March / April 2010 Issue |
Healthcare Journal of Baton Rouge
25
as patients arrive. You have qTrack protecting the main ED,
but now you have a provider up there protecting the qTrack.”
Ochsner has set a 20-minute time limit for a qTrack bed. If
someone is going to need a bed more than 20 minutes they
probably need to be in the main ED, said Cuba.
“We’ve instituted a change in mindset, a change in philoso-
phy,” said EKL’s Freeman. “It used to be that everyone had to
be triaged, but now if a bed is available you are brought right
back.” Triage and registration may occur simultaneously or at
the bedside, eliminating a step or two up front. The ER has
also rearranged scheduling of physicians and residents to
better meet the needs of the volumes they are seeing and has
created different waiting areas where someone who has had
tests done can wait for results and free up that bed. Couk said
that at each step that would be done before a patient is eligi-
ble to see a doctor, they are looking for ways to decrease the
time it takes and move seeing the doctor up in the process.
“Triage and registration used to take 21 minutes and now
takes six minutes since we combined the process,” he said.
“We’ve looked at all kinds of things, even online registration
that puts you in a queue,” said Rhorer. “We’ve not necessar-
ily felt that that’s the direction we’re headed today.” He said
the hospital is very technologically advanced with a lot of
tools to make it more efficient, but he worries whether a per-
son who is registering online or surfing the web to see what
wait times are is really using the emergency department for
emergencies. “Sometimes I think it’s very important to exam-
ine what the message of some of these tools are. There’s a
difference between being efficient and giving a message of a
physician’s office rather than an emergency department.”
OLOL does use bedside registration. “If someone is waiting
20 minutes in the waiting room while we clean a bed, we don’t
register them out there. We put them in the bed and they get
registered there,” said Rhorer. “The time clock starts from the
minute they say hello, but registration may be 20 minutes
later when they are in the bed.”
Lane RMC implemented bedside registration about a year
ago. With bedside registration the patients come into the hos-
pital and they are triaged. Then, rather than being sent to the
waiting area, they are brought straight to the back and regis-
tered at the bedside, said Conerly. That means the doctors
often see patients before they are actually registered. Conerly
said it has definitely led to a decrease in wait times.
INFORMATION
PLEASE
National studies report that patient satisfaction with their ER
experience is more closely tied to how well they were
informed than to how long they had to wait. In fact patients
who were well informed about delays were equally likely to
report being satisfied whether they spent four hours or one
hour in the emergency room. Press Ganey’s 2009 Pulse
Report indicated that while being kept informed was the top
priority in patient satisfaction surveys, how long they had to
wait to see a doctor was ranked fifth. “We stress it a great
deal, keeping patients updated,” said Conerly. “It’s one of the
questions on the Press Ganey survey and we have been in
the 99th percentile on patients’ perception of ED staff keeping
them informed. That’s certainly an improvement. And we
stress that to all of our staff.” Lane uses patient liaisons to
help with this task, visiting with patients in the ED and letting
them know what the holdup is. Ochsner also uses Press
Ganey and Cuba notes that one of the four questions under
Provider Satisfaction is ‘How well were you kept informed?’
“Our biggest gain probably is understanding how important
that is. It’s common sense. We’ve all been patients. You need
to be kept informed even if you’re disappointed.” ER staff
writes doctors' and nurses' names on a white board in the
room or hands patients a business card, said Cuba. That way
they know who to ask for if they have a question and it helps
them feel more in control.
OLOL feels that having a doc-
tor on the triage team goes a
long way to keeping patients
informed because they have
access to a physician in the
waiting room. They also have
prominent signage encourag-
ing patients to let the staff
know if they are having chest
pains, stroke symptoms, or
other issues or concerns. “We
John Couk, MD