Doctors, hospitals trying to shorten patients' long wait

Sunday, November 5, 2006

By LINDSEY TANNER

The Associated Press

CHICAGO -- Time seems to pass at an excruciatingly slow pace when you're waiting for medical care.

Whether it's emergency room treatment, routine doctor's appointments, or those anxious days between getting poked and prodded for medical tests and receiving the results, waiting happens to just about everyone seeking medical care.

After years of overcrowding, overbooking and angry patient complaints, many hospitals and doctors' offices are finally doing something about those waits:

Providing test results quickly onsite or online. Offering same-day exams to patients who call early. Speeding up emergency-room triage. And offering restaurant-style pagers so not-so-sick patients don't feel stuck in a crowded waiting room.

Shortening waiting times is part of a nationwide move toward empowering patients, reducing medical errors and improving health care.

Emergency waits

An Institute of Medicine report on the crisis in U.S. emergency care detailed trends that have contributed to long emergency room waits, including increased demand, staff shortages and hospital closings.

Between 1993 and 2003, the number of U.S. emergency departments fell by about 425, or about 12 percent, while the number of patients seeking ER care jumped 26 percent to 114 million. They include uninsured or underinsured patients and those who seek emergency care for non-emergencies because they have no regular doctor.

Many hospitals are creating "fast-track" programs for these patients who will not require hospitalization and who tend to wait the longest for emergency care.

Montefiore Medical Center in New York City spent at least $35 million in the past five years on ER improvements, including a fast-track program that has cut average arrival-to-discharge times for less serious cases from about six hours to two.

Changes included hiring about 50 additional emergency room doctors and building a separate area for fast-track cases.

Silver Cross Hospital in Joliet, Ill., gives out restaurant-style pagers that allow patients awaiting care to grab a bite in the hospital cafeteria or just get some fresh air.

Nonemergency waits

Waits for routine exams often are due to overbooking. That happens partly because under many health insurance reimbursement systems, doctors are paid by volume.

The American College of Physicians, which represents about 120,000 internists and other doctors, issued a policy statement earlier this year advocating changes to help address the waiting problem.

Recommendations include insurance reimbursement for less traditional patient visits, such as telephone and e-mail consultations to give patients speedier access to doctors.

The group also supports "open-access" scheduling, in which doctors reserve up to 70 percent of their daily schedules for patients who call early for same-day appointments.

Awaiting test results

At Boston's Beth Israel Deaconess Medical Center, patients can get test results electronically the same time as the doctor through a private online account called PatientSite.

"There is no waiting for paper printouts to arrive by mail," said Dr. John Halamka.

All test results show up on the site, except those for cancer or HIV, "assuming that this news should be delivered in person," he said.

With mammograms, research has shown that having a radiologist read the breast cancer scans immediately and give results during the appointment reduces women's anxiety.

But many physicians think the conventional method is more efficient, having technicians perform dozens of routine screenings daily, piling up X-ray images that a radiologist reads later in bulk. Patients get the results days or weeks later.

Also, malpractice concerns and low insurance reimbursements for mammograms have led to radiologist shortages in some places, and not all centers are equipped to offer same-day results for routine exams.

But Faulkner Hospital's breast center in Boston is, with three radiologists reading mammograms full-time and a computer-assisted system that helps identify X-ray abnormalities.

Dr. Norman Sadowsky, a radiologist who helped create the program more than 30 years ago, said he's given talks around the country promoting the same-day service but few centers have followed suit.

"This is the most anxiety-producing routine exam," Sadowsky said. "You come in and you worry, and you worry until you get an answer.

"If we can get the patient an answer before she leaves, that's the way to do it. You get a lot of kisses" instead of complaints, he said.


On the Net:

Institute for Healthcare Improvement: http://www.ihi.org

American College of Physicians: http://www.acponline.org

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