Yelp now lets you see how long the wait will be at the hospital's ER(mashable.com)
mashable.com
Yelp now lets you see how long the wait will be at the hospital's ER
http://mashable.com/2015/08/05/yelp-hospital-data/?utm_cid=mash-com-fb-tech-link
49 comments
To be fair, ERs are being rated, not doctors. They are generally independent of each other.
" How friendly the staff is is absolutely irrelevant when you have a medical emergency. "
I disagree, delving into the negative spectrum of interpersonal communication could cause unwarranted stress which could exacerbate many conditions.
I agree that staff shouldn't be expected to bend over backwards, but there's no need for negative treatment. And I don't consider saying "no" to a low priority case as negative treatment. And if as an ER employee you can't handle the stress of the ER you may need to change departments or get some training.
" I'd always chose the bigger ER over a smaller one "
Which requires research, which most people don't have time for in an emergency. But I agree completely with this. I live in one of the largest medical centers in the world and I know where to go.
" How friendly the staff is is absolutely irrelevant when you have a medical emergency. "
I disagree, delving into the negative spectrum of interpersonal communication could cause unwarranted stress which could exacerbate many conditions.
I agree that staff shouldn't be expected to bend over backwards, but there's no need for negative treatment. And I don't consider saying "no" to a low priority case as negative treatment. And if as an ER employee you can't handle the stress of the ER you may need to change departments or get some training.
" I'd always chose the bigger ER over a smaller one "
Which requires research, which most people don't have time for in an emergency. But I agree completely with this. I live in one of the largest medical centers in the world and I know where to go.
Many empirical studies point out that in fact, the 'friendlier' the staff is (meaning higher 'patient satisfaction scores') the poorer the actual clinical outcomes are at that facility.
See: https://www.advisory.com/daily-briefing/2012/02/15/patient-s...
Longread but excellent: http://www.theatlantic.com/health/archive/2015/04/the-proble...
As someone who works in healthcare (formerly at the bedside), and who's partner is a current ED nurse, this infuriates me. Department budgets are related to patient satisfaction scores, the EDs generally tend to have low scores because, yes, sorry you've been here for 3 hours, but we had 4 other patients come in (and HIPPA prevents me from telling you that they were level 1 gunshot wounds) and we can't tend to your constipation right at this second. If someone actually were to check Yelp for wait times and then have to wait longer...scores go even lower, reimbursements decrease, staff have higher patient ratios, lather, rinse, repeat.
I assure you, I have seen many, MANY patients complain and file greivances with the Department of Health, Joint Commission, etc, that their toothache, or even general wellness physical, should take prescedence over cardiac arrests. This is in a top 10 hospital in the United States, and we generally score above average with patient satsifaction. The public has no clue and this is not helping.
See: https://www.advisory.com/daily-briefing/2012/02/15/patient-s...
Longread but excellent: http://www.theatlantic.com/health/archive/2015/04/the-proble...
As someone who works in healthcare (formerly at the bedside), and who's partner is a current ED nurse, this infuriates me. Department budgets are related to patient satisfaction scores, the EDs generally tend to have low scores because, yes, sorry you've been here for 3 hours, but we had 4 other patients come in (and HIPPA prevents me from telling you that they were level 1 gunshot wounds) and we can't tend to your constipation right at this second. If someone actually were to check Yelp for wait times and then have to wait longer...scores go even lower, reimbursements decrease, staff have higher patient ratios, lather, rinse, repeat.
I assure you, I have seen many, MANY patients complain and file greivances with the Department of Health, Joint Commission, etc, that their toothache, or even general wellness physical, should take prescedence over cardiac arrests. This is in a top 10 hospital in the United States, and we generally score above average with patient satsifaction. The public has no clue and this is not helping.
I'd guess that patient ratings (of doctors, maybe not ER rooms) correlate with the doctor's willingness to prescribe all the drugs if asked, which could be what we're seeing here.
My personal experience leads me to hypothesize that it's just simply how fast patient requests are fulfilled and how well their questions are answered. A LOT of that comes down to nursing. The doctor may explain things incredibly well, but frequently patients turn and ask the nurse questions after the doctors leave the room, because they didn't quite understand what was being said. Also, it's the nursing staff that's toileting patients, getting and administering their meds, walking with them, talking with them about their condition, etc.
Pain management comes into it as well, but I also think that's something that could be added to improved patient education in this country (per my commentary below). For example, when people talk about their family members being in the hospital, and how their pain is bad, I ask why they don't get palliative care involved. 9/10, I get 'well they're not at end of life, so why would I do that?' Pallitive care focuses on quality of life at any point, and a large part of that is pain management. Most people don't know that, however, and the system is unfortunately set up such that patients and their family members often hold this (incorrect) belief on what palliative care does.
