Today, I write to y’all from the lovely city of Richmond, VA, a lovely colonial-era town which blends striking 18th-century row homes with dazzling modern palaces of light and tinted glass. Among those businesses with a shining presence in downtown Richmond are a handful of established hospitals, and they play to the modern city-dweller.
Several HCA hospitals, including those in in Richmond, have put the latest hospital marketing tool into place — a service which lets patients know how long the wait time will be if they visit the facility’s emergency department. This is happening elsewhere in the country, too, and my read is that it’s likely to pop up more often.
HCA hospitals provide the “door-to-provider” time, or the time from the patient’s arrival to the time he or she is seen by a doctor, physician’s assistant or nurse practitioner. Cell phone users can use the system by texting “ER” to 23000. Other facilities have developed iPhone applications allowing patients to get a read on ED conditions.
This “check your wait time” thing sounds good to me, when I think like a patient at least. But I also see some serious downsides to this practice: 1) It encourages people to think of the ED as a primary care setting, where timeliness is key, 2) it could encourage inappropriate behavior.
Also, isn’t it possible that stressing brief wait times will expectations that emergency care can operate like a dry cleaner or a McDonald’s?
Bottom line: I like creative marketing as much as the next guy, but this doesn’t feel right. Maybe I’m just too cynical. What do you think?
The nextHospital Manifesto 
iTriage is a free, consumer-based app and the first to push out emergency department wait times on a mobile application.
We’ve heard nothing but positive comments from end users who have accessed those times. One particular case comes to mind — an iTriage user wrote to say that he checked for ER Wait Times for a loved one that was vomiting for hours. While they waited for the ambulance, they found a 10 minute wait time at one ED and directed the EMTs to that facility.
We continue to hear from end-users in other parts of the country who truly want this level of transparency from their local hospital systems. By now, healthcare consumers know the wait can be long, but keeping patients informed of the wait should reduce frustration that could later be broadcast to their virtual world online.
Marcia Noyes
Director of Marketing, PR
Healthagen — developer of iTriage
Marsha, thanks for stepping in to comment on this discussion! It’s great to get anecdotes from the developer’s point of view.
For what it’s worth, I have no doubt whatsoever that consumers like this application — my local DMV does something similar, and I LOVE it.
That being said, I do worry that the secondary effects of installing such technology might change the way care is delivered.
If it’s true that “you get what you measure,” we’d better be sure that measuring promptness of service doesn’t impact the ED’s flow negatively.
Do you have any data on what changes occur within EDs once your system is installed?
-Anne
clever marketing indeed, but how long will it last as a strategy? when volume begins to peak in the late fall or in jan and feb; will they continue to broadcast the wait times as they increase?
and how are they calculating wait time? is the patient simply triaged? is that the time to be seen by a physician?
and let’s be honest, if i’ve nearly cut my finger off with a carving knife, suffered cardiac arrest, or some other malady requiring an ed visit, then i’m heading to, or the rescue squad is heading to the closest door.
i’d like to see some studies showing that this is an effective method by which to attract patients.
the ed’s are full with primary care patients now. that trend seems to be growing despite the advertising of wait times. that’s a whole other kettle of fish.
risky, possibly. smart, prove it.
ps – richmond va is a lovely city with great amenities and only a short drive to the blue ridge mountains, the atlantic ocean, and washington dc.
Mark, the question of whether a hospital will dare to keep using this system if the data looks less flattering is an interesting one. It’s a challenge along the same lines as that faced by quality-reporting pioneers in 2006 or so. In that era, I reported on one Midwest facility that decided to begin reporting quality metrics no matter what, and the results seemed very positive. Wonder if the same is true here.
Anyway, I guess I have a visceral feeling of discomfort, in some way, at the idea of hospital EDs sharing wait times with me like the Washington Metro does for when the train is going to arrive. That has more to do with psychology and taste, but there you have it.
-Anne
Great post and comments. I am a practicing ER physician and the CMO and co-founder of iTriage. The ER wait time is calculated as the time from registration to seeing an ER provider (MD, PA or NP). While it may make some people uneasy I firmly believe in giving patients as much information as possible in making healthcare decisions. iTriage is providing quality information, cost information and capabilities of facilities putting more power in the patient’s hands to make the best healthcare as possible. We believe increased transparency is good and empowering. These ERs with short wait times have worked hard to improve their processes to see and treat their patients in the shortest time possible. Thank you for writing about this important and emerging trend.
Dr. Guerra:
It’s great to hear from you, and I’m delighted to get your perspective.
Still, and here comes my pain in the butt, clinging to an issue side, is “treating their patients in the shortest time possible” the best possible target for improvement in an ER? Aren’t there other processes within the system which might be a higher priority?
I mean no disrespect to you in this — you’re the pracitioner and I’m just an analyst — but I can’t imagine how speeding people from lobby to practitioner is a particularly laudable goal unless the patient is very sick. And hopefully, triage would address this issue anyway.
For what it’s worth, what *I’d* go far out of the way for is a truly welcoming ER lobbying offering really comfortable chairs, soft lighting, abundant healthy food for a small price and perhaps even inexpensive daycare. For that, sign me right up!
-Anne
Anne, I’m definitely with you on the soft lighting, abundant healthy food and inexpensive daycare. The lighting is so harsh at the ERs that I’ve been to that I couldn’t imagine a better addition to these wait rooms. Go in with a serious migraine and you’ll be climbing the walls in just a few minutes.
I remember going in with a gall bladder attack years ago and all I wanted while I waited was for the lights to be dimmed and the pain to go away.
What is it about low lights that just makes you feel more at peace with your pain?
Marcia Noyes
Healthagen, LLC
I tried (unsuccessfully as it turned out) to get my hospital employer to do this back in 2003. To Mark’s point, above, nobody expects a consumer bleeding from a severed finger to stop and check ER waiting times. It’s really about framing expectations and showing respect for consumers be empowering them with information. More on my blog at http://healthcarestrategist.blogspot.com/2010/03/using-iphone-to-post-er-wait-times.html
Very interesting article and comments, I believe these emergency room SMS programs are a great way to relieve some congestion in ER waiting rooms. At Globaltel Media we’ve tailored our SMS-based messaging solutions to be used for a variety of healthcare related activities, from sharing information between doctors, to appointment scheduling/reminders, to rehabilitation demos sent via mobile video. It’s always encouraging to see providers implement these types of programs, as it reaffirms the value of the technology in the space. Thanks for the article!
Interesting news coverage of the same thing in Roanoke. The HCA hospital actually acknowledges that their “wait time” marketing is aimed at people who use the ED for their primary care instead of going to a physician’s office, and says they “want people to use their ED”. Here’s the story:
http://www.wdbj7.com/Global/story.asp?S=12736334