Abstract
This paper issues an analysis of best practices for promoting flow, minimizing wait times, and optimizing the quality of care of patients in the emergency department. This paper discusses the problems linked to long waiting times in the emergency department. This paper will show that crowding, long wait times as well as poor conditions in the waiting room compromise the quality of the patient satisfaction.
This study begins by investigating the relationship between patient satisfaction and wait times. Best practices towards minimizing wait times are identified. The objective of this research is to identify the varied approaches that healthcare providers can use to minimize waiting times. The literature review provides a proposal to act as a guide for the National Health Care Reform in the United States. This article proposes the Emergency Medical Treatment and Active Labor Act (EMTALA) as a useful framework for lowering the costs of healthcare and improving patient care. The last section focuses on the implications of the study and provides an analysis of learned lessons.
Time frame
The search for related sources took one month.
Introduction
Patients in a hospital expect that their medical needs will be addressed thoroughly since it has been an assumption that health is the number one priority of hospitals. However, even if the hospitals would like to address these needs thoroughly, they have been limited due to their resources and some other factors like inefficiency in the reception of patients. Such inefficiencies in receiving patients would be more detrimental if this is true for the emergency room department.
In a bid to minimize waiting time in emergency rooms, it is imperative to highlight and understand the factors that contribute to delays. A delay may come because of the absence of a specialist. A majority of the medical professionals specialize in specific areas. Thus, the absence of a specialist that can handle a certain health condition may lead to a patient spending a lot of time in the emergency room.
In the United States, emergency physicians are always available to handle different cases. Nevertheless, medical specialists like cardiologists, neurosurgeons, and orthopedic surgeons are summoned in the case of an emergency. Thus, a patient might be forced to wait while the emergency physicians try to reach the available specialist. Many patients who visit emergency rooms end up being admitted. Inpatient, services are a major cause of the increase in waiting time in the emergency rooms. Medical practitioners monitor the admitted patients regularly. Thus, they do not get adequate time to attend to the incoming patients resulting in overcrowding. Indeed, patients wait for approximately four hours in the emergency rooms in the United States. Handling the factors that contribute to increasing waiting time in emergency rooms can go a long way towards reducing delays and enhancing service delivery.
The majority of the hospitals in the United States have managed to reduce waiting times. For instance, at Queens Hospital in New York, the waiting time has gone down from 146 minutes to 60 minutes over two years. This decline is largely attributable to the emergence of online booking services since they assist in predicting the number of patients expected in a particular day. Despite the progress, the level of patient satisfaction is still low.
Most patients continue to complain that they do not receive emergency services on time. On average, in most hospitals across the U.S, patients wait for at least 45 minutes before they receive emergency services (Atkinson, 2009). Thus, it is the focus of this paper to address the long waiting times in the respective emergency room departments of hospitals. The paper will discuss the possible measures that can be taken to mitigate the problem.
Background Information
Overcrowding of patients in the hospital’s emergence departments is an emerging threat to patient health and the health sector globally. Ding et al. (2010, 819) define crowding as “a condition in which the determined need for intervention services overwhelms the available resources for patient care in the emergency room”. In today’s changing scenario of health care, emergence rooms are not only a source of care for the sick, but they also act as a rescue point to offer care to patients regardless of their capability to pay. The emergency rooms have been seen as convenient compared to family doctors due to poor timely appointments.
This factor has led to a substantial increase in the number of patients visiting the emergency rooms. There are many causes of crowding most of which are related to the availability of resources, patients perception about emergency services, and response from other hospital departments. Consequently, the concerned institutions have focused on improving the patient experience.
Emergency room wait times is a prevalent concern across the globe with report emanating from all corners about escalating capacity and prolonged wait times for patients. With the increasing rate of crowding in the emergency rooms, the U.S government sought to understand the factors that influenced patient care, and identify major practices that could be adopted in the emergency divisions. Since it seems there may be no perfect solutions available to this complex situation, an increase in waiting time will lead to a high mortality rate since most patients leave the emergency rooms without being treated (Prakash, 2010). This paper will conduct a systematic literature review to understand patients experience concerning waiting times.
