Oh dear.

**canoehead, BSN, RN** · Jun 11, 2010

Are the wait times for a triage level 3, 4, or 5?

Our wait times for a 1 are nonexistent, 2 has never been more than 30minutes, and they are started on labs etc before that, 3, 30-60min average, 4, 90+minutes, and 5 will be there until the charge nurse finishes her lunch break. How do they decide which time to post?

bjaeram · Jun 11, 2010

for the last time:
if wait time is a factor in deciding when/where/if to go to the emergency department ...
you are not experiencing an emergency.
this is good news for you. stay home, and enjoy your day. thank you.

exactly what i was going to say! if you are sick enough to need an er you won't wait!

whichone'spink, BSN, RN · Jun 11, 2010

Are the wait times for a triage level 3, 4, or 5?
Our wait times for a 1 are nonexistent, 2 has never been more than 30minutes, and they are started on labs etc before that, 3, 30-60min average, 4, 90+minutes, and 5 will be there until the charge nurse finishes her lunch break. How do they decide which time to post?

Do they base the wait time on what it is at the moment? Because that changes so fast. It may be 30 minutes but that can change to 2 hours and 30 minutes because of more important cases from the waiting room or via ambulance.

Editorial Team / Moderator · Jun 11, 2010

For the link I posted, the time is calculated from the time the patient's name appears on the EMR tracking board to the time that a provider (doc/PA) clicks onto the patient's name. I can tell you for many of those facilities, the waiting room time is much longer, and I know at one of them, there is RARELY any waiting room time at all.

I was speaking with someone from another one of our facilities about the whole thing, and she rolled her eyes and said that marketing rushed this out there, without much input, and that no one but marketing likes it at all.

Hagabel · Jun 11, 2010

This is ... I don't know what to call it. Pardon me while I think of something appropriate, but take a look:
Emergency Room Wait Times - Inova Health System

LMAO...

I work for this system!! The one place I work at is failry representative but they are all about discharge times...forget pt care, pt needing meds etc..get those pt discharged to make 'the numbers look good'.

A lot of the population is of the higher socio economic population so they are very entitled.

Anything beyond a 20 min wait means complaining to the triage nurse.

:smokin:

sissiesmama, ASN, RN · Jun 12, 2010

Our local hospital has this also. They've even gone so far as to have billboards up around town with a number you can text to get the current wait times.

We have these up around our area too.

mwboswell · Jun 12, 2010

I think the elephant/rhino/gorilla in the room here is that we need to aknowledge that ED is "not just for emergencies" any more!

As a nation and a culture, we have shifted the mindset to "Now" care regardless if it's an "emergency"or not.

People that are working in emergency medicine or nursing need to realize that this IS the way it IS now - it's not what it WAS before and it's NOT going back to that anytime soon.

If emergency staff find themselves being upset, disgruntled, frustrated, mad etc about "non-emergencies" coming in, they need to either (a) adjust their mindset or (b) find a new line of work because an unhappy employee is an unsatisfied employee and (i) more prone to mistakes (ii) more likely to give bad customer service etc, etc.

What the "secret" is that your admin is NOT telling you, is that they WANT the business.

The PRIMARY role of the ED is that which is mandated by federal law (EMTALA), the SECONDARY role of the ED is an "intake" or "access" point for hospital admissions. Hospital admissions = revenue, which equals profit for the shareholders/stakeholders.

Ah, but the old argument that "all our patients have no insurance"....

...this is only partly true.

The national average is that approximately 30% of your ED patient mix has NO insurance whatsoever. The other 60% has some form of payor status (private, third party, auto, medicare, medicaid). That 60% is what the hospital wants.

And if you think about it, who are you more likely to admit?

a) a medicare patient (someone typically over 65 +/- who has health conditions)

b) an unisured patient (who typically is

Look at your trauma patients.

What is the #1 cause of trauma? ANS: Blunt trauma

What is the #1 cause of blunt trauma? ANS: MVC's

For the most part, what payor status are MVC patients - INSURED (auto Liability Insurance in MOST states)....This pays big $$$$$

Even if your ED patient doesn't get admitted, think of all the referrals that come out of the ED: referrals for outpatient testing, office visits, specialist consults, procedures etc - if your hospital is networked with the providers of THOSE services, then it's a 2/3 (60%) chance that the pt being referred has insurance and thus the referrals will have about a 60% payor status.

So, you give away 1/3 of your care to capture the 2/3 that are paying...not too shabby.

But wait, there's more....

If your facility is not the "average" and your unisured payor status is greater than 30%, you argue that you're loosing money...

Well, maybe, but that's where state and federal matching money comes in to subsidize uninsured care based on your percentage uninsured.

Also, if your facility is listed as "non-profit", then the tax benefit for writing off "charity care" is even more beneficial to them which helps keep their income taxes reduced even more which means MORE of the 60% payor's money goes into their pockets.

Why am I saying all this...?

When it was the time that I finally realized that the ED was not "the" money-maker, but rather it played a role in the hospital making money - it all became much easier to swallow and understand the bigger picture.

For when you see the big picture, you start to see your role, your department's role in it.

allnurses Guide · Jun 12, 2010

Sounds like they actually are encouraging people to regard the Emergency Room as a walk-in clinic/urgent care center, and that might partially be due to an article I was recently reading. It was written by an ER doc describing how he loves these visits and describes maximum profit potential for his Emergency Group through the coding process. Advises doing "wallet biopsy" first, of course.

mwboswell · Jun 12, 2010

Sounds like they actually are encouraging people to regard the Emergency Room as a walk-in clinic/urgent care center, and that might partially be due to an article I was recently reading. It was written by an ER doc describing how he loves these visits and describes maximum profit potential for his Emergency Group through the coding process. Advises doing "wallet biopsy" first, of course.

You got it!

As far as the wallet biopsy - it's not even necessary; just treat ALL patients like they have insurance and that way you'll maximize documentation level revenue for everybody and that will capture the 60% who DO have the insurance.

Once you see the bigger picture, it becomes so much easier to understand the role of customer service, marketing, patient recruitment etc.

Editorial Team / Moderator · Jun 14, 2010

It was weird -- over the last three days, I seemed to have more patients apologizing for not having health insurance than I remember in a long time. I tell all of them that I don't worry about that detail one bit, and they really appreciate it. Because really, without trying to sound too much like Polly-freakin'-anna, I really do try to treat everyone as I would want to be treated. Even the patient in handcuffs who was whistling the same Journey tune over and over and over and over until we were all humming it, too ... LOL

One of our nurses said, "The ER should be for true emergencies only!" I asked if she was willing to cut 50% of our staff. Heh.

**canoehead, BSN, RN** · Jun 22, 2010

But still...I'm happy to see-treat the triage 4-5 patients, but the sicker people MUST come first. That's why we have a wait, and also why the complaint from Joe with the toe pain is so frustrating. We explain that the sickest people go in first, and he's still on a tear about how long he's waited. I love the fast track patients, much prefer them over admitted ones that never move to the floor.

Maybe if they added to that wait time page, in big bold letters, "Patients are not seen in numerical order, the sickest people go in first."