No matter where people are, whether it be at a fast food restaurant, a bank, at the ER or at the doctor’s office, nobody wants to wait for long periods of time, so in recent years medical practices have come up with creative ways to significantly shorten wait times for patients and people associated with patients. Considering the advancements of hospital technology, medical practices have embraced the use of these advancements in order to alleviate concerns of long wait times.
Some hospitals have resorted to allowing people to use mobile apps that have specifically designed to monitor emergency room wait times. One such app is called the ER Wait Watcher, which has been designed to give people more extensive information on not only the conditions of patients, but also on nationwide data supported by the United States Federal Government that shows a patient how long it takes on average to see a doctor and officially get checked in at the hospital.
This particular data features Medicare and Medicaid services on measures that are taken in the hospital, and an entire year’s worth of data is updated quarterly by the Centers of Medicare and Medicaid Services (or CMS). These measures specifically examine the average wait time for a patient, how often patients have been sent home by the Emergency Department after checking in, how often patients have had to be readmitted, and how often patients have abruptly left without being seen.
It is no secret that long wait times eventually have a negative impact on patient satisfaction, referrals, and overall revenue, and in some cases, there may not actually be a need for an emergency room at all. Although it would be hard to imagine a hospital not having an emergency room, technological advancements are making it more feasible for hospitals to consider this option. Some hospitals throughout the United States have taken bold measures to establish systems where patients check in, go to one of a varied amount of stations, collect a digital badge device and a pamphlet, and then immediately go to an exam room. These exam rooms are casually labeled and separated by sections, such as calling these sections Beach Sections, Mountain Sections, Forest Sections and Dessert Sections.
These digital badge devices that patients collect proactively monitor patient wait times, and medical staffs address these issues as they arise, decreasing overall wait times and improving patient satisfaction. The software that is connected to these digital badge devices displays wait times for each patient on workstations or overhead LCD screens, and it generates automatic visual cues or alerts should a patient’s wait time exceed a pre-established benchmark.
After they have been given a digital badge device, patients are given the freedom to room themselves similar to how customers would check themselves in to a hotel. As they enter the exam room, their presence is noted by the device and their names are displayed on the electronic board via the device. This allows the medical staff to know where to go next right away, avoiding confusion and keeping the amount of wait time low.
Finding new creative ways to overcome the challenges and create safer, more efficient environments for patients hasn’t been easy for hospitals, but with the unique combination of Six Sigma, CAP (Change Acceleration Process), and work-out (and Healthcare consulting expertise), hospitals are targeting critical aspects of patient flow, access, service-cycle time, and admission and discharge processes. By removing bottlenecks or system inefficiencies, it is beneficial for all parties involved, patients, staff and the bottom line, to operate at a disciplined pace that works. Door to doctor times and lengths of overall stay have also been positively impacted by this unique combination.
By initiating a Six Sigma project, the Rapides Regulatory Medical Center in Alexandria, Louisiana noted that its vitals were to have a 388 investor-owned hospital and having approximately 40,000 Emergency Department visits per year. Their main goal was to reduce the 10% rate of patients leaving the Emergency Department without being seen (LWBS) through a concurrent reduction time it took to get a patient to an inpatient bed. The changes that were noted in this project included a reduction of radiology time and sending admitted patients to the inpatient bed floor sooner.
What exactly is Six Sigma? It is basically a disciplined, data-driven approach and methodology for eliminating defects in any process, whether it be manufacturing, or transactional, or anything ranging from product to service. To achieve Six Sigma, a process can’t produce less than 3.4 defects per medical opportunities. A Six Sigma defect is defined as anything outside of customer specifications. A specially designed Six Sigma calculator has been designed to process such sigma statistics. Six Sigma is also classified as a measure-based strategy that processes potential improvements and variations of reduction projects.
A Six Sigma opportunity is then the total quantity of chances for a defect. Six Sigma is broken down to two separate sub-methodologies, which are DMAVD and DMAIC. The DMAVD process (Define, Measure, Analyze, Verify, Design) is an improvement system used to develop new processes or products at Six Sigma quality levels. The DMAIC process (Define, Measure, Analyze, Improve, Control) is an improvement system for existing processes falling below specification and looking for incremental improvement. Both of these sub-methodologies are executed by Six Sigma Green Belts and Black Belts, and are overseen by Six Sigma Master Black Belts.
Applying a Six Sigma system to reducing the amount of patient wait times would be very wise since such systems are constantly checking on the efficiency of a hospital. Consistently checking on data and statistics that relate to a patient’s waiting time is a great way to gain a better understanding of what needs to be done on the part of doctors.
The Edward Hospital in Chicago, Illinois offers ways patients can be alerted to wait times for its ER, and there are 4 different ways that have been made available to patients of this hospital. Using a website, a mobile app, texting or even making a phone call are all acceptable methods a patient can use when it comes to keeping track of wait times. The times are updated electronically as patients register. If delays spike due to any form of trauma or a relatively difficult case, explanations can be added and an extra team of professionals can be brought in. The Edward Hospital issues anywhere between 400 and 700 texts per month with wait times.
Mobile apps ask the public to basically smooth out their arrivals instead of directly asking the hospital to schedule staff to match the arrival of patients. A small community hospital located in southwestern Ontario is doing just that, but not with the use of technology. The St. Thomas Elgin General Hospital provides a low-tech solution to improving patient wait times and overall hospital flow. The hospital cut the amount of time it takes a seriously ill patient to be admitted from 12 to 7 hours and had the shortest wait times in the province in 2012. The St. Thomas Elgin General Hospital began thinking about reducing wait times in 2008 after Ontario introduced a financial incentive program with the idea of enticing hospitals to cut wait times to no more than 8 hours for complex conditions and 4 hours for cases that are less complex as the maximum limits.
Some of the questions that the small southwestern Ontario hospital have been asking include what are the people coming in for, how do they flow through the hospital, and what exactly is stopping the patient flow. Taking some valuable hints from the United Kingdom’s National Health Service, the St. Thomas Elgin General Hospital brought in professionals from KM&T Lean Evolutions to start analyzing the hospital’s metrics from the time the patients spent in the ER to the number of patients that were readmitted to the hospital or who left the ER without being seen. KM&T Evolutions commented on their findings, stating that sometimes wait times were 13 hours when more beds were available for patients, but then when beds were tight for availability, the hospital seemed to flow better, which as a result did not make any sense. It was because of problems like these that the St. Elgin Thomas General Hospital took action on its own accord without the help of technology to reduce their patient wait times.
To completely summarize the issue of patient wait times, there is no wrong answer when it comes to what specific methodology a hospital wants to use. Whether it be high-tech or low-tech solutions, as long as the general patient flow standards are held to consistent figures, hospitals should receive more relief. Whether a hospital would like to implement a system similar to the Toyota Production System lean management methodology where exam rooms are specifically monitored, or if a hospital wants to take a more practical approach and accept the additional incentives that entices its staff members to cut down on wait times, the integrity of the hospital must be kept in tact.