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ED wait times touted online, but docs point to a dangerous trend

There were no patients waiting for emergency care at Oregon's Sacred Heart Medical Center RiverBend in Springfield yesterday around 6 p.m., but there were five in line at its sister hospital, University District in nearby Eugene.

Patients could assess their chances of being seen quickly at either ED simply by going to Sacred Heart's Web site. ED wait times are updated every five minutes through infrared badges pinned to patients in line, electronically tracking their flow.

Advertising your hospital's ED wait times and the number of patients in line is an emerging marketing strategy around the country as facilities search for ways to grab market share from their competitors and make sure their patients have the best possible experience.

Last year, Joy Cresci, Sacred Heart's emergency trauma assistant administrator, recalls that the system endured "a lot more volume in our emergency department than we anticipated by a significant amount," creating perception problems in the community "We were having long patient waits in the lobby; patients were unhappy."

For Sacred Heart, the posting is an effort to appease patients and ramp up competition against McKenzie Willamette Medical Center, which is a competing hospital, Cresci says.

But officials for the American College of Emergency Physicians are not so sure the idea is medically sound.

"I would say this is a gimmick more than anything else," says Sandra Schneider, MD, ACEP president-elect, and an emergency physician at Strong Memorial Hospital in Rochester, NY.

"I like the idea that some EDs are out there trying to be better, but at the same time I worry people might delay coming in to be seen. Sometimes a fairly minor symptom, like jaw pain or a bit of chest discomfort, can actually be a serious sign or condition that we need to jump on right away.

"And with this system, my concern is that people will wait in line at home rather than wait in line in an ED where a trained nurse has screened them," Schneider says.

Another facility posting ED wait times is Methodist Stone Oak Hospital in San Antonio, where the wait around 6 p.m. was only five minutes. And at Scottsdale Healthcare facilities in Arizona, a viewer could expect to wait 142 minutes for care at the Osborn emergency facility, but no waits at Thompson Peak ER, the Shea Main ER or the Shea Kids ER.

Still a variation on the theme of posting your hospital's ED wait times is a strategy that allows patients to buy, for $24.99, the ability to register online for a place at the head of the emergency room wait line at participating hospitals. The concept, called InQuickER—"Skip the ER Waiting Room"—was developed three years ago as a customer service program.

The patient prints out a confirmation number with instructions for what time to be at the hospital so they don't have to wait.

So far, three hospitals have signed up: Emory-Adventist Hospital in Smyrna, GA, Florida Hospital Waterman in Tavares, FL, and Infirmary West in Mobile, AL.

"We have a disclaimer. I am not experiencing a life-threatening emergency," says InQuickER CEO Tyler Kiley. Also, a charge nurse evaluates the nature of the symptoms or complaints the patient lists on the online registration form, to make sure that the patient's complaints aren't truly emergent, or require an ambulance.

Kiley says InQuickER has calculated return on investment for participating hospitals of between 200% and 2000% because patients who buy into the service won't go somewhere else.

InQuickER has experimented with various price points "and discovered that for $24.99, people absolutely love the service. They say 'This is the best $24.99 I ever spent.' And we're coming up on 3,000 patients who have used this across all of our sites."

ACEP is concerned that some seriously ill patient may attempt a much longer drive to a more distant hospital with a shorter advertised wait time, or one offering advance registration, yet not make it there fast enough.

"Patients don't understand how emergency rooms work, and expect to be taken in order they came, one, two three ...They don't understand that we always take the sickest patients first," Schneider says.

Nevertheless, it is the way some hospitals hope to woo patients, a strategy Schneider thinks is ill-advised.

"A better thing to work on is to find out what's jamming up your emergency department in the first place, get your patients on the floor, get them feeling better rather than working to post your times. I would save my money, and let the emergency department take care of emergencies."

At Sacred Heart, Cresci acknowledges that initially, doctors in the emergency department "weren't all that hot on the idea. They were worried it would set false expectations, and some people would complain that, 'Hey, I saw on your Web site there was nobody waiting, and now there's five people.'"

She adds that typically, emergency room doctors don't want to tell people how long a wait there might be, "because you could have five ambulances come in all at once. So we do have a disclaimer, and we do update the site every five minutes.

"And so far, we have not had one complaint."