Implementing and improving existing solutions could help alleviate one of the biggest problems facing emergency departments across the country.
Emergency rooms are crowded and waits are long. According to the 2010 Emergency Department Pulse Report by Press Ganey, a hospital consulting firm, patients spend an average of four hours and seven minutes in the ER, half an hour more than they did in 2002. Delayed care increases stress on providers and endangers patients.
‘Too many people are coming in; we can’t effectively treat them in the ER, so that’s a bottleneck. And, we can’t get them out of the ER quickly, so that’s another bottleneck,” Kuzniak told HealthBiz Decoded.
It’s a multifaceted problem, he said, and will require solutions at every point on the system.
From The Outside
“People can’t get in to their primary care physician in a timely fashion, they don’t want to go to the ER, so we have this new solution: urgent care facilities that are going up like McDonald’s at every corner,” Kuzniak said.
According to the Urgent Care Association of America, as of 2012, there were approximately 9000 urgent care centers across the country, with estimated growth at eight to 10 percent annually.
Urgent care centers answer patient questions quickly and help save money by keeping people from the ER if they don’t really need emergency care, he said.
“A head cold goes from an $80 problem to a $4,000 problem when you go to the ER.”
But urgent care centers, like the ER, have no record of individual patient histories, which results in discontinuity of care.
“If you have six sinus infections yearly, the ER is not going to recognize the pattern,” he said. Diagnosing the patient with allergies would save expensive ER trips.
A better front-end solution to ER overcrowding may be to improve access to primary care physicians, who have patient records, without the urgent care middleman, Kuzniak said.
“The question is how we match acuity to cost and create access that’s more effective,” he said. “We’re going to see technology solutions jump into that space.”
The key, Kuzniak said, will be to incentivize providers to give continuous care outside the bricks and mortar of a normal office.
That could mean introducing “simple sick” care centers on the grounds of large corporations for employees to visit during the workday. Some companies have already tried this and have had success, he said.
If work-based care centers aren’t available, another solution could be telehealth, remotely linking the patient to the provider in real time and eliminating access barriers.
“One thing everybody has access to is the Internet,” he said. “I find as a clinician, 99 out of 100 times the patient needs reassurance when I get called on off hours. You could have meaningful engagement with a patient with a smartphone or an iPad or a laptop with a camera.
From The Inside
Technology could also be an answer to ER overcrowding, by managing the flow of patients.
For years, hospitals, doctors and medical innovators have been trying to incorporate electronic dashboard or ‘whiteboard’ systems, which put patients on a real-time waiting list and evaluated based on medical need. These systems generally have boards in the bays and a larger one at the front desk for staff to communicate room availabilities.
While these systems have the potential to cut down on crowding and wait times significantly, they haven’t been widely implemented.
“The first thing is that the system that we’re talking about is not an electronic medical record,” said Darrell Oller, Director of Information Systems at Abraham Lincoln Memorial in Lincoln, Illinois. “This is a system that is trying to improve the throughput of patients in the ED.”
But like EMRs, dashboards suffer from a lack of flexibility; there are few available nationally, and those that are generally aren’t flexible enough to adapt to different health systems. Hospital administrators are left having to develop their own dashboard programs or go without.
Oller, who has a background in programming, was able to develop a system in just over two months, that has cut ER wait times to as little as 15 minutes. But many hospitals aren’t so lucky.
Stephen Few, founder and principal of the data information consultancy Perceptual Edge, said this is because there aren’t enough viable options for institutions to choose from.
“Rather than saving time, a lot of systems are actually causing everything to slow down because they’re just clumsily built,” he said. “People, of course, are very wary of information technology based on that experience, and I don’t blame them.”
Commercially available systems largely don’t work well, he said, and most hospitals don’t have the resources to develop their own system.
“They don’t display information in useful ways – they don’t display it in ways that people’s eyes instantly take in easily. They’re just kind of these often flashy screens that are very colorful and have all kinds of wonderful lighting effects and so forth that aren’t very informative.”
There have been individual successes, like Oller’s, but there is no network for sharing that data, Few said.
Inside and outside ERs, combating overcrowding will depend on turning ideas into reality, and implementing proven solutions on a wider scale.