May 9th, 2013
KITCHENER — When St. Mary’s General Hospital started posting current emergency room wait times online, it expected patients with less-serious problems to come when the department wasn’t as busy.
What they discovered in the year since the site’s launch in April 2012 is that substantially fewer patients are coming to emergency for care.
Meanwhile, Waterloo Region’s other two hospitals were not seeing a similar drop, nor was there a rise in less-sick patients coming in.
“They were clearly making a decision differently for St. Mary’s than they were for the other hospitals,” said St. Mary’s president Don Shilton.
As a bonus, emergency room wait times at the Kitchener hospital are also down.
The online wait-time clock — the first for a hospital in Ontario — targets people with less serious illnesses who have discretion about when or if to go to the emergency department. Such people account for about one-third of patients.
“It’s a big group,” Shilton said
“When we started, we were anticipating patients would come, but they would come at a different time.”
During the first month there was a shift in arrival times, then after a few months some were deciding not to come at all. By August, visits by patients with less-serious concerns were down 22 per cent.
Over the whole year, the drop was 12 per cent — equal to 1,800 fewer less-urgent patients. This April had 1,069 of those patients, compared to 1,204 and 1,252 in previous years.
A survey of patients who used the website, which includes the current wait time and the projected waits over the next six hours, found going to the family doctor or walk-in clinic were popular alternatives.
Shilton was concerned at first to see the drop in patients, but it was found the more serious patients who needed emergency care were still coming in the same numbers — even slightly more — and with the same arrival pattern.
“That gives us some confidence the tool wasn’t being used inappropriately,” Shilton said.
The site gets 4,000 visitors a month now, compared to upwards of 12,000 in the first few months. Ninety per cent of patients will be seen within the stated time.
“There’s a pretty good chance you’re going to be seen sooner than what the clock says,” Shilton said.
That accuracy has health care staff at the hospital more comfortable with the tool, especially since the length of wait is the most common question asked.
Shilton said it was a gamble to post wait times because people could get upset if the hospital didn’t deliver.
“You’re taking a bit of a brave step to put your performance out there for people to judge you,” he said. “We didn’t know how the public would respond.”
The software was developed by the hospital’s IT staff and it set up a company, Oculys, to market and tweak it. Shilton said there is considerable interest, including from the region’s other hospitals, and another Ontario hospital bought it but has not yet launched the online tool.
“I’m hopeful that more hospitals will go live with this because right now we only have one hospital’s experience,” Shilton said.
Generally, feedback is good, although he said there is some criticism in the field from people who say medical professionals should decide whether or not a person needs care in the emergency department.
But, Shilton countered, “people make decisions about their health care every day of their lives.”
He said the online clock is helping to trim the time patients spend in emergency before being released or admitted.
“Our wait times are better. We’ve still got lots of work to do there,” Shilton said.
St. Mary’s is working with Grand River Hospital, which shares staff including a chief of emergency medicine, on a pilot project to post a doctor at triage. An early trial found half the patients could be sent home right away because their concerns could be dealt with quickly. The doctor would also be able to get patients started on testing.
Shilton said they’re looking to see if it’s possible to have a doctor at triage regularly.
“I’m excited where that may take us.”
Johanna Weider, Waterloo Region Record