Originally created 11/05/06

Hospitals, doctors work to cut patients' wait time



CHICAGO - Beatrice Vance died of a heart attack. The coroner says waiting in the emergency room helped kill her.

The 49-year-old woman's chest was tight with pain when she walked into the ER at Vista East Medical Center in Waukegan, Ill., last July. A blood clot had lodged in her heart.

It was 10:15 p.m. when Ms. Vance checked in, a coroner's report shows. She was told to wait for a doctor. So she waited. At 12:25 a.m., she collapsed, her heart starved of blood flow.

Doctors rushed to treat her, but she had no pulse. It was too late.

Even when the consequences aren't so tragic, time seems to pass at an excruciatingly slow pace when you're waiting for medical care.

Whether it's emergency room treatment, routine doctor's appointments, or those anxious days between getting poked and prodded for medical tests and receiving the results, waiting happens to just about everyone seeking medical care. It's often one of the most frustrating parts about seeing the doctor.

AFTER YEARS OF overcrowding, overbooking, and angry patient complaints, many hospitals and doctors' offices are finally doing something about those waits:

Providing test results quickly on site or online. Offering same-day exams to patients who call early. Speeding up emergency-room triage to get patients faster treatment, and offering restaurant-style pagers so not-so-sick patients don't feel stuck in an emergency waiting room.

Shortening waiting times is part of a nationwide move toward empowering patients, reducing medical errors and improving health care.

When patients are ill, "the longer that they have to wait to get into the system, the greater the chance" their sickness will worsen, too, said Sue Gullo, of the Institute for Healthcare Improvement. The nonprofit group helps doctors and hospitals devise solutions.

"That's a huge problem," Ms. Gullo said, because it puts patients' health at risk and costs hospitals more in resources and money.

FROM 1993 TO 2003, the number of U.S. emergency departments fell by about 425, or 12 percent, while the number of patients seeking ER care jumped 26 percent to 114 million. They include uninsured or underinsured patients and those who seek emergency care for nonemergencies because they have no regular doctor.

Many hospitals are creating "fast-track" programs for these patients who will not require hospitalization and who tend to wait the longest for emergency care.

Montefiore Medical Center in New York City spent at least $35 million in the past five years on ER improvements, including a fast-track program that has cut average arrival-to-discharge times for less serious cases from about six hours to two.

Changes included hiring about 50 additional emergency room doctors and building a separate area for fast-track cases.

Montefiore's walkout rate, reflecting patients who get fed up with waiting and go home, dropped from about 5 percent to 1.5 percent this year, said Peter Semczuk, the hospital's vice president of clinical services.

That's significant because walkout patients often get sicker and show up later in worse shape.

PATIENT SATISFACTION WAS the idea behind restaurant-style pagers distributed in the emergency waiting room at Silver Cross Hospital in Joliet, Ill. They allow patients awaiting care to grab a bite in the hospital cafeteria or just get some fresh air.

Anita Uthe gave the new pagers a thumbs-up. The 43-year-old mother from New Lenox, Ill., waited four hours for emergency care with her 11-year-old son last winter after he slipped on ice and suffered a concussion.

She braced for another long wait at Silver Cross last month when her son stepped on a rusty nail. This time she got a pager.

"It helps, because if you want to step outside (you can)," she said.

Just then, her pager flashed - it was her turn, after only half an hour.

For Santa Clarita, Calif., college professor David Stevenson, 46, the Wait from Hell involved a vasectomy. He and his wife took time off work, hired a baby sitter for their three children and checked in at the doctor's office. After 15 minutes, they were told he was next. The waiting room emptied, filled, and emptied again "and then it was just me," Ms. Stevenson said.

After an hour and a half, the doctor said he had to leave for an emergency. Fuming, Mr. Stevenson said he'd continue waiting, but the doctor "just said, 'Sorry, buddy, you're going to have to reschedule.'"

SUCH WAITS OFTEN are because of overbooking. That happens partly because under many health insurance reimbursement systems, doctors are paid by volume.

Doctors "are responsive to the same economic pressures that everybody else is," said Dr. Michael Barr, of the American College of Physicians.

The group, which represents about 120,000 internists and other doctors, issued a policy statement earlier this year advocating changes that Dr. Barr said could help address the waiting problem.

Recommendations include insurance reimbursement for less-traditional patient visits, such as telephone and e-mail consultations to give patients speedier access to doctors.

The group also supports "open-access" scheduling, which some doctors already use, reserving up to 70 percent of their daily schedules for patients who call early for same-day appointments.