Pain management comes into it as well, but I also think that's something that could be added to improved patient education in this country (per my commentary below). For example, when people talk about their family members being in the hospital, and how their pain is bad, I ask why they don't get palliative care involved. 9/10, I get 'well they're not at end of life, so why would I do that?' Pallitive care focuses on quality of life at any point, and a large part of that is pain management. Most people don't know that, however, and the system is unfortunately set up such that patients and their family members often hold this (incorrect) belief on what palliative care does.
> patients turn and ask the nurse questions after the doctors leave the room, because they didn't quite understand what was being said.
This makes me extremely curious as to how hospitals in the US work. Why does the doctor leave the room and leave the patient there? What's the doctor doing elsewhere? What's the patient doing in there?
This makes me extremely curious as to how hospitals in the US work. Why does the doctor leave the room and leave the patient there? What's the doctor doing elsewhere? What's the patient doing in there?
So the way inpatient (hospital) settings work here in the US is that patients have their own rooms (occasionally shared rooms, with one or maybe two other people, but by and large patients have a private room). Usually the doctors round in the morning, meaning they stop in to the room, talk with and examine the patient, and then update the plan of care as necessary. The nurses then execute the plan of care--the nurses administer medications, explain processes, etc. The nurses cannot diagnose a disease (officially), nor can they prescribe medications (officially). Typically, conversations patients and nurses have result in the nurse suggesting a doctor look at a specific cluster of symptoms or test for a specific diagnosis, and/or prescribe given things. Nurses are supposed to be advocates for patients. Doctors plan the care. Excepting surgeons, doctors rarely actually administer the care.
The inpatient system works this way because it is easier to scale--our nurses often have bachelors degrees, with an emphasis on biosciences: pharmacology, pathophysiology, anatomy and physiology, etc. The providers (doctors, hospitals) are reimbursed based on what is prescribed (the procedures) and (this is key) how many people they see. So, it makes the most sense, financially, to have the doctors see each patient for, say, 10-15 minutes only, and then have the nurses carry out the plan of care. If you have a good working relationship between the doctor and the nurse, the doctors will often rely on what the nurse thinks to decide on what tests to order and/or what meds to prescribe. How does it work in your country?
The inpatient system works this way because it is easier to scale--our nurses often have bachelors degrees, with an emphasis on biosciences: pharmacology, pathophysiology, anatomy and physiology, etc. The providers (doctors, hospitals) are reimbursed based on what is prescribed (the procedures) and (this is key) how many people they see. So, it makes the most sense, financially, to have the doctors see each patient for, say, 10-15 minutes only, and then have the nurses carry out the plan of care. If you have a good working relationship between the doctor and the nurse, the doctors will often rely on what the nurse thinks to decide on what tests to order and/or what meds to prescribe. How does it work in your country?
Huh, that's quite interesting, thanks for the thorough explanation.
I live in Argentina, and it works quite differently. Patients wait outside the doctor's office, the doctor will call them in, examine, and prescribe any study, treatment or medication necessary. The patient leaves and the doctor remains in the room.
If the patient needed some study (eg: some scan, blood test, etc), they'll need to head to the hospital's lab with the order and get it done there (or you can go to another hospital if you prefer, though I don't think this is common at all). If there's a medicine prescription, then the patient will have to go to a pharmacist and get it himself, again, with that order.
Private hospitals are paid by each patient they see (and studies are paid separately), either by the patient or their health plan. Public hospitals are free, though they may charge some studies/supplies. Some public hospitals won't attend you for free if you have a health plan and will instead force you to use it instead.
I'm not sure which system is faster, but there's no nurse involved in general when just seeing the doctor, which must make a difference (eg: less personnel), and it's the patients who move around instead of the employees.
I live in Argentina, and it works quite differently. Patients wait outside the doctor's office, the doctor will call them in, examine, and prescribe any study, treatment or medication necessary. The patient leaves and the doctor remains in the room.
If the patient needed some study (eg: some scan, blood test, etc), they'll need to head to the hospital's lab with the order and get it done there (or you can go to another hospital if you prefer, though I don't think this is common at all). If there's a medicine prescription, then the patient will have to go to a pharmacist and get it himself, again, with that order.
Private hospitals are paid by each patient they see (and studies are paid separately), either by the patient or their health plan. Public hospitals are free, though they may charge some studies/supplies. Some public hospitals won't attend you for free if you have a health plan and will instead force you to use it instead.
I'm not sure which system is faster, but there's no nurse involved in general when just seeing the doctor, which must make a difference (eg: less personnel), and it's the patients who move around instead of the employees.
"(meaning higher 'patient satisfaction scores')"
I was not addressing this at all. Patient satisfaction scores are a lot more broad than "staff was friendly, check".
I even state the following "And I don't consider saying 'no' to a low priority case as negative treatment."
I have family and friends that are ER physicians (and have done it in multiple countries), and they can handle the stress of stressed patients without needing to resort to stress induced interaction themselves. This is all that I was referring to.
