Sacramento Hospital Creates a No Wait ER

Julie Shenkman
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One of the biggest problems associated with health care in the United States is the need to wait several hours for emergency care. The typical emergency room is packed with patients, some of whom come to the ER for non-emergent medical care because they do not have insurance. Kaiser Permanente in South Sacramento found a way to reduce wait times by using hospital data to create a no-wait ER.

Because Kaiser is a trauma center, it has the busiest emergency room in Sacramento. The hospital is on pace to handle 120,000 emergency visits in 2015, which is nearly double the number of patients seen in the ER in 2008. One of the biggest challenges of running such a busy emergency room is the long wait times. Dr. Karen Murrell says a typical hospital is supposed to see 1,500 to 1,800 patients per year for every ER bed. Kaiser Permanente in Sacramento sees approximately 2,500 patients per bed each year.

Long wait times were not always a problem at the hospital. In 2008, ER wait times averaged 55 minutes. Patients were admitted to the hospital within an average of eight hours, or they were discharged from emergency care within an average of 4.5 hours. Unfortunately, poor patient flow made it impossible for physicians to see enough patients per shift. One doctor reports seeing eight patients in a 12-hour shift, leaving the waiting room filled to capacity. Angry patients left without getting medical care, and doctors and nurses spent a lot of time complaining to hospital administrators.

To combat long wait times, Kaiser Permanente implemented a performance improvement program in the emergency room. The program drastically improved ER wait times to an average of 19 minutes, allowing more people to get the medical care they need. Staff members in the no-wait ER also managed to reduce the average length of stay for each patient. For people with non-urgent medical problems, the average length of stay is down to 43 minutes. Patients are admitted to the hospital within an average of six hours instead of eight hours, freeing up more beds for ER patients.

Staff members use key metrics to manage the flow of patients and make decisions. As a result, ER physicians are able to see more patients in a typical shift. Patient satisfaction has improved, and fewer patients are leaving the emergency room without seeing a doctor. Staff members even replaced the old triage process with a streamlined triage system. It now takes two minutes to triage a new patient instead of 19 minutes.

As the health care system evolves, long wait times are likely to be a problem in many emergency rooms. Kaiser Permanente in Sacramento is a good example of what staff members can do if they band together and look for ways to improve the patient experience.

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