Decreasing Door to Doc Time: The Online Waiting Room

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Author: Christine Au
Medical Student- OMS-II
Western University of Health Sciences, College of Osteopathic Medicine of the Pacific
AAEM/RSA Social Media Committee

While the demand for emergency medical service has dramatically increased throughout the last five years, patients are finding that they are spending a great deal of time waiting to be seen.[1] In fact, emergency department (ED) visits have doubled the increase in population rates from 1997-2007.[2] On average, patients wait for two hours and 15 minutes from the time of arrival to the time they are admitted, or to the time of discharge.[2] However, this data point varies depending on the state the patient is being seen in, patient demographic, as well as the complexity of a patient’s case. In some of the more extreme cases, patients may wait an average of four hours or more before being seen by any healthcare professional.[1]

One of the reasons for long wait times is that EDs have experienced a 51% increase in patients needing care.[3] Further, the United States has experienced an 11% decrease in ED visits due to ED closures.[3] Patients in an ED are not seen on a first in first out basis because the patients that require critical care and the most immediate attention are seen first. It becomes rather frustrating for a patient who has a relatively simple injury such a superficial laceration that must then wait a significant amount of time, up to many hours before being seen. Further, the Annals of Emergency Medicine recently published a study which found that patients are now requiring longer and more extensive workups given the available imaging, tests, and serology studies in the emergency department.[3]

Several hospitals are starting to leverage varying technologies to help track and eventually decrease the “door-to-doc” time. In fact, several hospitals in Bakersfield, CA are among the few that allow non-emergent patients to wait at home and are given a time to arrive at the hospital (4). This is called the Online ER Waiting Service and has been put in place to drive a more efficient process and allow for patients who are non-emergent to wait in the comfort of their own home.

Crowding in EDs and an increased door to doctor time jeopardizes a patient’s well being. Studies have shown that patients who are treated in EDs when it is overcrowded tend to have worse outcomes and higher mortality, than patients who are seen when the emergency departments were not crowded. [5-6] Ultimately, this leads to worse outcomes for patients and lower patient satisfaction scores. Reducing the patient’s wait time in an emergency department is a longstanding topic of interest and it will be interesting to see how new technologies such as the Online ER Waiting Service will help to alleviate this issue.



References
1) The Push is on to Eliminate Hospital Wait Times. Hospital Health Networks RSS. http://www.hhnmag.com/articles/6417-the-push-is-on-to-eliminate-hospital-wait-times. Published November 1, 2013. Accessed August 4, 2016.

2) Emergency Department Wait Times, Crowding and Access Fact Sheet. American College of Emergency Physicians. http://newsroom.acep.org/fact_sheets?item=29937. Accessed August 4, 2016.

3) Pitts S. National Trends in Emergency Department Occupancy, 2001-2008: Impact of Inpatient Admissions Versus Emergency Department Practice Intensity. Annals of Emergency Medicine. 2012.

4) Online ER & Urgent Care Waiting Service™. ER & Urgent Care Wait Times. https://www.dignityhealth.org/stbernardinemedical/medical-services/inquicker. Accessed August 4, 2016.

5) Review of the Evidence on the Use of the Emergency Department by Medicaid Patients and the Evolving Role of Emergency Medicine Physicians . American College of Emergency Physicians. http://newsroom.acep.org/statistics_and_reports?item=30111. Published 2015.

6) Schull MJ, Kiss A, Szalai J-P. The Effect of Low-Complexity Patients on Emergency Department Waiting Times. HEALTH POLICY AND CLINICAL PRACTICE/ORIGINAL RESEARCH. June 2006. doi:10.1016.