Time Capsule: Meaningful Use in the ED: Get Outta My Emergency Room

I wrote weekly editorials for a boutique industry newsletter for several years, anxious for both audience and income. I learned a lot about coming up with ideas for the weekly grind, trying to be simultaneously opinionated and entertaining in a few hundred words, and not sleeping much because I was working all the time. They’re fun to read as a look back at what was important then (and often still important now).

I wrote this piece in February 2010.

Meaningful Use in the ED: Get Outta My Emergency Room
By Mr. HIStalk

At my hospital, we worry a lot about ED satisfaction scores. No matter how well we do in areas such as OB or surgery, the ED scores always drag everybody else down. It always seems that the best and the worst aspects of our hospital’s care happen there.

We can only do so much to raise those scores. It’s not a democracy in ED, even though patients think it should be. You might have arrived first, but if the guy sitting across from you has a butcher knife sticking out of his neck, your abscessed tooth is just going to have to wait.

The ED is aptly named since it exists to serve patients with emergent medical issues. If you aren’t one, feel free to enjoy that second half-hour of “The Price is Right” on the “please don’t change the channel” TV because, as Samuel Shem said in The House of God, you are a GOMER – get outta my emergency room.

I’m not really sure why we want our ED satisfaction scores to be high, anyway. We tell everybody how much money we lose there. We use it to park patients who need beds that we don’t have. It doesn’t seem like a good idea to make patients so happy about their ED experience that they keep using our services and recommend them to others. The last thing we need is for them to return with their next ingrown toenail.

I also wonder about the fad of plastering emergency department wait times on highway billboards. It would seem that we are encouraging patients who might be tempted to drop by on a whim. I would interpret thusly: if you aren’t sure if you are sick enough to be willing to wait an hour, come on over because, at this moment, we can see you in 15 minutes.

I’m as much of a hard-driving entrepreneur as anybody who has always worked as a non-profit hospital wage slave. That’s why I’m sure my latest idea is a winner:  modifying ED software to show wait times that are multiples of the real number.

Here’s what my company will offer. We will erect huge, blinding electric wait time signs over the ED entrance, out on the street, and right beside your blue hospital sign on the highway. We inflate the actual ED wait time ridiculously (in fact, we can probably just use a randomization routine instead of measuring anything since we’re just making it up anyway). Our artificially enhanced wait times will discourage people to stay the heck out of our ED unless they are truly sick enough to not mind the wait.

This should be an easy sell to the ED doctors, who didn’t take an emergency residency to perform primary care. The really ill patients will appreciate not having to grimace in pain while the seemingly healthy extended family in the next row over settles in for a loud, impromptu gin rummy game and sends out for fast food.

Best of all, hospital executives could tout their high number widely, eliciting sympathy and support from taxpayers who otherwise resent their million-dollar salaries. Who would feel sorry for a hospital that manages to see ED patients in 20 minutes?

For a slight additional fee, I would modify the garish signs to proudly display an inflated number of patients who have left against medical advice. Those are the kinds of patients who need to be gently pushed back into less-expensive medical venues – the ones who found it inconvenient to wait their turn. This is not a metric of inefficiency, but rather a measure of triage success.

I have another flavor of my business model that I think will be quite attractive. I will hack the billboard system of the other hospital in town in what I’m calling my patient flow maximization solution. If your ED gets backed up, you push a secret button that drops the wait times on the other guy’s billboard to five minutes. I am naming that enhancement the Elective Diversion Module.