Statement of Research Problem or Purpose of the Proposed Research
Medical practitioners cannot minimize waiting times in the emergency rooms if they do not understand the factors that contribute to the delay. Addressing factors like the absence of specialists and coming up with a proper triage can go a long way towards minimizing waiting time in emergency rooms. The objective of this research is to identify the varied approaches that healthcare providers can use to minimize waiting times. Delays in the emergency room may result in fatalities or complications. A majority of the patients that visit the emergency rooms are normally on the verge of losing their life. Apart from identifying how health practitioners can minimize waiting times in emergency rooms, the research also seeks to identify the dangers of spending a lot of time in the waiting room.
A patient’s wait time begins as he/she enters an emergency department and extends until the patient is assessed and admitted or discharged. The factors leading to long queues vary depending on each emergency department. The patient’s visit comprise of various steps or services that are termed as patient flow. These services involve triage, registration, assessment, consultations, and treatment. Therefore, a delay in one or two of these steps lengthens the patient’s stay and can lead to loopholes in the emergency department. Research by Crow et al. (2002) suggests that activities outside the hospital often influence the emergency department wait period.
These effects include things such as how fast and effective in-patient beds are vacated and prepared for the next patient to occupy. Additionally, the order and time taken to assess a patient vary on the urgency of the patient’s condition. However, these dynamics have caused confusion and inefficiency within the emergency department (Ding et al., 2010). Therefore, this paper seeks to address these issues and generate an effective formula to minimize the wait time that a patient needs to spend before a physician attends to him.
Research Methodology
This study conducted a comprehensive search of relevant literature to identify many scientific articles related to the issues of emergency department and crowding. This review utilized the Goldschmidt’s Information Synthesis as a conceptual framework for the literature review. This research identified thirty references but only ten studies were found most suitable because they had undergone peer review.
This review used Medline, PubMed, ProQuest, and EBSCOhost databases to search for relevant sources. The key words included patient satisfaction, emergency rooms, wait times, patient flow, and EMTALA. The search for related sources took one month. The inclusion criteria considered original peer-reviewed articles and published in English. This study excluded articles that did not tackle issues of the emergency department. This study consulted two colleagues to review the selected topics and abstracts for the relevance of the article. The information is readily available and of good quality because it has undergone peer assessment. This secondary information is used to clarify the research questions by comparing data from various sources. This secondary method offers answers to the uncertainties and narrows down the subject hence creating a basis for future research.
Patient Satisfaction as Proxy Gauge of Healthcare Quality
Society with functioning or healthy citizens is ideal to attain the maximum potential for development in many fields and aspects such as labor work and services. In response, many institutions, including private and public institutions, have been created to make sure that the poor health of the society does not hinder development. Hospitals are one of these primary institutions among many that ensure that the citizens are healthy, and they must continue to operate effectively to provide necessary healthcare (Crow et al., 2002).
There are many requirements imposed on a hospital to continue operating. One of these requirements includes the overall well-being of an outgoing patient. No hospital would continue operating when most of their patients continue to suffer from bad health despite the efforts that were made. An inability to make patients better will render the primary goals of hospitals to make citizens productive and healthy moot. Likewise, the improvement of their patients serves as a gauge for the measurement of the quality of health care that hospitals provide (Crow et al., 2002).
Aside from the overall well-being of a patient, patient satisfaction is also an important gauge for the measurement of the quality of the healthcare that hospitals provide. This is because “patient satisfaction does not only reflect the mood of the patients but also on their retention, clinical outcomes, and medical malpractice claims” (Crow et al., 2002, p. 48). Moreover, if the patient satisfaction proved to below, it may affect the hospital even if they provide an effective patient-centered delivery of excellent healthcare.
Unsatisfied patients tend to be more problematic as hospitals may be using up all their time and efforts in disproving their malpractice claims. Likewise, no hospital would continue to operate if most of their patients were not satisfied despite their healthcare quality (Prakash, 2010). In summary, a hospital must satisfy their patients to keep on providing healthcare services and focus on improving the healthcare services they provide.
