Hospitals turn to Internet to fight emergency room wait times
Tom Blackwell Apr 17, 2012 – 8:51 PM ET
Patients who log on to the website for Calgary’s hospitals are offered a surprising choice these days: wait times for four emergency departments across the city, posted automatically, 24/7 in “real time.”
A hospital in the Southern Ontario city of Kitchener has just become the first in that province to launch its own, enhanced version of the same idea, amid predictions the consumer-oriented service will soon spread throughout the health-care system. A smartphone app for the Kitchener facility is coming soon.
Administrators argue the online information should help patients better decide where to seek out medical aid, spur staff to improve service — and one day even fuel competition between hospitals under new, demand-based funding models.
“Having our wait times out there, warts and all, is certainly a motivator,” said Don Shilton, president of St. Mary’s General Hospital in Kitchener. “What we’re trying to do is to inform consumers. … Our view is information is power.”
Critics question, however, whether an idea born in the competitive world of American for-profit hospitals will be useful in Canada’s publicly funded system, or might even have unintended, harmful effects.
Emergency physicians stress that treating patients more quickly is an essential goal. But they worry about doctors and nurses cutting corners to speed up the Internet clock, and critically ill patients staying clear of their local hospital because of long queues that might not even apply to them.
“It leads to the commercialization of the care we provide in emergency departments,” said Dr. Peter Toth, president of the Canadian Association of Emergency Physicians. “It’s a marketing strategy, perhaps. I’m not sure how it really adds to the overall quality of the experience.”
The idea of publicly advertising emergency wait times emerged a few years ago in the United States, where some private hospitals display the number on billboards, using the promptness of their service as a marketing tool.
Alberta Health Services, which administers much of the province’s health-care system, introduced its version last July in four Calgary hospitals, as well as two “urgent-care” clinics in the city that are suggested as alternatives. St. Mary’s General Hospital in Kitchener followed suit last week, posting wait times that are updated every 20 minutes, as well as statistics on the number of patients waiting and being treated at any given time. It projects wait times for the next six hours, as well, and lists alternative clinics in the area.
The wait times are calculated electronically by computer algorithms that combine such factors as number of patients and the size of the medical staff on duty. Calgary’s times are for people who fall in the middle of the five-stage illness-severity scale recognized by emergency medicine, meaning some would be seen faster, some less so. Kitchener’s are for those in the three least-severe levels.
For patients not critically ill, the combination of information should make it easier to decide where and when they ought to seek treatment, said Mr. Shilton.
St. Mary’s is already fielding inquiries from other hospitals about its system. Mr. Shilton sees more applications as the idea spreads and Ontario moves to so-called patient-based funding of hospitals, where the province pays hospitals per patient treated, rather than handing over money in annual lump sums.
Better posted wait times could attract more patients, and mean more funding for a hospital, he said.
In Calgary, officials noticed a curious phenomenon after the online wait times were introduced; it appeared patients were moving from urgent-care centres to the emergency departments, said Dr. Grant Innes, chief of emergency medicine for the city.
Earlier reductions in emergency crowding may have made the departments more appealing to patients than clinics, he said. Meanwhile, Dr. Innes said it seems people are still largely choosing the hospital nearest them, not necessarily the one with the shortest wait time.
For the staff working in emergency departments, though, the online postings could have unwanted effects, pushing them to give short shrift to some patients to improve the numbers and satisfy superiors, said Dr. Brian Goldman, a Toronto emergency physician and host of the CBC-Radio show White Coat, Black Art.
He also worries about patients choosing the hospital that posts the shortest wait times, potentially meaning a longer trip that could prove fatal for someone suffering a heart attack.
“We’re the safety net for the health-care system,” said Dr. Toth. “The last thing we would want is people making a decision not to present to the emergency department because of fears of long waits.”
Dr. Innes said that concern seems unfounded, while he does not believe any staff would take shortcuts to speed up service and improve the real-time wait number. If the public alerts add a little pressure, however, that would not be a bad thing, he said.
“I think a much greater danger is that we have sick people having to wait so long in emergency departments,” said the Calgary physician. “I think we need to feel a great deal of pressure to reduce our wait times, in order to improve patient safety.”
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