I do not tolerate rude medical staff, and no one should. Again, if you can't handle the stress, get training or change departments.
I was not addressing this at all. Patient satisfaction scores are a lot more broad than "staff was friendly, check".
I even state the following "And I don't consider saying 'no' to a low priority case as negative treatment."
I have family and friends that are ER physicians (and have done it in multiple countries), and they can handle the stress of stressed patients without needing to resort to stress induced interaction themselves. This is all that I was referring to.
I do not tolerate rude medical staff, and no one should. Again, if you can't handle the stress, get training or change departments.
I appreciate and understand that they are significantly more broad than the friendly staff metric. However, patients who feel the staff were friendly tend to give higher overall ratings. And I know that you stated that you don't consider saying no to a low priority case as negative treatment, but again, I promise you, PLENTY of people do. I got it at least once a shift, if not more frequently. I have literally had patients come up to me in another patient's room WHILE WE WERE DOING COMPRESSIONS and complain that we weren't getting them ice fast enough.
I'm sure being an ER physician can handle the stress, because they aren't interacting with the patients like the nurses and techs interact with the patients. Have they ever had someone hit them because they didn't get their turkey sandwich fast enough? Spit in their face because they were made NPO? Pee on them on purpose? I sincerely doubt it. The scope of practice is entirely different. I think the nurses and techs do an incredible job of keeping it together and maintaining a friendly demeanor towards patients when they have to put up with these things. It's easy for you to say 'If you can't handle the stress, get training or change departments'. That's exactly the response that causes nursing to have such a high turnover and burnout rate.
No one is advocating for staff to be rude, I'm advocating, however, for better ratios for the nursing staff and more patient education on the other side of healthcare. And frankly, I think that sometimes, it should be okay for healthcare workers to interact with a patient like they are an asshole because THEY ARE. You'll get the same standard of care, but I'll be damned if I'm going to go to another floor to search for some ice cream for you after you called me every name in the book and pulled out your IV for the third time in the past 4 hours because you didn't like that I still won't give you another dose of dilauded...and you're in the hospital because you're diabetic and morbidly obese.
I'm sure being an ER physician can handle the stress, because they aren't interacting with the patients like the nurses and techs interact with the patients. Have they ever had someone hit them because they didn't get their turkey sandwich fast enough? Spit in their face because they were made NPO? Pee on them on purpose? I sincerely doubt it. The scope of practice is entirely different. I think the nurses and techs do an incredible job of keeping it together and maintaining a friendly demeanor towards patients when they have to put up with these things. It's easy for you to say 'If you can't handle the stress, get training or change departments'. That's exactly the response that causes nursing to have such a high turnover and burnout rate.
No one is advocating for staff to be rude, I'm advocating, however, for better ratios for the nursing staff and more patient education on the other side of healthcare. And frankly, I think that sometimes, it should be okay for healthcare workers to interact with a patient like they are an asshole because THEY ARE. You'll get the same standard of care, but I'll be damned if I'm going to go to another floor to search for some ice cream for you after you called me every name in the book and pulled out your IV for the third time in the past 4 hours because you didn't like that I still won't give you another dose of dilauded...and you're in the hospital because you're diabetic and morbidly obese.
"And I know that you stated that you don't consider saying no to a low priority case as negative treatment, but again, I promise you, PLENTY of people do."
And I'm on the practitioner's side here. And yes I can see that this influences ratings. My quick one liner about evaluation of facility vs. independent doctor may be confusing in that the rest was not addressing evaluation but rather treatment of patients.
"Have they ever had someone hit them because they didn't get their turkey sandwich fast enough? Spit in their face because they were made NPO? Pee on them on purpose? I sincerely doubt it."
Yes and worse. But given that, I can certainly see that this is the status quo for nurses/techs and not for doctors so I can certainly sympathize. I'm not defending these actions.
"'If you can't handle the stress, get training or change departments'. That's exactly the response that causes nursing to have such a high turnover and burnout rate."
Yes, it is easy for me to say, but my ease by no means releases someone from their responsibility to control their emotions under stress. And I'd like to hear more about that being the reason for high turnover.
"I'm advocating ... more patient education on the other side of healthcare."
Ha! In the U.S. this is a lost cause. I do agree with you completely, but the system is set up in such a way that medical knowledge is abstracted away from normal life/people to a ridiculous degree. And both parties, the lay and the physicians, seem to prefer this. Incredible!
"And frankly, I think that sometimes, it should be okay for healthcare workers to interact with a patient like they are an asshole because THEY ARE."
('you' used in the third person below)
If that means reacting in kind then I disagree. If you're rude to a rude person then you're a rude person. If you decide that somehow a rude person deserves a lesser degree of care then you should get reacquainted with medical ethics.
You did add "You'll get the same standard of care." So the above is a general comment and not 'aimed' at you personally.