Reducing Waiting Time in Emergency Rooms to keep Patients Satisfied
After establishing the relevance of patient satisfaction, it is essential to devise schemes that will see to it that patients that respective hospitals serve will be satisfied. In a report released by the Institute of Medicine in 2001, “they set forth six goals for quality health care system patient safety: (a) equitable, (b) safe, (c) evidence-based, (d) efficient, (e) timely; and (f) patient-centered” (Ding et al., 2010, p. 817). Being efficient, timely and patient-centered were said to influence patient satisfaction. Moreover, timeliness is important when dealing with patients, especially in emergencies. If time is not an issue and patients can wait since their concern is not urgent, patients usually set appointments; however, from time to time they require immediate attention that emergency rooms promised to provide. Moreover, if a hospital fails to address emergencies because of time constraints, it is no doubt that no patient will be satisfied, and their health will be put into jeopardy.
Simple measurement of waiting time of the patients in the emergency room cannot provide a conclusive data for since many factors in the emergency departments need to be taken into account. Therefore, using Quantile Regression model can be of huge benefit in estimating the service completion experience of the patients (Arya et al., 2013). After extracting information about the time spent in emergency rooms as well as other important information about the patients, Quantile regression is used to evaluate the service given by the hospital staff members through the amount of time that the regular and new patients have spent in the emergency room.
Quantile Regression is used so that the 10th, 50th, and 90th percentiles of each of the service times of the different types and levels of healthcare provided in the emergency are estimated room. The different Quantile Regression obtained based on the data are then compared and put into observation. From the observation and data provided, mathematical models of different service times will be formed. This method is expected to produce highly accurate results as opposed to the current methods regarding the patients’ experience in the emergency rooms (Ding et al., 2010).
Efforts Done to Minimize Waiting Time in the Emergency Rooms
Many hospital management teams did several efforts to address the problem involving waiting time in the emergency rooms of the hospitals. Some hospitals now provide online booking services for their emergency rooms through an application that can be downloaded online. Patients can schedule appointments regarding the urgencies just by paying the right amount of charge. However, many debate this kind of proposal. This is because time is vital in emergencies, and if emergency slots are reserved, then the importance of time will not be valued and such cases will not be emergency anymore (Sadick, 2014).
As the emergency slots become less as many books them, patients with more urgent needs that walk right into the emergency rooms that have failed to make their reservations will more likely be neglected as a result.
The importance of a minimized waiting time, especially in emergency rooms to guarantee patient safety has been emphasized by many hospitals. In response to this, many hospitals in the United States have embarked on campaigns to improve services in their emergency departments. As part of their effort to make the institution successful, they advertise their waiting time, which proves to be inaccurate at certain times. Accuracy is hard to attain because emergencies cannot be planned for since they occur unexpectedly. Some emergencies are intense than others and may require much time compared to less intense situations. When the advertised wait times are exceeded, patients become agitated and lose trust in such organizations (Ding et al., 2010).
It has also been reported that one of the greatest concern to patients is their long door-to-doctor waiting times (Eller, 2009). Seeing that the inflow of patients greatly affects a hospital’s standard emergency room wait time it is important to focus on the inflow of patients among many other factors. To manage this, emergency departments, doctors and hospital management have devised strategies to cope effectively with the increasing flow of incoming patients to prevent overcrowding and increase patient satisfaction. One strategy to reduce the waiting time for patients is the triage-driven bed placement.
This strategy minimizes the wait time for patients by taking patients directly to areas where they will be given immediate treatment after triage and a “mini” registration. This mini registration, unlike the most common registration practices, asks minimal necessary information like their social security number, name, and age. Complete information is later asked once the patient had settled down. Asking minimal information proves that a hospital’s priority is not gathering insurance information but to take care of its patients. This strategy improves the wait times for patients and demonstrates a hospital’s ability to cater to one’s health needs. In turn, greatly increase the satisfaction of patients (Karpiel, 2004).
Another method used to manage patient inflow is the use of Split Emergency Severity Index 3 Patient Flow Model, or simply Split 3. Patients are distinguished based on the level of acuity and utilization. Patients assigned at levels 1 and 2 require more medical attention and emergency response is severely needed, which includes diagnosis and other preliminary tests. This is because patients in levels 1 and 2 have unstable vital signs and prolonging their wait time will have serious repercussions. Patients assigned at levels 3, 4 and 5, on the other hand, relatively require less attention as their vital signs are relatively stable compared to those at levels 1 and 2.
