If you have reason to go to a Susquehanna Valley area hospital for emergency treatment, the odds are you will wait less time now than you would have a year ago.
Local hospital administrators, physicians and nurses are working on reducing patient wait times in their hospital emergency departments and clinics by hiring more physicians and changing the way patients are treated.
According to the most recent national data set from the U.S. Centers for Medicare and Medicaid Services (CMS) — from October 2015 through Sept. 2016 — the average wait time for patients to see a doctor in the E.R. at Sunbury Community Hospital was 25 minutes, and at Geisinger Medical Center, Danville, 21 minutes. For the entire Geisinger system, the average wait time from walking in the door to seeing a doctor was 32 minutes. At Evangelical Community Hospital, Lewisburg, the wait time was 37 minutes.
At UPMC East, in Monroeville, near Pittsburgh, the wait time before seeing a doctor in the 2015-2016 period was 13 minutes. At 156 beds, UPMC (University of Pittsburgh Medical Center) East is close in size to the 118-bed Sunbury Community Hospital, which UPMC Susquehanna purchased this year. The change in ownership became official today.
For 2017, Evangelical's emergency room wait time from door to doctor was up to 43 minutes, Geisinger's was 16 and Sunbury's had ticked slightly higher to 29 minutes, according to officials from each of the area hospitals. CMS has not released data for 2016-17, but it will be available at data.medicare.gov. UPMC East's current wait time numbers were unavailable.
To help speed up the process, facilities are bringing more employees on board. In the past three years, Geisinger has hired 15 board certified emergency medicine physicians in its hospitals in Danville, Shamokin and Bloomsburg and 21 across the Geisinger system, said Andrea Wary, Geisinger's associate vice president, emergency medicine. Evangelical has added seven ER staffers, including three physicians.
Evangelical President and Chief Executive Officer Kendra Aucker said the hospital triages patients in the E.R. to prioritize them. But if someone is waiting there wondering why it may be taking a little longer, they may not have seen the ambulance pull in with the heart attack patient.
"People have to be understanding," Aucker said. "They can't always see what is happening in the back."
She said the hospital formed a "throughput committee" aimed at studying the flow of patients and also added staff.
"We've seen a 50 percent decrease in the times from the door to a licensed provider," Wary said.
Geisinger also boosts staffing levels for busier times of day and night and employs Rapid Assessment Units that include a physician, physician assistant or practical nurse to evaluate less serious injuries or illnesses.
Wary said when there is improved access to other facilities, there are fewer visits to the E.R. Besides seeing physicians in one of Geisinger's many clinics, patients also can seek treatment in Geisinger's Careworks urgent care facilities, even registering online and showing up at a specified time.
Meanwhile, a 2017 national survey shows the time it takes to schedule a new patient appointment with a physician has increased by 30 percent in some parts of the country.
In the past year, Evangelical has added three new emergency department physicians for a total of 16; three new E.D. mid-level staff, such as physician assistants, for a total of nine, and four new nurses in the department, for a total of 56, according to figures provided by Deanna Hollenbach, the hospital's public relations and communications manager.
Eliminate wait times
Sunbury Community Hospital pledges to get the emergency room patient in to see a medical professional in 30 minutes.
The average wait time in the emergency department is 29 minutes and wait times in the clinic are on average less than 10 minutes, said Emergency Department Director Lynn Taggart.
"We have not seen a fluctuation in wait times over 2016," according to Taggart. The hospital's average wait time was down to 25 minutes in 2015, according to the CMS figures.
The goal of reducing wait times was thrust into the spotlight in December, when Geisinger President and Chief Executive Officer David Feinberg wrote on social media of his health system's intentions to not only improve its waiting time for patients, but to bring the wait time down to zero minutes by 2019.
"Personally, I'd like to eliminate the waiting room and everything it represents," Feinberg wrote. "A waiting room means we're provider-centered — it means the doctor is the most important person and everyone is on their own time. We build up inventory for that doctor — that is, the patients sitting in the waiting room."
Across all of its emergency rooms, Geisinger gets 250,000 visits annually and 47,000 at the Danville hospital, according to hospital spokesman Joseph Stender. Evangelical Community Hospital in Lewisburg saw more than 31,500 patients in its E.R. last fiscal year, and Sunbury Community Hospital sees close to 15,000 per year, hospital officials said.
"We've begun the process of looking at inpatient flow to admitting wards to get them up to the floors quicker," said Dr. Edward Hartle, chair of Geisinger’s Institute of Medicine. "We have seen improvements in wait times, particularly in the population of patients less critically ill."
"It's imperative on our part to provide them access," Hartle added. "We are working to get us to that point."