Assault = police.
And I'm on the practitioner's side here. And yes I can see that this influences ratings. My quick one liner about evaluation of facility vs. independent doctor may be confusing in that the rest was not addressing evaluation but rather treatment of patients.
"Have they ever had someone hit them because they didn't get their turkey sandwich fast enough? Spit in their face because they were made NPO? Pee on them on purpose? I sincerely doubt it."
Yes and worse. But given that, I can certainly see that this is the status quo for nurses/techs and not for doctors so I can certainly sympathize. I'm not defending these actions.
"'If you can't handle the stress, get training or change departments'. That's exactly the response that causes nursing to have such a high turnover and burnout rate."
Yes, it is easy for me to say, but my ease by no means releases someone from their responsibility to control their emotions under stress. And I'd like to hear more about that being the reason for high turnover.
"I'm advocating ... more patient education on the other side of healthcare."
Ha! In the U.S. this is a lost cause. I do agree with you completely, but the system is set up in such a way that medical knowledge is abstracted away from normal life/people to a ridiculous degree. And both parties, the lay and the physicians, seem to prefer this. Incredible!
"And frankly, I think that sometimes, it should be okay for healthcare workers to interact with a patient like they are an asshole because THEY ARE."
('you' used in the third person below)
If that means reacting in kind then I disagree. If you're rude to a rude person then you're a rude person. If you decide that somehow a rude person deserves a lesser degree of care then you should get reacquainted with medical ethics.
You did add "You'll get the same standard of care." So the above is a general comment and not 'aimed' at you personally.
Assault = police.
> And frankly, I think that sometimes, it should be okay for healthcare workers to interact with a patient like they are an asshole because THEY ARE.
Irritability is a part of suffering.
Irritability is a part of suffering.
I get and appreciate that, but I really don't think it's appropriate to hit someone over a turkey sandwich. If you're able to eat that and walk around on your own and watch the ball game, pretty sure your suffering isn't sufficient to warrant punching a nurse in the chest.
Fundamentally I believe non-consensual violence is the result of suffering. I think isolating violent people and protecting yourself is much better than meting out arbitrary punishments. Consider that someone willing to punch a nurse in the chest over a turkey sandwich very likely has some kind of mental health issues. If the assault is actually a problem on the level of a crime, then call the police.
Agreed with Ectoplasm here. My mother was a psych nurse and this was par for the course. She did not enjoy this part of the job.
The appropriate response to assault is getting police involved.
Try landing on a carrier, the pilots get graded on every single landing, in one of the most stressful environments out there.
They have Landing Signal Officers who make sure the pilot is safely on the glidepath, and in difficult conditions "sweet talk" the pilot with instructions [0]
If the LSO & Air Boss (in charge of the flight deck) and staff don't do their job, and a jet runs out of gas in the pattern they will have some major explaining to do. The officers involved will be called before a mishap board.
If a hospital ED patient flow was actually ran like the Air Boss runs the carrier deck, then things would go a lot smoother. An F/A-18 at landing weight ends up in the water if they have to wait more than about 30-45 minutes, unless refueled in the air.
The other thing to remember is that in major hospitals, the Trauma service and the Emergency Department have a separate patient flow. If someone is having a heart attack or serious injury, they will be handled by the trauma service. The nurses handling the ED are not treating immediately critical patients, except perhaps on initial triage.
Also, a "broken leg" can easily end up critical from puncturing the femoral artery if its not stabilized and/or the patient will go into shock, if not given appropriate pain meds.
I personally think that ED staff should be graded for QA of treatment and "Patient Interaction". Neither of which requires lengthy interaction with the patient, only maintaining standards. I'm not sure I'd apply the typically subjective Yelp standards to ED evaluation either.
[0] https://www.youtube.com/watch?v=sD_mUwzpUs4
They have Landing Signal Officers who make sure the pilot is safely on the glidepath, and in difficult conditions "sweet talk" the pilot with instructions [0]
If the LSO & Air Boss (in charge of the flight deck) and staff don't do their job, and a jet runs out of gas in the pattern they will have some major explaining to do. The officers involved will be called before a mishap board.
If a hospital ED patient flow was actually ran like the Air Boss runs the carrier deck, then things would go a lot smoother. An F/A-18 at landing weight ends up in the water if they have to wait more than about 30-45 minutes, unless refueled in the air.
The other thing to remember is that in major hospitals, the Trauma service and the Emergency Department have a separate patient flow. If someone is having a heart attack or serious injury, they will be handled by the trauma service. The nurses handling the ED are not treating immediately critical patients, except perhaps on initial triage.
Also, a "broken leg" can easily end up critical from puncturing the femoral artery if its not stabilized and/or the patient will go into shock, if not given appropriate pain meds.