They are considered less acute and can be responded to and treated with quick analysis, such as an immediate check-up. This strategy allows a more customized and more capable process by reducing wait times and increasing the responsiveness to patients about their needs. Aside from that, it also reduces the accumulation of patients in the emergency room. This strategy, among its many benefits, had been proven to increase patient satisfaction (Arya et al., 2013).
Aside from advocating and promoting certain medical reform and categorizing patients by their needs, most emergency departments are now are training their staff on management skills. Likewise, these tools and principles from production companies had been used to assess better the processes that have proven to be ineffective and flawed. Toyota Production System uses LEAN in its manufacturing process and it has delivered quality cars that are produced in a timely and efficient manner.
This methodology, LEAN, improve process efficiency by reducing wastes or parts of the operation that do not contribute to making the process efficient. This methodology may be applied in a hospital setting by relying on hospital staff and management in identifying the said wastes. They identify the waste by observing the wait time, registration, triage, and physician time. Through the identification of the wastes that aggravate the whole process, standardization may be achieved. Besides, quality service that promotes patient satisfaction may also be guaranteed (Eller, 2009).
From a basic knowledge and understanding of the matter at hand, the literature review must be directed towards specific goals. Thus, research questions that need to be addressed had been formulated. The following are some of the research questions that the research seeks to address:
- What problems does a longer waiting time in the emergency room pose?
- How can waiting times in emergency rooms in the hospital minimized?
Literature Review Findings
The studies used in this research are credible based on the analysis given on the summary table.
A Proposal for Jump-Starting National Health Care Reform
The study by Atkinson (2009) sought to persuade everyone, including politicians, policymakers, the medical community, and patients to believe that reforms in medical operations, particularly in Emergency Medical Treatment and Active Labor Act (EMTALA) will lower the costs of healthcare and improve patient care. Ideally, this author defines EMTALA and other available reforms that were implemented.
EMTALA was enacted to address emergencies and requires hospitals to provide a proper medical screening exam to anyone who walks in with emergency health concerns. Without the said medical screening, the hospital cannot issue the transfer of a patient to another hospital or facility that can address the issue better (Atkinson, 2009). EMTALA fails to provide guidelines for how a hospital should perform the medical screening exam and what constitutes an appropriate exam.
Thus, EMTALA promotes confusion when trying to address emergency health concerns (Atkinson, 2009). This consequently results in a longer medical screening examination that lengthens the patients’ waiting time and reduces patient satisfaction (Atkinson, 2009). To address this, Atkinson (2009) suggested that the Congress make reforms to EMTALA. This is to give hospitals the flexibility to triage patients with not so emergencies and refer them within the shortest time possible to assure their satisfaction and safety.
This scholarly work, specifically the new Emergency Medical Services, may be used by most of the hospitals to address their long and inefficient waiting time that may lead to more serious implications. However, the work lacks substance as it failed to present data that may support the aforementioned claims (Crow et al., 2002). An extensive review of related literature that focuses on minimizing the wait times of emergency departments in hospitals and patient satisfaction could be done to strengthen one’s claims. Thus, this research will try to supplement this work by selecting works that could contribute to the understanding of the operations of emergency departments and the current reforms that are proposed to address issues of longer wait times in patients.
What problems does a longer waiting time in the emergency room pose?
Long wait times hurt patient outcomes, and they increase the risk of death (Jouriles, Simon, Griffin, Williams, & Haller, 2013). In some instances, patients may become tired of waiting and opt to leave hospital premises without receiving a diagnosis. Even though emergency departments are working tirelessly to ensure the most urgent patients are prioritized and that all patients are attended within the shortest duration possible, the strategy seems lacking, and the resources of the emergency room are overwhelmed. Consequently, patients may wait dangerously for a long period and even risk losing a life before the diagnosis is administered.
Due to long wait times, overcrowding has become the norm of the emergency room. When emergency rooms hit such a saturation level that they can longer receive patients, they end up diverting patients to other hospitals. Such diversions cause life-threatening delays in care. According to Sadick (2014), about 17% of hospitals in the U.S reported that their emergency rooms were over-utilized hence compromising the quality of care. For instance, this author indicates that in 2007 alone, 200 emergency physicians confessed that they had witnessed patients die while waiting for inpatient services.
