by Physicians Weekly | Nov 29, 2012
More than 100 hospital emergency departments are borrowing an idea from the restaurant industry: online reservations. Additional concierge services such as mobile apps for wait times make ER experiences more agreeable. ERs are going mobile at least partly to increase patient satisfaction scores, which are tied to hospital reimbursement for Medicare patients under the Affordable Care Act. Higher scores = hospital bonuses. The reservation service requires that patients describe their ailment. Patients who indicate they have serious symptoms such as chest pains are directed to go to the hospital or call 911. Critics argue that if someone is able to make an appointment, it’s not an emergency and may encourage inappropriate use of already crowded emergency rooms. They also claim that the service may discriminate against lower-income patients who don’t have access to smartphones or computers. However, the check-in service has undergone legal review and doesn’t appear to violate the Emergency Medical Treatment and Active Labor Act. A hospital’s triage and throughput process remains the same, and care is provided based on the most urgent medical need. Physician’s Weekly wants to know… Do you think scheduled appointments qualify as an...
by Physicians Weekly | Nov 20, 2012
Hospital-based EDs are increasingly overburdened throughout the United States, resulting in a widening gap between the quality of emergency care Americans expect and the quality of care they actually receive. Longer lengths of stay within the ED have led to increased provider stress, greater risks for adverse events, and reduced patient satisfaction. Length of stay for patients seeking psychiatric care in the ED appears to be even longer than that of people without psychiatric concerns. This fact, when coupled with an increasing volume of psychiatric visits to EDs (23% growth between 2000 and 2007), have led to a real crisis for this vulnerable population in psychiatric distress. Identifying patient and clinical factors associated with long ED lengths of stay for psychiatric patients is critical to the development and implementation of targeted quality improvement efforts. To that end, my colleagues and I conducted a study to seek out these factors in this patient population and measure the effect of these variables on time spent within the ED. Our prospective analysis, published in the May 2, 2012 Annals of Emergency Medicine, involved 1,092 adults treated at one of five EDs. Secondary analyses considered patients discharged home and those who were admitted or transferred separately. Factors That Increase Hospital Length of Stay According to the findings from our study, the average length of stay in the ED was 11.5 hours for psychiatric patients, but lengths varied based on certain characteristics. Patients who were discharged home stayed 8.6 hours in the ED, while those admitted to psychiatric units within the hospital stayed 11.0 hours. Patients transferred to outside units within the local healthcare...