I personally think that ED staff should be graded for QA of treatment and "Patient Interaction". Neither of which requires lengthy interaction with the patient, only maintaining standards. I'm not sure I'd apply the typically subjective Yelp standards to ED evaluation either.
[0] https://www.youtube.com/watch?v=sD_mUwzpUs4
I don't think that comparison is valid.
* On a carrier 100% of the people are well trained professionals. Not so in a hospital, were patients have never been trained to be good patients.
* Not only are people not trained to be patients, they are, especially in situations of distress, usually not helpful at all. As a rule, you do not trust a diagnosis provided by a patient (even if a doctor!) because the person might exhibit an acute stress reaction (https://en.wikipedia.org/wiki/Acute_stress_reaction) - avoiding this state by prior exposition is one of the reasons why pilots train emergency situations in flight simulators.
* Managing "hospital ED patient flow" is something that has improved a lot (see your example of direct transfer to trauma units), but it still is the attempt to manage the inherently unmanageable: On a carrier you know how many jets you have in the air and how long their fuel lasts and thus you can coordinate, in an ED you can only, if such a system exists in your region, have incoming ambulances diverted to other hospitals. But you still have no idea who will stumble through your door the next moment, brought by friends or taxis.
I am all for collecting data and applying metrics to make a process better, but there are some areas where the collection and evaluation should be done by professionals who understand what they are grading, not by amateurs who either entered that area involuntarily (actual emergencies) or who just try play the system for their own advantage (getting prescriptions).
* On a carrier 100% of the people are well trained professionals. Not so in a hospital, were patients have never been trained to be good patients.
* Not only are people not trained to be patients, they are, especially in situations of distress, usually not helpful at all. As a rule, you do not trust a diagnosis provided by a patient (even if a doctor!) because the person might exhibit an acute stress reaction (https://en.wikipedia.org/wiki/Acute_stress_reaction) - avoiding this state by prior exposition is one of the reasons why pilots train emergency situations in flight simulators.
* Managing "hospital ED patient flow" is something that has improved a lot (see your example of direct transfer to trauma units), but it still is the attempt to manage the inherently unmanageable: On a carrier you know how many jets you have in the air and how long their fuel lasts and thus you can coordinate, in an ED you can only, if such a system exists in your region, have incoming ambulances diverted to other hospitals. But you still have no idea who will stumble through your door the next moment, brought by friends or taxis.
I am all for collecting data and applying metrics to make a process better, but there are some areas where the collection and evaluation should be done by professionals who understand what they are grading, not by amateurs who either entered that area involuntarily (actual emergencies) or who just try play the system for their own advantage (getting prescriptions).
These are good points, but I feel like #1 and #2 contradict each other a bit. Yes, you don't give the slightest shit how friendly the ER staff is when you're having a heart attack or a stroke. And yes, if you come in with a broken leg, that's not nearly as urgent, so you shouldn't complain at waiting three hours because people with heart attacks and strokes are being seen first.
But on the other hand, the same thing that means you can wait three hours for a broken leg means that the friendliness of the staff becomes more important, and more feasible. If they're not treating you right away then they should at least be nice to you while you wait, possibly in agony.
Really, I think this illustrates that "the ER" is a little too general. There's good reason for that, of course. You want to have a one-stop shop available when something important happens. I think the proliferation of "urgent care" facilities is a response to this. People there will be less distracted by emergencies where seconds count, and be more able to give you better, or at least nicer, care for your broken leg.
But on the other hand, the same thing that means you can wait three hours for a broken leg means that the friendliness of the staff becomes more important, and more feasible. If they're not treating you right away then they should at least be nice to you while you wait, possibly in agony.
Really, I think this illustrates that "the ER" is a little too general. There's good reason for that, of course. You want to have a one-stop shop available when something important happens. I think the proliferation of "urgent care" facilities is a response to this. People there will be less distracted by emergencies where seconds count, and be more able to give you better, or at least nicer, care for your broken leg.
And that is indeed, the goal--Urgent Care unless you are actually having a heart attack or some such (or it's after hours). Emergency room is just that--for Emergencies.
It's going to take a massive public education campaign for this to switch--with the passage of EMTALA back in the 80s, people started treating the EDs as their PCPs, and somehow 'Emergency' became synonymous with 'Fast' care. I don't forsee the government undertaking this, nor do I see the payers (insurance companies) undertaking this, and providers don't necessarily have the time. This also assumes the public is receptive to this kind of education.
The healthcare delivery system is incredibly ripe for disruption.
It's going to take a massive public education campaign for this to switch--with the passage of EMTALA back in the 80s, people started treating the EDs as their PCPs, and somehow 'Emergency' became synonymous with 'Fast' care. I don't forsee the government undertaking this, nor do I see the payers (insurance companies) undertaking this, and providers don't necessarily have the time. This also assumes the public is receptive to this kind of education.
The healthcare delivery system is incredibly ripe for disruption.