Due to overcrowding in emergency rooms, the process of care is compromised, and quality deteriorates. Doctors tend to respond to long queues by issuing quick services that might lead to staff error and lead to quality decline. Spending limited time with patients may ease the congestion, but crucial tests may be omitted, and arrangements for follow-up after discharge may be ignored. Medical errors include issuing medications at the wrong dosage and frequencies.
This insufficiency may lead to increased cases of readmission of patients who have been diagnosed in a rush. According to Prakash (2010), the mortality rate increases with increasing waiting time and ambulance diversion contributed to increased cases of mortality. Due to longer wait times, the cost of care is likely to increase incredibly. Long wait times translate to overcrowding. When there is overcrowding, emergency departments respond by diverting ambulances to other hospitals. When this happens, further expenses are incurred, and budgets are distorted. Due to long wait times, minor cases end have into complex medical cases.
How can waiting times in emergency rooms in the hospital minimized?
Every emergency department varies and attends to a unique patient population. Regardless of these variations, the emergency departments are faced with similar problems that lead to long waiting times. However, some of the common solutions to minimize the wait time are discussed below. Emergency rooms wait time can be minimized through the appropriate use of the available resources. Availability of resources such as capital, labor, and infrastructure are the common claims quoted by most of the administrators in the emergency departments. However, the number and kind of staff coupled with how they are tasked should be consistent with the numbers and timing of when patients are expected to the clinics.
The physical setting of an emergency room should be organized in a way that optimizes the number of patients seen. The layout should allow ease of movement within the premises. Moreover, equipment and supplies should be stored appropriately to reduce the time spent by staff when attending to patients (Jouriles et al., 2013).
While seeking to reduce the wait time in the emergency rooms, it is essential to consider what happens in other departments and even outside the hospital. Hospitals that concentrate only on the activities of the emergency room to minimize wait times might not be successful. Other hospital departments such as the laboratory and X-ray sections should be assessed to review how they prioritize patients in a bid to realign their programs to meet the demands of the emergency room.
In most cases, laboratory performance leads to delay in treatment leading to poor patient care particularly in high capacity patient care units. Similarly, the staff should not focus much on the urgent and critical patients to an extent of neglecting the needs of the moderate and less urgent patients. Thus, it is recommendable to balance the response rate for both cases bearing in mind that extending the wait time for moderate and less urgent patients would lead to a more complicated situation (Karpiel, 2004).
In most hospitals across the United States, it has been noted that the emergency departments are replacing the services that would conveniently be offered in the home-based programs by family physicians. Developing community-based alternatives to emergency room care, such as emergency care centers can substantially ease the burden of patient flooding to an emergency facility (Eller, 2009). The limitation with this approach is that patients tend to be reluctant to be referred to family doctors since they feel they can get better specialists and assessment of their situations by visiting emergency departments. Therefore, it is essential to provide educational programs to educate people regarding the importance of seeking alternative care rather than flooding to the emergency departments where the services are limited.
Real-time observation and the measuring of the time spent by patients before they are attended as well as issues leading to longer waiting should be noted and acted upon to eliminate them. Currently, in the U.S, most of the emergency departments are recording such data, but less action is been taken to implement changes that target limiting wait time. However, according to Jouriles et al. (2013), hospitals in the U.S are advertising emergency room wait times on social media and billboards to lure patients. Unfortunately, this report identifies that patients end up being disappointed when they find out the real-time spent in the emergency rooms exceeds the time advertised.
These authors gathered data from various emergency departments including Akron, Ohio. This study established that posted wait times were shorter compared to real wait times at all facilities on covered. Jouriles et al. (2013) concluded that many hospitals were advertising emergency room wait times to grow market share. Besides, since patients form the group that is most affected by longer wait times, it is advisable to listen to them and incorporate them in dialogues about the wait time for successful outcomes.
Strategies to minimize wait times
In a bid to fully address the above issues and minimize wait times, this paper formulates a plan that consists of five goals. The first goal entails increasing the efficiency of higher capacity emergency rooms. Enhancing how an emergency division responds might not necessarily need more funds or additional resources. Thus, the goal should be on alleviating the obstacles that block or delay patient flow (Sadick, 2014).
