Hospitals working to make patients happier while lowering costs

Mini-emergency rooms inside the emergency department. Appointments for emergencies that aren’t life-threatening. Guaranteeing patients will see a doctor in 30 minutes. Texting to get wait times.

Baton Rouge- and New Orleans-area hospitals, like those throughout the country, are exploring a number of strategies to reduce the amount of time patients spend in their emergency departments. That’s largely because consumers, who bear a growing portion of health care costs, are demanding better service. The Affordable Care Act ties a small percentage of Medicare payments to patient satisfaction. The longer patients wait, whether in the emergency department or a clinic, the lower the satisfaction rating.

“Reducing the amount of time a patient has to wait in the emergency department helps hospital revenue because it means fewer patients walk away,” said Dr. James Augustine, a spokesman for the American College of Emergency Physicians. “Just like any kind of processing, if you process more people, the average marginal costs go down.”

There may not be a tremendous difference in those costs for the hospital, but less time typically means lower costs for the patient and the hospital, Augustine said.

In general, the larger the hospital, the busier the ER is and the longer the wait time. The average wait time in “very high volume” emergency departments — those that treat more than 60,000 patients a year — is 40 minutes nationally and 33 minutes in Louisiana. Everyone is trying to do better.

Baton Rouge General and Ochsner Health System have hired Lafayette-based Schumacher Clinical Partners, which specializes in emergency room management and staffing, to help cut wait times. Our Lady of the Lake Regional Medical Center is working with GE.

Baton Rouge General’s average door-to-provider wait time — the combined figure for the Mid City and Bluebonnet campuses — was 26 minutes, according to the most recent figures from the federal Centers for Medicare and Medicaid Services. The figures cover the 12 months ending March 31.

The General closed the Mid City emergency department in early 2015. Wait times for each campus were not available because the General has a single provider number for both campuses, according to CMS.

“Our company looks at those benchmarks and medians and we have a target that’s lower than that,” said Dr. Randy Pilgrim, Schumacher’s chief medical officer.

The company works with about 200 hospitals in 28 states, including 34 in Louisiana. In addition to the General and Ochsner, Schumacher is working with a number of New Orleans-area hospitals.

“The rule of thumb is that there’s not a one-size-fits-all solution,” Pilgrim said. “You have to customize a solution to the practice that you have, the physical space that you have and the resources that are available.”

The General recently added an Advanced Assessment Center at Bluebonnet, which is expected to reduce wait times.

The center redirects some patients, mainly those with chest pain or heart attack symptoms, to more specialized areas, said Dr. Kenny Cole, the General’s chief transformation officer. There, the patients can be monitored, treated and tested for a few hours without a costly hospital admission or taking up an ER bed that could be used by another patient with more immediate needs.

Putting the lower acuity patients — those with less severe issues — in a separate area from the patients with more severe illnesses is one of the industry’s major trends, Pilgrim said. The separate area almost functions as a mini-emergency room or urgent care clinic within the emergency department.

Dawn Peavey, Ochsner Health System vice president of service lines, said the system’s hospitals have used Q-track, or quick track, to handle nonemergency patients outside the main emergency department for many years.

Touro Infirmary has a “Fast Track” area, a sort of express lane, for patients with less serious illnesses and injuries. East Jefferson General Hospital has a Geaux Zone.

Pilgrim said he could not discuss how much Schumacher Clinical expects to reduce the General’s wait times, but a wait somewhere in the 20- to 25-minute average is considered good.

At Ochsner Medical Center - Baton Rouge, door-to-provider times average 21 minutes, according to CMS.

Ochsner also created virtual capacity to assist with emergency department patient flow; uses triage nurses to evaluate patients; and has a separate area outside the emergency department for nonemergency patients, Peavey said. For the past three years, Ochsner has had a 30-minute guarantee at its O’Neal Lane emergency department.

Those practices helped Ochsner Health System reduce its walkaways to less than 1 percent, said Dr. Joseph Guarisco, system chief of emergency services. The national average is 3 percent.

Billy Conerly, director of emergency department services at Lane Regional Medical Center in Zachary, said reducing wait times is a constant battle.

The hospital has bedside registration that allows patients to sign in at the front desk, then to a triage nurse and directly into an ER bed, he said. At peak times, the hospital also opens a separate triage area.

The result is an average wait time of 20 minutes for the 100 or so patients who come through Lane’s ER every day, Conerly said. In addition, Lane Regional has been able to slice about 20 minutes from the total time a patient spends in the emergency department.

Augustine said hospital emergency departments have gotten progressively quicker at getting patients to doctors over the past decade. But there is probably a limit to how much wait times can be reduced.

Less than 20 minutes probably is not possible for many hospitals, Augustine said.

Some larger emergency departments see more than 150,000 patients a year.

Sometimes 25 people arrive in an hour, and that may happen two or three hours in a row.

Setting aside the space and keeping enough staff available to handle that many patients would be cost-prohibitive, Augustine said.

The emergency department at the Lake’s main campus, its pediatric emergency room and Livingston facility treat about 500 patients a day, Chief Operating Officer Terrie Sterling said. To help accommodate that kind of volume, the Lake starts working to cut wait times long before patients arrive at the emergency department.

The first step is persuading patients to establish a relationship with a primary care provider or family doctor, Sterling said. It’s the most important thing a person can do to avoid an emergency visit.

The Lake also tries to give consumers more options through its urgent care clinics, which offer extended hours. The Lake wants to make certain that consumers are only 10 to 15 minutes away from primary or urgent care.

The options include Lake Express Check-In, which lets consumers go online by computer or mobile device and pick an appointment time, Sterling said. The appointment can be in the emergency department, but only for minor emergencies, an urgent care clinic or a doctor’s office.

The Lake added the service about six months ago, and 40 percent of users don’t have a family doctor, she said. But 90 percent of the users like the service.

The Lake’s clinical team can review the patient’s symptoms before that person arrives, Sterling said. In one case, a parent made an appointment for a child later in the day.

“But based on clinical presentation, they were able to call the parent and say, “We really believe your child needs to be seen now,’” Sterling said. The clinical team was at the door waiting when the family arrived.

Average wait times at the Lake emergency department was 48 minutes, according to CMS. But Sterling said in the past 10 months, the Lake has cut the median door-to-provider time — half the patients wait longer and half wait less — to under 20 minutes.

Despite the advances in reducing wait times, don’t expect to see a tremendous decrease in the total time patients spend in emergency departments. The national average is 141 minutes, according to CMS. In Louisiana, it’s 139 minutes.

That’s because a growing percentage of emergency department visits consists of older patients, Augustine said. Those patients generally have more complex problems.

“They have shortness of breath. They have abdominal pain. They have headaches. They have things that require hours to try to work up and begin to treat,” Augustine said.

It may take three or four hours of diagnostic testing and treatment before the doctor can send those patients home, he said. But taking that extra time means patients don’t end up being admitted to the hospital unless they’re very sick, something both the patients and insurance companies prefer.

Follow Ted Griggs on Twitter, @tedgriggsbr.

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