Why wouldn't the insurance companies do it? Surely getting more of their customers into urgent care instead of ERs would reduce their costs.
why would the insurance companies want that? Lower costs means lower revenue over the long term. Given that they are effectively capped at a maximum profit margin, they can't make up for this with increased profitability. It's part of why healthcare operates so differently from everytihng else.
If they have time to be friendly, perhaps they aren't so overworked and can really treat you more effectively. It sounds like an indicator of better treatment.
If doctors are always rushed off their feet, that's probably not an ideal hospital to be in. It sounds like mismanagement. We wouldn't accept it in most other industries.
If doctors are always rushed off their feet, that's probably not an ideal hospital to be in. It sounds like mismanagement. We wouldn't accept it in most other industries.
It's not mismanagement. It's a matter of applying business concepts of productivity to the healthcare setting.
Ex: In business, if Joe the factory worker can make 100 widgets in an hour, and Mike can make 150 in an hour, with the same number of defects, Mike is more productive than Joe.
So now let's apply this to the ED: If Joe the nurse can discharge or admit 10 patients in an hour, and Mike can admit or discharge 15 in an hour, Mike is more productive, right? Well, no, because maybe Mike had patients that were triaged as low priority, but Joe was working Level 1 trauma side. Or you have patients presenting with the same things, but one is a healthy 30 year old and another is 80-something with multiple comorbidities.
I've seen Baumol's Cost Disease used to explain why we see the healthcare industry grappling with rapidly increasing costs, especially wage costs: because we can't measure productivity. I'd argue, from what I've seen, that in fact, that's not true. I even came up with a formula to measure nursing staff productivity relative to patient acuity levels, but never had any buyers. Why? You start getting into questions about actual patients that no one wants to answer, because they're uncomfortable ethical questions, and reimbursements will drop regardless of the answers.
Being treated effectively at this point is being treated as a human, and either bringing the disease under control, or getting rid of the disease. We need to undersand that although these healthcare workers are in caring professions, their work is being increasingly shifted from what we all think effective treatement should be, to what the business thinks effective treatment should be (read: profitable).
You do accept this kind of rushing in other industries, because you believe in productivity. And that's fine. It's also fine to believe in productivity in healthcare (I do), but not in the patients/hour concept. As a country, we need to change this model. I'd encourage you to advocate for safer staffing ratios, at a minimum, for nurses and doctors.
Ex: In business, if Joe the factory worker can make 100 widgets in an hour, and Mike can make 150 in an hour, with the same number of defects, Mike is more productive than Joe.
So now let's apply this to the ED: If Joe the nurse can discharge or admit 10 patients in an hour, and Mike can admit or discharge 15 in an hour, Mike is more productive, right? Well, no, because maybe Mike had patients that were triaged as low priority, but Joe was working Level 1 trauma side. Or you have patients presenting with the same things, but one is a healthy 30 year old and another is 80-something with multiple comorbidities.
I've seen Baumol's Cost Disease used to explain why we see the healthcare industry grappling with rapidly increasing costs, especially wage costs: because we can't measure productivity. I'd argue, from what I've seen, that in fact, that's not true. I even came up with a formula to measure nursing staff productivity relative to patient acuity levels, but never had any buyers. Why? You start getting into questions about actual patients that no one wants to answer, because they're uncomfortable ethical questions, and reimbursements will drop regardless of the answers.
Being treated effectively at this point is being treated as a human, and either bringing the disease under control, or getting rid of the disease. We need to undersand that although these healthcare workers are in caring professions, their work is being increasingly shifted from what we all think effective treatement should be, to what the business thinks effective treatment should be (read: profitable).
You do accept this kind of rushing in other industries, because you believe in productivity. And that's fine. It's also fine to believe in productivity in healthcare (I do), but not in the patients/hour concept. As a country, we need to change this model. I'd encourage you to advocate for safer staffing ratios, at a minimum, for nurses and doctors.
I have no problem slapping faces of healthcare professionals.
"The more people they treat, the more experienced they are." - I've been playing golf for 20+ years and often get beat by 15 year olds
"The more people they treat, the more experienced they are." - I've been playing golf for 20+ years and often get beat by 15 year olds
Except for, a healthcare professional playing golf cannot cause nearly as much harm as a golf player playing healthcare professional.
Emergency Departments don't run on a "first come, first served" basis. Triage will assess how critical your condition is and use that to determine how fast you can be seen, in relation to how many other critical patients are already in the unit.
If you show up with complaints of chest pain, you get an EKG right away. If that doesn't reveal any impending doom, you may sit in the waiting room for a while.
If your situation is deemed life threatening and the unit is full, they WILL MAKE room for you. Conversely, if you're only in low or mild pain and you're at the ED simply because it's 2am and Urgent Care is closed, your waiting time will be high.
I've seen a few hospitals advertise ED waiting times but they tend to cater to populations who use the ED like an after-hours Urgent Care department.