Each emergency department has unique needs, and intervention measures have to be tailored to consider this fact. For instance, every emergency department addresses staffing issues based on the number of expected patients and levels of patient urgency. In this scenario, the main objective should be to ensure effective staff scheduling, supportive environment and policies, and swift flow of patients. In a bid to maximize proficiency in high capacity emergency rooms, the way staff is assigned, and the roles physicians take must be addressed. Staffing procedures must be consistent with patient numbers and urgency. Skill mix should be factored to ensure that the appropriate staff members are available to cater to the demands of the patients (Sadick, 2014).
Effectiveness can depend on other indicators apart from staffing. Various hospital policies have manifested adverse effects on emergency room wait times in the past (Mowen, Licata, & McPhail, 1993). Such policies include discharge policy concerning when a practitioner makes discharge orders. Most of these policies are inconsistent with the current needs of the emergency department. Therefore, these policies need to be highlighted, reviewed, and improved to match the emergency department requirements. The physical and social environment of the emergency department can also adversely influence efficiency. Good working conditions can foster efficacy and eliminate wait times (Mowen et al., 1993).
Ensuring that large numbers of moderate urgent patients are dealt with swiftly and effectively can minimize emergency room congestion (Atkinson, 2009). Since this group of patients might not need in-patient services, unutilized spaces should be designed to cater to their needs. Front-line emergency room personnel should be trained in efficacy development to minimize wait times in the emergency rooms. Further reviews should be conducted to identify more training needs.
The second goal entails facilitating access to community-based health care services. The community-based programs should foothold the effective use of emergency services. A huge number of patients seek services of an emergency room because they lack personal doctors, or they are not capable of finding such services elsewhere. Consequently, high numbers of moderate urgent patients cause congestion in an emergency room and cause longer wait times. A 2003 report issued by the Government Accounting Office identified that about 86% of patients who visited emergency rooms were grouped as less urgency (Karpiel, 2004). Conventionally, the assumption has been that minimizing or rechanneling the number of non-urgent patients would not substantially cut demands on an emergency. However, the current study by Sadick (2014) challenges this assertion by showing that community-oriented alternatives to the emergency rooms lower the number of patients who show up there.
According to Arya et al. (2013), to fulfill this goal, the plan has three main objectives. First, facilitate access to family physicians. Some patients turn to emergency departments because their family doctors may not be available to offer timely services. Besides, most family doctors do not provide services past working hours or on weekends. Consequently, patients lack alternative but to visit an emergency department even when they experience mild illness.
The appropriate action should involve providing incentives to family doctors to raise the frequency of evening and weekend services. Second, facilitate campaigns to encourage patients to seek alternative care services since they can be of more value as opposed to waiting in emergency rooms and increasing chances of poor quality care. Many patients may be not aware that community-based services are well equipped to address their health demands. Third, holding admitted patients who are unable to clear their bills is a factor leading to emergency room overcrowding. However, policy reforms should target effective means of addressing cases of bill clearance and abandon the traditional way of holding patients.
The third goal entails the use of the Spilt Emergency Severity Index 3 Patient Flow Model. This procedure separates high severity patients from low severity patients when determining the duration spend with a doctor. The essence of splitting patients concerning their urgency is to offer more customized and efficient services (Arya et al., 2013). This study indicated that less urgent patients required fewer resources and rarely needed significant doctor’s attention.
On the other hand, patients that are more urgently needed much attention from doctors. The split strategy ensures that each staff is accountable for a particular stage of operation to enhance the smooth flow of patients. For instance, the split system adopted a flow model that entails quick registration based on the main complaints. Arya et al. (2013) established that a split strategy accounted for 9% to 18% reduction in wait times. Moreover, this approach signaled patient satisfaction because improved flow influenced not only the quantity but also the quality of care. This approach is highly recommendable for emergency departments encountering prolonged stay for low, moderate, and high urgency patients. This approach has reduced pressure on emergency departments experiencing in-patient constraints but has enough space to allow segmentation.
Managerial policies
Management represents a link between other departments and collaboration within a department. The management determines how the emergency department fits into the entire health sector. Managerial policies are viewed to have both positive and adverse effects on wait times depending on how they are applied. Some of the managerial policies that influence emergency rooms wait times include bonus payments, quality staffing, team working, and appropriate communication channel.
According to Thiedke (2007), team working in emergency departments is formed when a major issue arises in the department and then disintegrates when the situation is handled. This study further identified that when bonuses are paid against the performance, wait times improved concerning all other measures apart from the wait for inpatient beds. Appropriate communication channel facilitates quick access to information.
