Competitive Hospitals

From Albany Times Union:
"If it's an emergency, they're on the clock"

A searing pain in Todd Croote's rib cage sent him to a local emergency room last year. He sat on a gurney in the ER's hallway for six hours without ever seeing a doctor until he left in frustration and found care elsewhere. On Wednesday, Croote rested on the bumper of a minivan in the parking lot of Albany Memorial Hospital, which has been advertising itself as the ER where you "get the care you need, fast." When his wife had stomach pain the night before, they went to Memorial Hospital to see if the claim was true. A doctor examined his wife, Angela, within 20 minutes of her walking through the door. "I'm pleasantly surprised," said Croote, a warehouse supervisor from Greenville. Competition for ER patients has not yet driven Capital Region hospitals to post live, up-to-the-minute wait times, but they are heading there. "It's certainly something the public wants," said Dr. Roger Barrowman, chairman of the department for emergency services at Schenectady's Ellis Medicine. "Americans don't want to wait for hamburgers or Disney World rides, and they certainly don't want to wait for medical care." Area hospitals have launched a variety of efforts to reduce waits for ER patients. In addition to building new treatment rooms, creating express units for minor injuries and registering patients at the bed side, hospitals have instituted the following:

- Physician in triage: Rather than the traditional nurse triage, doctors make the first assessment and can immediately order X-rays, CT scans and other tests.

- Electronic patient tracking boards: The most advanced versions tell staff in real-time when a lab result is ready, or when a patient is being admitted to a hospital bed. The board flashes a warning when a patient has been waiting too long.

- Advance orders: Standard protocols based on symptoms that allow nurses to start blood work and other diagnostic tests without waiting for a doctor.

- Patient navigators: Guide patients through the ER process and advice people about wait times.

For patients who see the physicians in triage, the door-to-doctor time dropped from 45 minutes to 20 minutes at Memorial Hospital, said Dr. Clifford Erickson, director of the emergency department. Ellis Medicine's Nott Street ER saw a similar drop when doctors started handling the first exam. Both hospitals deploy the triage doctors from about 11 a.m. to 11 p.m. Heated competition in other areas of the country has prompted some hospitals to publish live wait times by text message and flashing billboards, marketing devices that target patients with minor injuries. Memorial Hospital hopes to post its real-time numbers someday. "One of the greatest sources of frustration for patients in the emergency department is lack of the ability to get a good idea of how long a visit is going to take and having no control over that," Erickson said. "This may help allay some of those fears, or ease expectations." Hospital officials at Albany Medical Center Hospital and St. Peter's Hospital aren't so eager to post their times, saying that their ERs have heavy volume, extreme surges in visits and high-intensity patients. Both said their priority is quality, not speed. Albany Medical is the region's top-level trauma center and its ER accepts 5,000 transfers from other hospitals annually. St. Peter's said it has the oldest patient population who often come with many health problems. "Our first and foremost concern is that we are providing the best care we can, not the fastest care we can provide so we look good on a billboard," said Elmer Streeter, spokesman for St. Peter's. Albany Medical would not provide door-to-doctor wait times. "You may wait X amount of time, but once you get in the door what you are going to get is high quality care," said Dr. Dennis McKenna, medical director at Albany Med. Emergency room patients in the Capital Region waited 30 to 48minutes to see a doctor in 2009.

^ I used to live in the Capital District and went to some of the hospitals mentioned. Ellis Hospital was pretty fast and effective. They even made special arrangements for me when I had to be admitted for the night. One hospital not mentioned in the article, the Samaritan, I did not like at all. While I was brought to a room fairly quickly I did not see a doctor nor got any pain medicine for over an hour. The worse hospitals were when I lived in Virginia. I remember telling a stupid triage nurse that unless they took care of the person I was with (who was brought in by an ambulance and just left in the waiting room until I showed up) right away that I would take her to another ER. The nurse threatened to call the police and have me arrested to which I told her that she should call the police so they could see how the hospital and the nurse were refusing to treat a person in pain. That made her call a hospital supervisor and after I yelled at the guy for not taking care of the person I was with and telling him that unless the person was seen right away I would go to another ER and make sure the media heard about how the hospital treated us. The person was then brought to a bed. It is sad that I had to threaten the nurse and supervisor but that was the only way they would get off their arrogant high horse and help someone in pain. Things will only get much worse if Obama's health care reform are allowed to take effect. I only hope that the people in Congress who voted for it will be sent home in November and the reforms will be overturned. ^

http://www.timesunion.com/local/article/If-it-s-an-emergency-they-re-on-the-clock-632251.php