If you show up with complaints of chest pain, you get an EKG right away. If that doesn't reveal any impending doom, you may sit in the waiting room for a while.
If your situation is deemed life threatening and the unit is full, they WILL MAKE room for you. Conversely, if you're only in low or mild pain and you're at the ED simply because it's 2am and Urgent Care is closed, your waiting time will be high.
I've seen a few hospitals advertise ED waiting times but they tend to cater to populations who use the ED like an after-hours Urgent Care department.
Do people really check Yelp for hospital reviews? I live in a reasonably rural area, but even we have a couple of hospitals within reach. It never really occurred to me to not go to the nearest one for emergencies. I couldn't imagine a deep gash in my leg or my child screaming and me on my phone looking up hospitals.
Although then again, I suppose the argument will then become that I can ask Siri for the closest hospital (travel time) with the shortest wait time total.
Although then again, I suppose the argument will then become that I can ask Siri for the closest hospital (travel time) with the shortest wait time total.
Well, I have currently 4 large hospital centers within of a few km of me and a few doctors that also provide emergency care, but while one of the hospitals has amazing healthcare in all areas, they have long wait times. Another has better care for broken bones, but they have far worse methods for treating neurological issues, etc.
So, depending on what happens, I’ll go to different places, no matter the distance.
So, depending on what happens, I’ll go to different places, no matter the distance.
You could also regularly check Yelp and put a post-it on the fridge (or even a marker on your GPS app/device) with the current best. If the difference in distance wasn't particularly great, I'd consider doing so.
And make sure the ones on your list are in-network...
I doubt most people prepare to this degree though. And having the convenience of finding the best ER that services your health insurance close by is probably of high value.
I doubt most people prepare to this degree though. And having the convenience of finding the best ER that services your health insurance close by is probably of high value.
I doubt most people prepare to this degree though.
Well, Yelp could send that suggestion to its users. It'd be a good excuse to get them to login again.
Well, Yelp could send that suggestion to its users. It'd be a good excuse to get them to login again.
Maybe not relevant to check in an actual emergency, but I would certainly check just for the sake of checking to get an idea of the best ER's to go to should there in fact be an emergency.
While I don't use Yelp a lot at home, I find it indispensable when traveling.
While I don't use Yelp a lot at home, I find it indispensable when traveling.
People go to hospitals for non-emergencies as well: like for instance breaking your collarbone or getting bit an animal.
The real problem is data quality:
1) hospitals get rated on 'door to doc' time, so they tie part of compensation to this metric. It is measured based on the time when the doc clicks on your name in the computer, which is of course, not the same as when they actually see you, they might physically see you an hour later.
2) Some hospitals have a doc see you in triage. This is great for the hospital's wait time numbers, but they are not going to be responsible for the whole of your care. They usually just order some medications or tests, then you wait for the 'real' doctor to see you, which might take another hour or two. If there is going to be a wait, doing things this way is not necessarily a bad thing, and probably does shorten your overall 'door-to-discharge' time by doing some of the steps in the process in parallel, but the point is that the 'wait time' alone is almost meaningless.
3) the times listed are average times over one year, whereas what you need to make decisions on are realtime wait times
Online reviews of doctors are already useless. People rate their "experience", rather than actual effectiveness.
Tons of reviews about bad docs that turn out to be hurt feelings of the morbidly obese when told to diet. Especially women at OBGYNs, which is telling as the US has a fast growing rate of deaths of mothers during child birth - completely driven by obesity (heart failure, etc.).
doc didn't give the me wonder drug advertised on tv, therefore one star.
Tons of reviews about bad docs that turn out to be hurt feelings of the morbidly obese when told to diet. Especially women at OBGYNs, which is telling as the US has a fast growing rate of deaths of mothers during child birth - completely driven by obesity (heart failure, etc.).
doc didn't give the me wonder drug advertised on tv, therefore one star.
> People rate their "experience", rather than actual effectiveness.
Most people have absolutely no idea what effectiveness is.
I read the post-mortem written by a founder of a effectiveness-comparison company, and their market research eventually found out (too late, because otherwise they would never have started the company) that people didn't really want it. They wanted to feel like they were being treated well and were high-status and could have someone to blame if things didn't work out. Taking the path of best expected results wasn't really on customer radar.
Most people have absolutely no idea what effectiveness is.
I read the post-mortem written by a founder of a effectiveness-comparison company, and their market research eventually found out (too late, because otherwise they would never have started the company) that people didn't really want it. They wanted to feel like they were being treated well and were high-status and could have someone to blame if things didn't work out. Taking the path of best expected results wasn't really on customer radar.
We ran surveys on our patients for 3-4 years. Turns out that, by far, the biggest variable in assessing EVERYTHING about us was the wait time. Short wait time, they loved us (99% in national rankings). Long wait times, patients said we were rude, had ugly facilities, they had bad outcomes, etc.
