Some ERs Putting Wait Times on the Internet

NEW ORLEANS – A quick check on the Internet could have avoided an 80-minute emergency room wait for a sick toddler.

"Now that I know I can do that, I will," the child's grandmother, Michiko Honore, said as she recently left Ochsner Health System's main campus with Kyraine Washington.

She'd seen the big screen at the front desk, showing no wait at the Ochsner emergency room four miles away. But her daughter had phoned Kyraine's medical information to the main campus in Jefferson, just outside the city, so Honore thought she had to stay put.

With four Ochsner hospitals on a 20-mile line in and near New Orleans, doctors often wait for patients in one ER while patients wait for doctors at another.

Officials say the system that started March 11 already is beginning to even the load.

When there's a long wait at Ochsner's main campus just outside New Orleans, many people walk in, look at the screen and leave for one of the other three Ochsner hospitals within 12 miles, registration coordinator Monica Samuel said.

"Instead of people constantly asking us how long they'll have to wait, they come in and see for themselves," she said. Another big result, she said, is a 25 percent drop in calls to ask about wait times.

Dr. Joe Guarisco, chairman of Ochsner's emergency department, said Internet "hits" on the site rose significantly in March, and waiting times got longer at its Kenner ER, which had consistently had the shortest times before that.

He sent more doctors to Kenner, 11 miles west. "This will sort itself out. But clearly people are moving to the most efficient ED in their minds. That's what we want them to do," he said.

A spot check of a dozen of the 125 hospitals and hospital systems with emergency departments around Louisiana did not find a similar system.

In Australia, the government for the state of Western Australia has a more detailed site for information about ERs at five hospitals in and within about 25 miles of Perth. It shows, for each emergency department, whether ambulances are being sent to other hospitals, the average waiting time for patients who are injured or incapacitated but whose life and limbs are not threatened; the number of patients waiting to be seen and the total number of patients.

Ochsner's system was inexpensive — perhaps $2,500 in programming time, Guarisco said. The information was already in the computers, and Ochsner already had the flat screens and extensive Web pages.

It could be seen as advertising relatively short waits at a time when the national average is almost an hour and rising — with occasional times so long they end in death — and in an area where hospitals and ERs have been swamped since Hurricane Katrina closed several hospitals.

Ochsner's busiest emergency department, at the main campus, saw about 120 patients a day before the storm hit in August 2005. The average is now about 170.

Ochsner's is among several ER wait time sites announced around the country in the past few months. It's not something the American College of Emergency Physicians tracks. But they include at least two hospital chains, three individual hospitals, and one chain of three urgent-care clinics.

All are aimed at injuries and ailments considered urgent, at worst — not the 16 percent of emergency room patients treated for emergencies and life-threatening problems.

Anyone who thinks it's an emergency should call 911, not check the Internet, Guarisco said. "Emergency patients get seen right away."

But many patients don't know how sick they are — people with heart attacks or appendicitis often think they have heartburn or a virus, said Dr. Peter Viccellio, vice chairman of the emergency medicine department at the State University of New York's medical school and hospital.

One-quarter of all ER patients who don't think they need immediate treatment are diagnosed with a life-threatening or emergency condition, he said.

He and Dr. Todd Taylor, immediate past council speaker for the American College of Emergency Physicians, said ER wait time sites often have more to do with marketing than emergency care.

Taylor said that when his father's doctor recently sent the older man to the ER, he went to one advertising a 30-minute wait. Minutes after he arrived, a doctor had ordered tests and the urinary catheter his father needed. "It was 3 1/2 hours before he got the catheter placed! So you tell me, what was the wait time?" Taylor asked.

Ochsner makes no such promise. And Taylor and Viccellio both said Ochsner is using a reasonable measurement. Each posted time, constantly updated by computer, is the longest current time for a patient in an exam or waiting room who is not yet being treated by a doctor.

On March 12, for example, a woman with the flu waited more than 7 hours at the main campus. At 5:09 p.m., about halfway through her wait, there was no wait at Ochsner Medical Center-Baptist, five minutes away, or in Kenner. And the waits were never longer than 45 minutes at Baptist, 31 at Kenner.

Guarisco said patients in that position can ask the registration desk to send their record to another Ochsner ER and get credit for time already spent waiting.