April 29th, 2013
An experiment in online listings for emergency room wait times has produced some surprising results.
A year into Ontario’s first experiment with an online real-time emergency room wait time calculator, St. Mary’s General Hospital in Kitchener discovered a remarkable result.
“We had expected to see people would adjust their arrival times,” said Don Shilton, president of St. Mary’s. “What we’ve actually seen is that a number of them have decided not to.”
Diverting the “non-complex care” patients in ER to family doctors or clinics works only if the system guarantees sick people can get in to see their family doctors in 24 to 48 hours, Shilton said.
St. Mary’s introduced its real-time digital clock in April 2012 as one way to chip away at four- and five-hour ER wait times. Created by Oculys and the hospital’s IT department, the calculator now has an accuracy of 90 per cent, said Shilton.
Two other Ontario hospitals will introduce the system this summer, said Franck Hivert, CEO of Oculys, a third-party company set up by St. Mary’s to market the device. He declined to name them.
“A lot of money has been put into ERs to try to fix them,” said Hivert. “The notion behind a solution is changing the behaviour of patients. Why not try it? A large percentage (of people in ER waiting rooms) should be going to their family doctor.”
Vancouver hospitals just jumped into the real-time ER service, introducing an online “dashboard” for five Lower Mainland hospitals that is updated every five minutes.
“This is not for people having chest pain,” said Dr. Eric Grafstein, head of emergency services for Providence Health Care, who developed the device in Vancouver.
“They have to call 911. This public website is only part of the project to improve wait times.”
In its first week, he said, 10,000 people checked the device.
He admitted it’s only an estimate that could change if, for example, more serious emergencies arrive by ambulance.
Still, he said, “most of the time it’s going to be accurate. If it does nothing else than give people information, why not do it?”
Dr. Howard Ovens, director of the Mount Sinai emergency centre in Toronto and co-chair of the provincial ER expert panel, has many reasons why not to invest in ER wait-time digital clocks.
“To me, this very subtly, subliminally shifts the responsibility from the government and a system level to the patient. The message is: It’s your responsibility to make a decision. There are so many things wrong with that picture.”
The Ontario Ministry of Health posts monthly average ER wait times for all of the province’s hospitals, which Ovens contended are just as accurate as any digital device.
He criticized St. Mary’s, which on the ministry site has total ER treatment times of 4.7 to 8.6 hours.
“If you’re going to post a wait time of five hours, I’m a little concerned with the idea of just publicizing the fact that their wait times are poor.”
He compared it to McDonald’s telling customers to come in at 10 a.m. because it’s less busy than dinner time, rather than adding more staff in the evening.
The St. Mary’s staff also like the real-time monitor, Shilton pointed out.
“In emerg, patients and family are often asking how long is it going to be. This reduces the trips back and forth to the desk.
“We have a long way to go to reduce our own wait times. But it’s important that patients and families be informed.”
Canada is tops among developed countries for the length of its ER wait times.
Lesley Ciarula Taylor, Toronto Star