Topic: Average ER Waiting Time? Planning for the Future, the Long View
In this week’s WSJ, there was an article on page D4 “Average ER Waiting Time Jumps to Nearly an Hour,” which summarized the CDC’s National Hospital Ambulatory Medical Care Survey: 2006 Emergency Department Summary, NHSR007, also published this week.
Here’s a few highlights:
· Source: 2006 CDC NHAMCS data, 119 Million visits, 40.5 visits/100 persons
· Comparison: from 10 years ago
· Finding: Average times: 38 min (1997), 47 min (2004), 56 min (2006) (mean waiting time to see a physician)
· In the 11th paragraph, the lead author explains that ‘Averages’ are skewed by outliers, and the correct measure to use is ‘Median’.
· Median time to see a clinician: 31 minutes
· Increasing frequency of ED visits (up 32%) and decreased number of EDs (4,900->~4,600)
· This 40 page CDC doc (NHSR007) is chock full of interesting and potentially useful benchmark data, including patient flow indicators, broader access issues, socioeconomics, and detailed utilization data.
I wanted to open the deeper HCIT issues for discussion.
What does this CDC data really mean about the healthcare system we’re trying to improve? In his book, The Art of the Long View – Planning for the Future in an Uncertain World, Peter Schwartz introduced many of us to the ‘scenaric approach.’ Probably best popularized in our HCIT industry segment by Gartner, the approach asks “what scenarios about the future might play out,” and then focus on “what are the early indicators to sort out which future is coming to pass.” This ER Waiting Time article may contain a few important early indicators.
As a brief aside, Schwartz spends several chapters on the value and mechanics of ‘Strategic Conversations.’ The book, first published in 1991, presaged the role and necessity of blogs, to help managers and leaders clarify thinking, understanding and correctly anticipating the external environment. In 2007, Nobel and Oscar recipient Al Gore concluded that such multi-way, strategic conversations are critical to reason and democracy functioning (or failing to). Wow, conversations may be a lot more important than most people realize.
Questions raised for conversation:
1. What are the ER Wait Times really telling us?: The ER Wait Times are supportive of the scenario of healthcare in the US becoming more fully three-tiered. From the HCIT perspective, this is best elaborated by FCG and Erica Drazen’s four truths, ending with Truth #4 here: “With a single payer system doubtful anytime in the near future and reimbursement continuing to decline, the healthcare system will settle into three tiers of patient. (2007).”
Economics will distribute resources, such as those driving the ER Wait Times, such as number of EDs and their characteristics, differentially across the patient tiers.
Can and will “Business Process Automation”(aka our healthcare information technologies) support these three tiers with different wait times? Is there really only one standard and one tier of service that makes any sense in terms of cost, quality and access for truly emergent care? What is the impact on tiers or lack thereof from HCIT today? Will wait times need to become longer, before better systems thinking takes hold? A few years back, demand management was growing, including calling a nurse for guidance, before meeting another nurse, the triage nurse at the ER. Is there a much stronger case for unified communications with the patient, to ameliorate the ER waiting time issue?
2. Is the data actually saying that our Emergency Medicine paradigm is dated? This same week, one day earlier on page D1, a different reporter, Laura Landro, wrote in her ‘Informed Patient’ column , “Options Expand For Avoiding Crowded ERs”. The numbers and details offer further quantitative elaboration of how healthcare delivery is moving. Search for the quote by Aetna CMO Troy Brennan. The policy articulated is ‘call your doctor first [before going to clinic or ER].’ Put these two articles together and you might conclude that ‘phone waiting times’ are more important to addressing the ER Wait Times than ER operations or resources. Again, from the HCIT standpoint, is unified communications with the patient an important, missing element from our paradigm?
3. Consumer decision making and the role of consumer behavior: When I call many doctors, the recording I get is, “if you think this may be an emergency, go to the ER.” The care decision and risk moved back to the consumer. How much of a factor is this in ER Wait Times?
4. Healthcare Editorial Policy at the WSJ: The other observation open for discussion is this: Are these topics, authoritative data on’ ER Wait Times’, and ‘Consumer Options to get Medical Services elsewhere’ relatively unimportant. That is, relatively unimportant to readers of the Wall Street Journal, such that they are buried in the D section. I will grant you- this may merely be an editorial decision or a very busy news day. And, how about the very misleading use of statistics in the title (i.e. Average rather than Median).
I’d love your thoughts on what HCIT should be doing to help patients get the right care without undue waiting time. If you don’t want to comment, but do what to keep reading on this topic, go here:, where the conversation about the economic, regulatory and professional aspects of this topic continues, in wonderful, rich blog conversational style!
