How Good Is My Hospital ER?

 In CHR Blog

When consumers think of going to the Emergency Room at a nearby hospital, one of the biggest concerns is waiting time.  Information published by the federal government yesterday at Hospital Compare reports the average (median) time that patients waited before they saw a provider was 23 minutes[1] from the time they arrived at the hospital.

Waiting time is a completely justifiable concern when it’s a matter of life, death, or relief from excruciating pain.  But at the moment of need, consumers won’t have time to check ratings of local hospitals.  That’s a task to take on in advance of your future need.  There is a lot to study – the government reports eight different measures of time in the ER that consumers might be interested in.  Additionally, wait time is not the only factor consumers consider.

Who should check their hospital’s Emergency Department ratings?  Management and the community relations department are already checking these ratings.  Departments that support the ER – such as Lab and Imaging might also check their hospital’s ratings.  Hospital Board members should also be educating themselves on what the ratings say.  But consumers too can benefit, since the likelihood is fairly strong that you or a loved one will make a trip to the Emergency Department every few years for one reason or another.  According to the CDC, nearly 17% of kids and 18.8% of adults age 18 and up had at least one ER visit in 2015.

Emergency Departments treat patients suffering from an acute serious illness or injury that would lead to severe complications (or death) if not treated quickly.   An ER is an advanced diagnostic center that has immense back-up services – with equipment, laboratory capabilities and access to medical and surgical specialists. They employ capabilities either onsite, through telemedicine, or by transfer to a more sophisticated or specialized hospital.  Many ERs are staffed with doctors who are Board certified in Emergency Medicine.  The physicians and the hospital departments supporting them are expected to be thorough and quick.

Fortunately, there are standardized measures in place to assess whether care is effective and timely.  Several Emergency Department performance scores are reported nationally for full service hospitals, and some specialty hospitals at hospitalcompare.gov .  Here is a sample along with the most recent national averages: National median for April 1, 2016 to March 31, 2017.  See chart.

Emergency Department measures at Hospital Compare (sample measures related to timeliness of care) National Average (most scores are from Apr. 1, 2016 to March 31, 2017)
Wait to see a provider after arrival – Average (median) time patients spent in the emergency department before they were seen by a healthcare professional 23 minutes
Total time in ER (not admitted) – Average (median) time patients spent in the emergency department before leaving from the visit 2 hours, 38 minutes
Time in ER before being admitted – Average (median) time patients spent in the emergency department, before they were admitted to the hospital as an inpatient 4 hours, 37 minutes
Time in ER waiting for an inpatient room (admitted) – Average (median) time patients spent in the emergency department, after the doctor decided to admit them as an inpatient before leaving the emergency department for their inpatient room 102 minutes hours
Heart attack (EKG) – Average (median) number of minutes before outpatients with chest pain or possible heart attack got an ECG 7 minutes
Heart attack transfers – Average (median) number of minutes before outpatients with chest pain or possible heart attack who needed specialized care were transferred to another hospital 58 minutes
Stroke – Percentage of patients who came to the emergency department with stroke symptoms who received brain scan results within 45 minutes of arrival 72%
Broken bones (pain management) – Average (median) time patients who came to the emergency department with broken bones had to wait before getting pain medication 49 minutes

At HospitalCompare.gov, consumers can compare 3 hospitals at once on their ER scores. And yet, the decision on which hospital to prefer is not necessarily easy. Take the real-life example of two major hospitals in a mid-sized Midwestern city. Hospital A:

  • Rates 3 stars (out of 5),
  • Emergency Department has a medium volume (20,000 to 39,999 visits a year),
  • Sees patients in about 17 minutes after arriving,
  • Average time in ER is 2 hours, 22 minutes,
  • Scores are better than the national average.

Hospital B:

  • High-volume ER (40,000 to 59,999 visits per year), that
  • Hospital overall rates 4 stars (of 5).
  • Sees patients in about 16 minutes despite being a busier ER
  • However, it takes 17 minutes longer on average than Hospital A in total time to treat a non-admitted patient, and about a half-hour longer for a patient being admitted as an inpatient.
  • Has better times than the national average for high-volume ERs

Which hospital should the family choose?  Is a 4-star hospital worth the longer treatment time?  Brand reputation will end up playing a large role in the patient’s selection.  Fortunately, in some cases – namely concern about heart care, stroke or broken bones, consumers can compare scores as noted above.  But ultimately, consumers may have to evaluate whether an eight-minute advantage in getting a pain med for a broken arm is valuable enough to decide to go to a hospital that has a lower star rating.

Selecting a hospital or an ER will also consider where one’s usual doctor practices, and possibly what the price is.  Whether you’re insured or uninsured, very few people know what the costs will be, unless their health plan caps expenses, for example, at $300 per visit.

We will know when healthcare ratings have truly evolved, when cost, quality and patient satisfaction are all at the same place.  And all factors are specifically related to the same service.  In this example, this means the star ratings would be for the ER itself, not only for the whole hospital.  The costs would be stated for the ER visit, and include physician fees, lab tests, x-rays and MRIs.  The patient satisfaction would reflect ER patients and not co-mingle opinions with the obstetric unit or other inpatients.  Some hospitals may voluntarily report such scores and costs at their websites.  Does yours?

Hospital ERs are among the most important institutions we have in society.  They are staffed 24/7 even on holidays, by staff who are committed to your well-being.  They literally may save your life.  With that in mind, consumers may wish to compare their local options before they need it.

[1] National median for April 1, 2016 to March 31, 2017.  See chart.

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