Jacksonville ER patients wait 41 minutes on average
By Derek Gilliam, The Florida Times-Union
Emergency rooms fill with anxious people waiting to see a doctor for broken bones, bleeding gashes, fevers and chills. In Jacksonville, patients wait on average 41 minutes before receiving care in an emergency room, according to the Centers for Medicaid and Medicare Services.
UF Health Jacksonville, formerly Shands Jacksonville, has the fifth-longest wait time in the state at 78 minutes.
The federal government calculates wait times from when patients enter the hospital until they are seen by a qualified medical practitioner.
Russ Armistead is the chief executive officer at UF Health, Jacksonville’s level-one trauma center. Armistead attributes the over-an-hour wait time to a disproportionate number of charity and Medicaid patients.
Also, parts of the emergency department are out of date with today’s standards, he said. A floor is undergoing renovations at a cost of about $5 million, and another floor needs similar renovations.
He said he’s unsure of where the next $5 million will come from as the hospital stands on a shaky financial foundation as many patients at UF Health Jacksonville don’t pay anything and Medicaid pays little.
“We are just at razor’s edge with very little financial backup,” he said.
The city offsets some of the cost of indigent care with about $26 million in funding. However, the hospital spent about $60 million in free services last year alone, Armistead said.
“We [Jacksonville’s emergency hospitals] are one of the places where people come when they don’t have money,” he said.
After a Medicaid or indigent care patient has been treated for emergency care, Armistead said it’s almost impossible for the hospital to send them to a non-emergency care facility.
As beds are filled with patients who no longer need emergency care, people waiting to see a doctor wait for a bed to empty.
“We have a really difficult time getting them out of the hospital because nobody else wants to take them because they don’t have any money, and if they take them, they are responsible for their care,” he said.
ProPublica.org, a nonprofit investigative news organization, pulled data from the Centers for Medicaid and Medicare Services for hospitals across the country and compiled it in a searchable, online database.
The information was gathered by the federal government starting in April 2012 and ending March 31, 2013.
Lena Groeger, designer and developer of the online database, said the news organization took on the project to generate public discussion about emergency room care. The organization’s headquarters is in Manhattan, N.Y. Because of long wait times at emergency departments there, it was faster for some New Yorkers to travel to New Jersey when a medical emergency struck, she said.
Type Jacksonville into the database and it provides a list of nearby hospitals, current drive times, average wait times and the percentage of patients that would “definitely recommend” the hospital.
Groeger warned the database shouldn’t necessarily be used in all cases. Emergency room wait times are averages, and when patients show severe symptoms, they are bumped to the front of the line.
“If you are having a heart attack or other life-threatening emergencies, you shouldn’t use the app,” she said.
The database can be found at projects.propublica.org/emergency.
Fred Jenkins, Memorial Hospital’s medical director of the emergency room, said administrators have focused on improving wait times.
The severity of a patient’s condition can be subtle, he said.
“By getting a provider in front of the patient as quickly as possible, there’s a potential for picking up on very serious conditions sooner than later,” Jenkins said.
Memorial has the fastest wait time in Jacksonville at 20 minutes.
“We constantly work to improve and make that happen,” he said.
Eleanor Lynch, Memorial’s senior vice president of operations, said a patient’s symptoms, availability of beds, staffing levels and efficiency of hospital processes typically drive wait times.
Amy Riley, Memorial’s director of emergency services, said the hospital drove down its wait times by eliminating waste and changing the culture. She said the culture change wasn’t just in the emergency department but the entire hospital.
“Process improvement is something that can yield meaningful results,” Jenkins said. “Our times look dramatically different than they did five years ago.”
Michael Aubin, president at Wolfson Children’s Hospital, said children’s fast metabolic systems mean mild symptoms can quickly progress to severe.
For instance, flulike symptoms that start with a runny nose can progress to respiratory distress to respiratory failure in a matter of hours.
Wolfson’s wait-time information wasn’t on the ProPublica.org database, but Aubin said the emergency room averages 34 minutes.
That wait time is achieved by fast tracking the sickest patients and focusing on processes that can be sped up by improving in all other areas of service. By improving other areas in the hospital, patients can be seen faster and others can then use the rooms, Aubin said.
Still, the focus is on the quality of care, not the expedience of care, he said.
“We don’t want to sacrifice quality for speed,” Aubin said.
Darin Roark, administrator for Baptist Clay and the emergency service line for all of Baptist Health’s hospitals, said Baptist Medical Center in Jacksonville has already improved its average wait time from the 54 minutes in March to about 35 now.
“We have been working all year to put in some performance improvement initiatives,” he said. “We have been able to substantially reduce that wait time [54 minutes].”
Roark said every patient seen in an emergency room at a Baptist hospital is guaranteed to see an actual medical doctor, unlike some of the hospital’s competitors that use nurse practitioners and physician assistants. He said this contributes to longer wait times.
Baptist Health uses historical data to create a model that it uses to guide staffing levels at its hospitals, he said.
But like other hospitals in the area, Roark said Baptist focuses on process efficiencies.
“We try to look at all those process efficiencies whereby we can shorten that length of stay thereby we can increase our supply of rooms available so that we can then meet demand as demand changes,” he said.
Still, Roark pointed out that wait times are an average and when 30 patients present needing emergency care, all averages can go out the window.
“When patients arrive in an unpredictable pattern, it certainly can challenge our resources,” he said. “And it’s what any emergency department struggles with.”
Kyle Sanders, president at St. Vincent’s Medical Center Southside, said both the Riverside and Southside hospitals have focused on improving their wait times by not only performance improvement initiatives, but with a website that lets patients wait at home.
WaitathomeER.com allows a patient to see when St. Vincent’s hospitals have an available appointment and gives a time when they should arrive.
Sanders said people who use the website wait on average about 15 minutes before seeing a physician. The program has a 90 percent recommend rate, and 51 percent of users sign in with a mobile device.
“We want to make sure we eliminate the time that a patient waits to as close to zero as we can,” Sanders said.
If something changes the next available appointment time, the patient is sent a notification and a new time they should plan on arriving.
“The beauty of it is they can wait at home,” he said.