On Time Guarantee

June 5, 2002
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Fed up with the persistent chaos of the emergency room and the stress that went with it, Gerald Buchanan was ready to give up.

Then came a new way to do things, one that prompted him to alter course and stick with the profession he loves. The plan was to change anything and everything about how Hackley Hospital’s Emergency Department operates in order to get physicians to a patient’s bedside as fast as possible.

Eight months later, after the Muskegon hospital altered more than 150 processes and procedures at the recommendation of six separate staff committees, Hackley’s emergency room is a far less stressful place to work. Patients are having their ailments and injuries diagnosed and treated faster than ever, the ER operates much more efficiently, and Buchanan is feeling much better about things.

“This system is one thousand times better than the old system,” said Buchanan, medical director at Hackley Hospital’s Emergency Department and a 16-year veteran of the ER. “It’s increased my longevity in the medical field.”

The changes that Hackley implemented in its ER a year ago follow a fledgling movement within the health care industry to do a far better job in managing emergency room cases and eliminating the long waits that many people have often endure, as they get shuffled behind patients with critical conditions.

Hackley even guarantees people coming into the ER with ailments such as the flu, a high fever, or injuries like cuts or sprains, that they will see a doctor within 30 minutes or less. If they don’t, they get free movie tickets, as well as an apology from the physician.

It’s an apology that Buchanan doesn’t mind offering. In the past, he had long been accustomed to apologizing to often-irate patients who had waited two or more hours to see a doctor. Buchanan, however, doesn’t have to say he’s sorry very often anymore. Hackley has reduced the average waiting time in its ER from 56 minutes in 1998 to 13 minutes, and hits its 30-minutes-or-less goal 99 percent of the time.

“You used to spend the first five minutes (with a patient) apologizing and trying to calm them down,” he said. “From a physician and staff standpoint, this has made our jobs a lot easier.”

While improving ER operations is certainly not a novel idea, especially in an era when health care providers are constantly being squeezed to improve operating efficiency, hospitals today are beginning to couple their efforts with a marketing campaign touting guarantees to patients that they’ll see a physician in a certain amount of time. Those hospitals that have initiated ER guarantees and promoted them have seen sizable increases in the number of people coming through their doors.

Hackley’s ER visits are on a pace to grow from about 42,000 last year to more than 46,000 this year. That’s an increase that thrills Hackley’s chief operating officer, Gayle Miller.

Sixty percent of the admissions at Hackley originate in the ER, Miller said. With a good percentage of the hospital’s revenues coming from inpatient services, the resulting increase in ER visits that are driven by 30-minute guarantee has been “definitely good for business,” Miller said.

“We’ve seen increases in our business we never would have expected to see,” she said.

ER visits at Metropolitan Hospital in Grand Rapids are up 14.5 percent since July, when the hospital began its Express Care program that aims to treat minor emergencies in 60 minutes or less. Helen Berghoef, manager of Metro’s Emergency Department, attributes the increase to a radio advertising campaign that accompanied the launch of Express Care, as well as word-of-mouth.

“They came to us for the express reason that they didn’t want to wait,” Berghoef said.

Metro’s Express Care is set up to handle patients from 3 p.m. to 11 p.m., a time when the ER is at its busiest and people who need to see a doctor are unable to get into their family physician until the next day.

Metro considered a more intensive program, similar to Hackley’s, but settled on limited hours because it wasn’t ready for something larger, Berghoef said.

“Once you do that you up the ante,” she said.

While the Metro and Hackley programs vary in intensity and scope, they both follow the same premise of doing a better job to separate critical and non-critical patients.

Many of the people who come into an ER require only a few minutes of a physician’s time, Metro Marketing Director Jim Childress said.

“Why should people wait for four hours for something that only needs 10 minutes to treat? You can give them the medical knowledge they need in a relatively compressed time,” Childress said.

Metro is better able to accommodate those less-urgent patients through Express Care, which is set up in a separate area of the ER that’s geared toward addressing non-critical cases.

“You used to have these less urgent conditions being mixed with serious conditions. You can take those less urgent conditions out of the mix and see them quickly and everybody’s happy,” Berghoef said. “Now we can move them to the front of the line because they’re going somewhere else.”

There are, however, those in the medical profession who question ER guarantees.

Pat Foley, director of communications for the Michigan Health and Hospital Association, says some consider ER guarantees as nothing more than “marketing gimmicks” that were designed to drive market share and revenues, rather than improve patient care.

“If the level of care doesn’t go along with it, there’s no sense in saying, ‘we can do it in 30 minutes,’” Foley said. “What it all boils down to is the right care in the most appropriate setting.”

Hackley’s Buchanan, however, brushes off such suggestions. He also is quick to dismiss concerns that ER guarantees will result in a lowering of the quality of care.

Buchanan pointedly asks whether it’s better for a patient with a high fever who turned out to have a high white-cell blood count to have their treatment begin 20 minutes after they walk through the door, or two hours?

“It’s better medicine,” Buchanan says of Hackley’s system.

As more hospitals begin to realize the potential benefits of guarantees, especially at a time of increasingly fierce competition and tight finances in the health care industry that has hospitals searching for ways to differentiate themselves, the use of ER guarantees is expected to grow, Foley said.

“Some hospitals will see other hospitals do it and give it a try,” he said.

To some, however, the simple need to improve service will force them to examine the inner-workings of their emergency departments, even if they’re not necessarily planning to offer guarantees. Patient satisfaction surveys have consistently shown that long waits in the ER are one of the biggest gripes people have with hospitals.

“That’s one of the biggest reasons people dread going to an emergency department,” said Bruce Rossman, a spokesman for Spectrum Health in Grand Rapids.

Spectrum presently has a task force examining its ER operations and how to make it more efficient as patient volumes continue to grow. By having better processes in place, hospitals can accommodate growing ER volumes without having to undergo costly expansion projects, Rossman said.

“There’s a finite amount of space and resources available,” Rossman said. “Let’s look at how we take a patient through the system and make the system more friendly to them.”

That trend is recognition by the health care community that hospital ERs have long changed from the traditional role of treating life-threatening emergencies to what essentially amounts to a walk-in medical clinic for minor ailments and injuries, said Dr. Billy Ben Baumann, president of the Michigan State Medical Society.

While the Society is “not wild” about the advertising and marketing aspects of the trend, Baumann applauds efforts to better manage critical and non-critical cases. The growing tendency by people to go to a hospital when they’re sick or hurt, rather than a family physician or local medical clinic, is overwhelming many ERs, especially those in inner-city settings, he said.

If a hospital can adapt to the situation and ease the strain, “who can quarrel with that?” Baumann said.

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