Summary and Discussion
Ten articles were selected for this study. These studies offer strong and reliable findings since they are peer-reviewed. Most of the studies were consistent about the factors that cause long wait times in the emergency rooms. A study by Jouriles et al. (2013) indicated that inaccuracy on posted waiting times is influenced by the flow of incoming patients among many other factors. Thus, it is more likely that hospitals with emergency departments, which see 2,000 or fewer patients per month, have more accurate posted waiting time than hospitals with emergency departments that sees 5,000 or more patients per month.
Furthermore, despite the increased efforts to ensure efficiency in the health sector, research suggests that there are no national agreed-upon standards for wait time in the US’ emergency divisions. In most hospitals, there is a lack of emergency division’s wait time data and the information available is often inconsistent. This inconsistency limits the ability to reference and plan appropriately. The available data indicates that more urgent patients are attended quickly while the less critical patients may end up waiting for a longer time than they should (Arya et al., 2013). This approach might not help solve the problem but rather increase crowding in the emergency rooms. Promoting community-based clinics can be a suitable way to ease congestion in the emergency rooms. Therefore, realizing the factors that lead to wait times forms the basis for addressing the issue.
Table 1 below shows patient satisfaction scores for the period running from 2004 to 2007. The table shows that patient satisfaction scores went up slightly and started to show consistency after the intervention. Between April 2004 and March 2005, the Table shows that the average monthly score was recorded at 79.8%, as well as attained the governmental benchmark of 85% for five months of the year (Jouriles et al. 2013).
The table below implies that reducing emergency department delays has been inconsistent over the three years of study. However, to ensure consistency in patient satisfaction based on reduced wait times, it is essential to ensure the emergency department operates effectively. Jouriles et al. (2013) posit that such inconsistency was due to the introduction of new sets of staff members during weekends and night shifts. Health care providers who do not have sufficient knowledge about the working procedures end up working on a catch-up basis. Consequently, before they can adapt, the emergency department found itself overwhelmed by the workload.
Implications
However, reducing wait times is essential to ensure that services are improved in all areas of operation. Most hospitals in the U.S have attained strong, desirable outcomes by implementing split strategies described earlier. However, research has found that it is often hard to sustain these changes. According to Thiedke (2007), the best way to instill and sustain these changes is through continued learning and effective communication. Medical staff will be more willing to adopt change if they believe that the model’s primary objective is to promote patient care by limiting wait times.
Proper communication channel may help eliminate misconceptions that changes are meant to save money or monitor the staff. If employees are guided to think in this line, it is highly likely that they will embrace change. Additionally, communicating with the staff regularly is important to ensure that the message becomes an organizational culture. Education and training are also necessary to ensure that staff members are in a position to group patients according to their needs and urgency. Since this program might be a new approach in many hospitals, the department must clearly explain its new operational roles.
Lessons learned
Based on the analysis, managing patient expectations at the emergency department is the basis for their satisfaction. Even though this study shows the need for more staff and training, innovative solutions are viewed to be very essential in reducing waiting time. For instance, bedside registration is an approach that can significantly reduce wait times by creating space in the triage section. Innovating staffing models by engaging nurse practitioners or physicians as part of the emergency department team has benefits on patient satisfaction and patient flow. When seeking to redesign the emergency room it is necessary to consider the diversity of patients and their stress level. LEAN methods are also seen as effective in improving emergency department effectiveness, particularly in the triage section.
Conclusion
Promoting general access to the health care sector should be a priority for the government of any state. Currently, the state and national authorities in the U.S have teamed to minimize wait times in emergency rooms. The aforementioned strategies are evidence of this devotion and offer an action plan for the objectives to be met. Actions that maximize efficiency in an emergency room and reduce wait times have been explored.
Nonetheless, with the Affordable Care Act among other health reforms expected to widen the healthcare scope to more Americans, the emergency room congestion may persist. Therefore, policymakers should address emergency room congestion as a public health priority. Ideally, the implementation of the earlier mentioned goals can assist to reduce the wait times in the emergency rooms. However, the accomplishment of these goals depends on the cooperation of top executives, policymakers, staff members, other hospital divisions, as well as professionals who have vast experience with emergency room process improvement.
References
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