The Emergency Room Balancing Act

By Jennifer Dennard
10:02 AM

There seems to be an undercurrent of debate going on with regard to emergency room wait times. I’ve come across a number of articles and blogs lately having to do with the growing trend of hospitals advertising the wait times of their ERs to the surrounding community. Healthcare IT is helping many to go mobile with these timely messages. Patients in need of emergency care can text their zip code to 4ER411 and receive a list of area hospitals and their ER wait times from Miami-based ER Texting. Hospitals themselves are developing smartphone apps that help patients find ERs in their area, with provide turn-by-turn directions based on GPS location.

My thankfully limited experience with the emergency room (See “Mobile Solutions Key to Evolving Emergency Care”) leads me to believe that these types of technologies are meant to benefit the patient in need of the closest, quickest emergency care. Why drive further than necessary? Why wait longer than you have to?

“We know that information in the hands of patients helps drive satisfaction,” said Jeffrey Finkelstein, Chief of Emergency Medicine at the Hospital of Central Connecticut, in a recent report. Central Connecticut participates in the ER Texting program. “This service helps us to be transparent to our patients, even before they arrive at one of our campuses,” he adds.

It’s this “transparency” that some in healthcare, particularly the folks at Medicaid, are finding fault with. The fear is that as hospitals market their ERs, the general public will use them for primary care rather than emergency care. After all, if a patient knows they have just a 5-minute wait at the ER down the street, why would they wait 25 minutes at an urgent care center further down the road?

As the Washington Post recently reported, “Efforts to reduce unnecessary ER visits by patients in Medicaid … are proliferating as states search for ways to control the soaring costs of the program. But state officials complain that their efforts are sometimes hampered by hospitals’ aggressive marketing of ERs to increase admissions and profits.” Medicaid officials in Washington State have even gone so far as to issue rules making it harder for hospitals to qualify for Medicaid bonus payments if they promote their ER for primary care.

So what’s a hospital to do? It’s no secret that a patient’s satisfaction (or dissatisfaction) with their experience in the ER can have a direct impact on a hospital’s bottom line, as Rene Letourneau recently pointed out in a recent report.

“When you look at patient flow, patients who left [the ER] without being seen or without being treated for whatever reason, usually because of the wait, have a financial impact on a hospital,” explained Christy Dempsey in the report. Dempsey is Senior Vice President for Clinical and Operational Consulting Services at Press Ganey, which recently released the results of its annual emergency department patient satisfaction survey. “When you reduce rates of patients leaving, there is a direct financial effect,” she added.

Hospitals are therefore trying to balance the need to keep ERs open for business with their need to keep patients satisfied. Some are turning to Nashville-based InQuicker, on online check-in service that, according to the company’s website, is “focused on increasing patient satisfaction in the ER and urgent care experience.”

For a small fee, patients can register at, locate a participating ER, check in online, receive a projected treatment time, and wait in the comfort of their own home. Users are sent updated treatment times via text message, and the company offers a money-back guarantee that patients will be seen within 15 minutes of their projected treatment time.

One of my favorite physician bloggers, Dr. Jayne of HISTalk, hashed out the pros and cons of a system like this in a recent blog. She brought up a few good points, which you can read here. I felt the need to ask the folks at InQuicker about the balancing act hospital’s are currently going through, and was fortunate to get in touch with Chris Song, Director of InQuicker’s PR and Brand Strategy.

“The fact is that InQuicker was created as a solution to help address ER overcrowding by redistributing low-acuity patient traffic during peak hours across a broader time frame,” Song explained. “InQuicker projected treatment times are specifically intended to estimate when individuals with non-life threatening conditions will be seen by a health care professional, enabling ER staff to space out low-acuity traffic to fill in those natural ‘valleys’ that occur in the ER queue.

“InQuicker exists to create a better non-clinical experience for those who choose the ER as a care provider, whatever their reasons may be, as long as they do not have life-threatening medical conditions,” he said. “I should add that the aggregate symptoms list of InQuicker users directly mirrors conditions presented by the general low-acuity ER population.”

InQuicker has served 12,000 people to date, and currently has 61 partner facilities in 14 states, and hopes to have 100 facilities on board by the end of this year. “Our list of partner facilities runs the gamut and includes teaching hospitals such as UCSF Medical Center, non-profit facilities like the Seton Family of Hospitals in Central Texas, and various other types of ERs serving many different types of communities,” Song said.

“The only pattern we see among our partners is that each and every facility is embracing the challenge of improving patient convenience and satisfaction in the ER experience, and they’ve partnered with InQuicker to meet that challenge. InQuicker provides a level of convenience that ER visitors have always expected – they just never knew it was a reality until they used our service, and 9 out of 10 InQuicker users indicate that they would recommend our service to family and friends.”

Are solutions like this the answer to ER overcrowding and increased patient satisfaction scores? Let me know your thoughts in the comments below.

Jennifer Dennard is Social Marketing Director for Atlanta-based Billian's HealthDATA and Porter Research.