If you're in the UK: Your local health community probably has some useful information that will help you avoid going to A&E units if you don't need to.
Here's the page for Gloucestershire: http://www.asapglos.nhs.uk/
Here's the page for Gloucestershire: http://www.asapglos.nhs.uk/
My experience with anything like that has been dreadful. If it seems like an emergency, run a mile from things like NHS Direct - the worst case was calling about our then 8 month old having trouble breathing, and being told a doctor would contact us within an hour. 18 hours, and an ambulance trip to A&E later, we had a call from the doctor's receptionist asking if we'd been seen.
Yes, in an emergency go direct to A&E or call an ambulance. The asapglos website and app give some advice about when to got to A&E or call an ambulance.
I'm sorry you had such a terrible experience for something so serious.
I'm sorry you had such a terrible experience for something so serious.
NHS isn't perfect, but it did used to be a lot better
Care is so varied between areas it's crazy. Hopefully it can be sorted out and kept in government hands :(
Care is so varied between areas it's crazy. Hopefully it can be sorted out and kept in government hands :(
I strongly recommend people avoid hospital ERs for anything but a true life threatening emergency. If you break your foot/arm or something go to an urgent care place that is 24x7, it will be way cheaper and basically the same care. Hospitals are a scam.
It sucks to get judged based on things that you have little or no control over. An ER nurse or doctor cannot control staffing levels for instance. I get that.
But, if one emergency room has shorter wait times (because the staff aren't spread as thin) than another, why shouldn't I take that into account when choosing where to go?
But, if one emergency room has shorter wait times (because the staff aren't spread as thin) than another, why shouldn't I take that into account when choosing where to go?
How will they avoid sampling bias by getting reviews from the ones who died?
They could encourage people to leave 0 star reviews and update them if they survive.
Yelp is fucked; they don't seem to have innovated in years and they've been riding on the whole reviews for restaurants for a while. Expanding into healthcare doesn't make sense unless they split it out as a separate web site or app; Yelp is for restaurant reviews, this only dilutes their brand.
This is mildly infuriating. Maybe it's different outside the small towns and rural areas I grew up in, but there I would be comfortable wagering the majority of the people visiting the ER are there to get pills.
I broke my leg from a rock climbing fall and was taken to a hospital in Tullahoma, TN. The fracture was difficult to see on the x-ray and the ER doc thought I just had a aprain. While filling out my paperwork, he asked me what kind of pain medication I wanted. When I told him I didn't want anything, he jerked to a stop and looked up at me when an incredulous look.
While in college at Johnson City, TN, I ran into a wall head-first diving for a basketball in a pickup game. My buddy took me to the ER to have them check on the concussion I had, and while we waited, someone walked in, asked what the wait time was, said, "that's too long and we'll be back later," and left. They got us into triage quickly, but we ended up waiting several hours (with a lot of folks in the ER clearly there to get pills) before my friend told the receptionists that we weren't there to get drugs, we just wanted to have them check to make sure my brain was okay. Within a matter of minutes they had me back to radiology and out the door shortly thereafter.
I broke my leg from a rock climbing fall and was taken to a hospital in Tullahoma, TN. The fracture was difficult to see on the x-ray and the ER doc thought I just had a aprain. While filling out my paperwork, he asked me what kind of pain medication I wanted. When I told him I didn't want anything, he jerked to a stop and looked up at me when an incredulous look.
While in college at Johnson City, TN, I ran into a wall head-first diving for a basketball in a pickup game. My buddy took me to the ER to have them check on the concussion I had, and while we waited, someone walked in, asked what the wait time was, said, "that's too long and we'll be back later," and left. They got us into triage quickly, but we ended up waiting several hours (with a lot of folks in the ER clearly there to get pills) before my friend told the receptionists that we weren't there to get drugs, we just wanted to have them check to make sure my brain was okay. Within a matter of minutes they had me back to radiology and out the door shortly thereafter.
How are you establishing that people are "just there to get pills"?
* How friendly the staff is is absolutely irrelevant when you have a medical emergency. In normal hospital settings, in most countries, what buys you "friendly staff" is paying a premium that allows the staff to actually have enough time to pity you. A nurse who only tends 3 patients can do that, a nurse who has to tend 30 cannot.
* Wait times in ERs depend on the severity of your condition in relation to what other patients have to deal with. Most urgent comes first. A broken leg hurts but it won't kill you no matter how much you moan. The unconscious guy with rapid blood loss would be dead if they prioritized patients according to some fifo or loudest moaner first scheme.
* I'd always chose the bigger ER over a smaller one: The more people they treat, the more experienced they are. Same is true for non-emergency hospitalizations.
The Spudd recently had a great comment on "educated" patients: http://thespudd.com/hospital-to-replace-doctors-with-parents...