Richard Siegrist, Jr. does not disagree.
"Emergency department care for certain situations can be cost effective," he says. "Things that could be better treated in a primary care setting if there were greater access would be preferable. But I agree with the emergency physicians that the emergency department can be the appropriate place for many treatments. As a company, we don't have a stance on that issue. There are obviously two sides to that discussion."
The Pulse Report analyzed the experiences of nearly 1.4 million patients treated at 1,725 emergency departments nationwide in 2008.
Among the findings:
- South Dakota has the lowest total time spent in the emergency department (2:52); Utah had the highest total time (6:48).
- Virginia patients spent 23 fewer minutes in the ED in 2008 than they had in 2007, while patients in Maryland spent 14 fewer minutes in the ED last year.
- The metro areas with the highest patient satisfaction in the ED for 2008 were, in order, Miami, Detroit, Philadelphia, Pittsburgh, Boston, Chicago, Baltimore, Houston, Dallas/Ft. Worth, and New York/Long Island. Miami moved up from third on last year's list, while Detroit moved up from fourth. Philadelphia was a new entry in the Top 10.
- Patients who arrive in the ED between 7 a.m. and 3 p.m. report higher satisfaction than those who arrive in the evening or overnight hours. Lowest satisfaction was reported among those who are in the emergency department between 3 p.m. and 11 p.m.
- While average total times have increased since data was first collected in 2002, patient satisfaction is improving as many hospitals are communicating better with patients about delays.
- The economy is having a significant impact as the proportion of emergency department patients without insurance is increasing. Fewer patients are seeking inpatient and elective services.
Christina Dempsey, senior vice president of clinical operations for patient flow at Press Ganey, says a growing number of hospitals are re-examining scheduling for elective surgeries and coordinating those schedules with the ED.
"The elective schedules coming in to the OR actually have more peaks and valleys than the ED arrivals do," she says. "By looking at that elected volume and smoothing that out over the week, getting rid of those peaks and valleys, improves patient placement, improves boarding in the ED, and opens capacity in the downstream units. You can do the same thing in the cath lab with the same methodology."
Deirdre Mylod, vice president of acute services at Press Ganey, says there is some indication that hospitals that have embraced technology are seeing higher levels of patient satisfaction. "It's not the case that simply applying technology to bad practices will solve the problems, but that in the face of improving processes, technology can make it that much more efficient," she says.