Jacqueline A. Fulton needed a boil under her arm drained. Her pulmonary specialist worried it could leak into the tubing of her pacemaker. But the emergency room at Hahnemann University Hospital, where she arrived with her daughter, Rosalind, on a recent Wednesday afternoon, was jammed.
The Fultons had not heard about a new, little-advertised service offered by Hahnemann: a clock posted on the hospital website displaying an estimate of the ER wait time. But they say they would have used it if they had known. When they learned some patients had been there four hours, they called a cab.
"We're leaving," said Fulton, 77.
Anyone who has visited an emergency room for stitches, or a broken bone, knows the drill. If you aren't showing signs of a stroke or heart attack, chances are you will wait awhile.
So several hospitals in the region have begun posting a rolling average of wait times on their websites, hoping to give patients a sense of what to expect when they arrive. Some say the wait clocks are a step toward providing people with more real-time information about their care.
Other hospital leaders have decided not to post a clock. They say it sends the wrong message — that an emergency room is a place for convenient, instead of critical, care. Or, worse, they worry that patients faced with a long wait will delay care when their health is at stake.
The clock trend is likely to grow, said Alan Zuckerman president of consulting firm Health Strategies & Solutions in Philadelphia.
"It's about time," he said.
Consumers have come to expect such services: a text from an airline about a delayed flight or signs along the highway that report driving times between major junctions. Zuckerman advises his hospital clients to get on board.
"I think it will become very routine in a matter of a couple of years," he said. "It's almost a no-brainer."
Hahnemann's for-profit owner, Tenet Healthcare Corp. of Dallas, is posting wait times for 40 of its 49 hospitals, including St. Christopher's Hospital for Children in Philadelphia.
St. Luke's Hospital and Health Network has posted clocks online and in the waiting rooms at its Allentown and Bethlehem emergency departments.
Aria Health plans to post them online for its three emergency rooms once it renovates those in Frankford and Torresdale. And Phoenixville Hospital and Pottstown Memorial Medical Center will include a clock on mobile websites set to launch this year.
Nationally, many of those posting wait times are community hospitals where averages rarely exceed 15 minutes. As an urban hospital, Hahnemann is different.
Its clock, which is seen only online, measures the average time over two hours that patients wait from registration to the point that they are escorted in. It also comes with caveats, noting that the wait time is "subject to change."
When the Fultons arrived midafternoon last week, the clock was nearing one hour and on the rise. By 8 p.m., it had passed three hours. That's hardly good advertising.
Mary Kay Silverman, director of emergency services, said the patients are more understanding about having to wait if they know what to expect. The goal, she said, is to be "open and truthful."
The Fultons like the idea. "People need to know what's going to be in store for them when they go to the ER," said Rosalind Fulton. Her mother ended up taking antibiotics from her specialist and feeling better without going to an ER.
Hahnemann has been working to better manage flow in its emergency department as volume has increased 23 percent in the last two years, Silverman said. In recent years, 15 percent of registered patients left the emergency department without being treated. Wait times averaged 12 hours, Silverman said. Last year, only 6 percent of patients left the ER without treatment. Silverman says the clock is a way of acknowledging that long waits are a problem, and that the hospital is working to fix it.
For years, emergency room professionals have been calling for help in alleviating crowded emergency rooms, caused largely by backups in hospital inpatient admissions. Hospitals are responding, in part because it will soon affect how they are paid.
Starting in 2014, the time it takes a hospital to move patients through the emergency room will be among the factors the federal government uses to decide how much to pay for services to Medicare patients.
But some see wait clocks as counter to those efforts.
Emergency rooms are expensive. Advertising short wait times might prompt people to visit them for issues better addressed by a primary-care physician, said Sandra Gomberg, chief executive officer of Temple University Health System, which does not post a clock online.
"We think that the notion is very confusing to the public," Gomberg said. "We want the public to be making good choices about the right place to get health care."
Others worry about safety. At St. Mary Medical Center in Middletown Township, Bucks County, which does not post a clock, emergency department chairman Gary Zimmer said he was concerned a lengthy posted wait time could cause some patients to put off necessary care.
Leaders at the American College of Emergency Professionals share his concern. The group does not endorse the clocks, said president Sandra Schneider.
Plus, she said, emergency rooms can change quickly. A rolling two-hour average could give the public a false impression. An influx of critical patients can really lengthen the wait for others.
But consumers are demanding more information, said Peter Hudson, a former emergency room doctor. His company, Healthagen of Lakewood, Colo., launched a smart-phone application in June 2009 called iTriage that lists hospitals, physicians, and pharmacies. Those providers can pay to enhance their entry in the database. More than 400 hospitals have upgraded their profile, Hudson said, and about 25 percent are posting wait times.
"Everybody talks about cost and quality in health care, and that they're difficult to measure and difficult to get the right numbers," Hudson said. "But the other factor that really matters to all of us is time."
At St. Luke's, the wait clocks are part of a broad effort to communicate more with patients about what's coming, whether they visit the emergency room for stitches or are preparing for a hip replacement, said Mark Lohman, nurse manager of the Allentown emergency department. Patients want to feel "more included in decision-making," he said.
Critics of the clocks say there is no industry standard for measuring wait times, making it difficult to compare one hospital's wait to another.
Even so, Lawrence Thompson, 55, was enthusiastic about the idea of comparing them. Thompson of Philadelphia had been waiting for an hour and a half at Hahnemann with his diabetic mother, who was short of breath.
"Then you know what hospital to go to," Thompson said, as he walked out to feed his parking meter.
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Information from: The Philadelphia Inquirer, http://www.philly.com