Mickey Mouse practices in the Emergency Department

A new Press Ganey “Pulse Report” on Emergency Departments received a good deal of attention today. The Washington Post covered it, which gave the headline writer the opportunity to write one of those inane medical headlines: The Doctor Will See You… in a While. Actually the story deserves that kind of headline, because the main findings won’t be a big surprise to anyone.

Our research has found that the average amount of time a patient spends in the ED is four hours and five minutes—an increase from last year. Patients also conveyed that satisfaction decreases with longer the time spent in the ED. Fortunately, our findings also show that the negative impact of a long wait time can be mitigated by communicating with patients about delays and by improving waiting room comfort.

According to the report, certain hospitals are doing something about this, with so-called “fast track” programs to speed things up for patients with less severe issues. I say so-called because the time spent drops from 4.0 hours to 3.6 hours, not exactly an impressive result for people whose conditions should be faster to treat anyway. (The report tries to make the difference look dramatic on p. 8 by displaying a bar graph with a y-axis that starts at 3.5 instead of 0.)
Disney figured out these mitigation strategies a long time ago. That’s why you see signs like “60 minutes from this point.” Usually they also try to manage expectations by making the signs worse than reality. The 60 minute sign might really mean 45 minutes. The “fast track” concept makes me think hospitals are trying to emulate the Disney approach more broadly. As long as they are doing so they might as well take things all the way! So here are some suggestions:

  • Rather than having patients sit in the waiting room, have them snake their way through several rooms. Make sure the patient can’t see too far ahead, so they will have the impression that they are almost there even if they’re not
  • If it looks like it’s going to be a four hour wait, tell the patient it’s 10 or 12 hours. Imagine how happy they’ll be when it’s just 5 or 6!
  • In the last step before actually letting them see a doctor, take a group of patients into a pre-show room with flashing lights and strange sound effects. Tell them a funny story or show a video of a crazy doctor chopping a patient into pieces or using one of those 6-foot hypodermic needles. Finally, open the door and let them see the doc!
  • Have a couple of roving triage nurses who have the power to make a “magical moment” for a patient by bringing him or her out of the line, right to the front, just for the sheer joy of it!

Of course running an Emergency Department is tough. But too many are still in the Stone Age when it comes to patient experience.

June 17, 2008

2 thoughts on “Mickey Mouse practices in the Emergency Department”

  1. Or hospitals could embrace Lean (read Toyota) production methods and discover that there really are ways to dramatically improve the flow of patients through ERs. Books such as Lean Hospitals by Mark Graban, and The Pittsburgh Way to Efficient Healthcare by Naida Grunden describe how this can be done, and is being done.

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