Spotsy Regional ER is tops in wait-time survey

BY JIM HALL

If you want to be seen quickly when you go to the emergency room, try the Spotsylvania Regional Medical Center and go in the morning.

The Spotsylvania County hospital had the quickest wait times during a recent weeklong survey by The Free Lance–Star. And like the other emergency departments in the region, its times were faster in the morning than later in the day.

The Free Lance–Star recorded wait times at regular intervals for all four area emergency rooms. The survey spanned seven consecutive days in late May and included Spotsylvania Regional, Mary Washington Hospital, Stafford Hospital and the Emergency Department at Lee’s Hill.

The wait times used were those published on the hospitals’ websites. All four ERs publish “door-to-doc” times, or the wait from the patient’s arrival to being seen by a doctor, physician’s assistant or nurse practitioner.

The survey found that:

–Spotsylvania Regional was the quickest of the local ERs during the study period. Of the six daily time periods checked, its average wait times were first five times and second once.

–Lee’s Hill was second. Its average times were first once and second three times.

Stafford Hospital was third. Its average times were second twice.

–Mary Washington Hospital had the longest waits. Its average times were slowest for four of the six time periods checked.

The newspaper’s survey also showed that wait times at all four ERs were better than the national average.

“What is considered a very good door-to-doc time is 30 minutes. The average is usually an hour or more,” said Dr. Howard Mell, spokesman for the American College of Emergency Physicians and director of the emergency department at TriPoint Medical Center near Cleveland.

The survey also confirmed what hospital officials across the country have learned about running an emergency department:

–Life in an ER gets more complex as the day wears on.

–Patient volume begins to grow around lunchtime and continues to increase throughout the evening, said Dr. Jody Crane, one of the physician leaders at Fredericksburg Emergency Medical Alliance, the physician group that staffs Mary Washington’s three emergency departments.

Soon, patients are “boarding” in the ER, waiting to be admitted to rooms upstairs. As a result, door-to-doc times increase.

“Most days, if you walk into an emergency department anywhere in the country at 7 a.m., at the start of the day shift, you’re as good as you’re going to look all day,” Mell said.

At Spotsylvania Regional, a patient who arrived on Monday morning during the study period waited 10 minutes to be seen by a provider. Later that same day, the wait was 71 minutes.

For all four ERs, the average wait time during the survey period jumped by 50 percent between noon and 3 p.m. and continued climbing until midnight.

“ERs are busiest right after school lets out with our children, and after work hours for our adults,” said Nancy Littlefield, chief nursing officer at Spotsylvania Regional.

–ERs are walk-in rather than appointment-based businesses.

ER workers have no idea how many people will come through the door or how sick they’ll be, Crane said.

During the study period, a patient who arrived at Stafford Hospital at 6 p.m. Monday waited 96 minutes to be seen. At 6 p.m. Friday, four days later, the wait was 10 minutes.

“We can accurately predict what a month is going to look like. It’s very hard to predict what tomorrow is going to look like,” Crane said.

–Busier hospitals tend to have longer wait times than hospitals that are not as busy.

Mary Washington, which had the slowest ER during the study, treats 70,000 patients a year, Crane said. This compares with 38,000 for Stafford; 38,000 for Spotsylvania Regional and 20,000 for Lee’s Hill.

“It’s a ripple effect,” Crane said. “As volume increases, your beds tend to be more congested, and you don’t have anywhere to put patients when they arrive.”

In addition, Mary Washington treats sicker patients than the other three emergency departments and admits a higher percentage for overnight stays, Crane said.

“These patients occupy nursing, doctor and bed resources,” Crane said.

Though there is disagreement on which measure to use, officials agree that wait times matter.

Mell, the spokesman for the American College of Emergency Physicians, said the door-to-doc time can be a “marketing gimmick” that hospitals manipulate by placing a doctor at the ER entrance to greet patients. Mell said he prefers length-of-stay as a better measure of an ER’s efficiency.

“How fast do you get me out?” he said.

Littlefield said that short wait times at the start of a patient’s visit increase satisfaction and reduce the chance of error.

In addition, long waits also can affect a patient’s health, as serious problems go untreated. Patients also may get tired of waiting and leave the hospital.

“Making somebody wait is disrespectful,” Littlefield added. “It’s a culture of respecting someone’s value.”

HOW WE DID THE SURVEY

The Free Lance–Star collected wait times from the websites operated by Mary Washington Healthcare and the Spotsylvania Regional Medical Center.

Kay Pollock, a retired database developer at Dahlgren, recorded the times at the request of the paper. She received no payment.

“I love numbers,” she said.

Pollock, 75, is a resident of Stafford County and has lived in the area since 1981. She is a member of Life Preservers, a community circle at the Unitarian Universalist Fellowship of Fredericksburg. The group focuses on health care and end-of-life issues.

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Her experiences inside a hospital include the births of her three children and knee-replacement surgeries.

The survey covered Sunday, May 20, through Saturday, May 26.

Pollock used her home computer and iPhone to check the websites six times a day at the same time each day. She checked at 9 a.m., noon, 3 p.m., 6 p.m., 9 p.m. and midnight.

The two hospital companies calculate their wait times in the same way. The times are rolling four-hour averages, updated every 30 minutes.

The wait is defined as the time from arrival (Spotsylvania Regional) or registration (Mary Washington) until the time the patient is seen by a doctor, physician’s assistant or nurse practitioner.

Mary Washington says that registration occurs when patients arrive at the ER and are handed a form to fill out. When they return those forms to the front counter, the wait clock begins.

The survey was limited since it looked at only one week, a small slice of the total time that the ERs were open.

Also, the survey did not take into account the number of patients seen, how ill those patients were, the number of patients admitted for overnight stays, or the number of ER workers on duty. All of those factors can affect wait times.

—Jim Hall

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