Taggart said the Sunbury hospital always strives to improve the patient experience and is always reviewing its processes, including analyzing patient data trends that show a typical patient experience, from entering the emergency department, to being admitted as an inpatient and to the time of the patient’s discharge.
"We work diligently so that patients are seen by a medical professional within 30 minutes of entering our emergency department," she said.
Waiting in line
As part of The Daily Item's reporting for this story, a question was posted on the newspaper's Facebook site asking readers how long they have had to wait in a hospital emergency room and how far in advance they have had to schedule a doctor’s appointment.
Ashley McCullough, of Sunbury, responded that the longest she's waited in an emergency room was 6 hours, at Geisinger Medical Center in Danville.
"My sister had waited so long once that she just left without being seen," McCullough, who's 21, wrote. "This was after 2-plus hours."
Gail Carr Freese, of Danville, said she waited four months to see a specialist at GMC and then, "I couldn't get a follow up appointment for 7 months."
Terry Laurie Schindler, of Sunbury, said she could usually see her family doctor the same day. "Evangelical usually less than 1.5 hours. Geisinger over 6 hours because they are a trauma center," she commented.
Shawnee Perchinski, 24, of Sunbury, wrote, "At family practice center in Selinsgrove I can call the same day and usually get in, if not the first appointment the next day! At Geisinger ER I've been in shortly after arriving, Sunbury ER it's been hours of waiting time past and present."
Area health care officials are hoping to make the positives the most common experience.
"We've been focused on this," Evangelical's Aucker said. "Last year, we added urgent care, Monday to Friday, 12 hours a day, 8 hours on the weekend. We will be increasing that to 12."
She and other hospital administrators have said that urgent care centers take some of the pressure off of emergency departments when patients with less-serious ailments go to the centers for treatment.
Taggart said Sunbury's clinic wait times are, on average, less than 10 minutes.
Close to averages
According to data collected by CMS, Geisinger Medical Center's patients' average emergency department wait time to see a doctor in 2015-16 was 25 minutes, a minute below the state and national averages. But the average time before being sent home from the ER was 3 hours, slightly longer than the state and national averages for similar sized and staffed emergency departments. Additionally, the time waiting before admission to the hospital was just over 6 hours, more than an hour longer than the state and national standards for comparable sized and staffed emergency rooms.
According to Geisinger figures, the average wait time between arrival and physician contact went from 32 minutes in 2015 to 15 minutes in 2017 for the Geisinger system, and from 21 minutes in 2015 to 16 minutes in 2017 for Geisinger Medical Center, according to figures provided by Geisinger.
Evangelical Community Hospital's average initial wait time between 2015 and 2016 was 37 minutes, but in the 2016-2017 fiscal year that crept up to 43 minutes. The average time before being sent home about 2 hours, 34 minutes. The waiting time before admission was 5 hours, 32 minutes, according to the CMS figures. Some statistics reported to CMS by Evangelical were inaccurate. The numbers in this story and in the accompanying graphics are accurate, according to hospital officials.
The time before admission is based on a sample of cases, Hollenbach said.
Sunbury Community Hospital's times for 2015 and 2016 were 25 minutes waiting, one hour and 47 minutes before being sent home and 4 hours and 8 minutes before admission, according to the CMS figures. UPMC East has the 13-minute wait time from door to doctor, an average time of 2 hours and 26 minutes before being sent home, and, for those admitted, 1 hour and 53 minutes before getting into a room.
"We continually strive to improve patient experience, and we know that in an emergency, every second counts," Taggart said. "That’s why we make the 30-minute pledge to our community members."
Setting up appointments
The wait time to get a doctor's appointment varies.
"Regular physicians are scheduled out a month or two," Evangelical's Aucker said.
"It all depends," Hollenbach said. "If it's flu season, you may not get in for a while."
She said Evan has seven family medicine clinics, for children and adults, and two internal medicine clinics, for adults.
Multiple providers work at each.
A survey conducted by Merritt Hawkins, a national physician search firm, the time it takes to schedule a new-patient appointment with a physician in 15 major metropolitan areas in the United States has increased by 30 percent since 2014. The 2017 survey of 1,414 physician offices looked at average wait times in five medical specialties: cardiology, dermatology, obstetrics/gynecology, orthopedic surgery and family medicine.
The firm's report hypothesized that the lengthened wait times are related to the advent of the Affordable Care Act (ACA), which greatly increased insurance coverage and subsequent consumer demand for physician services, and the aging of the population.
According to Merritt Hawkins, it now takes an average of 24 days for a consumer to make an initial appointment with a physician in the 15 large urban areas. By comparison, the report said, the average wait time for an appointment in the same markets was 18.5 days in 2014, 20.5 days in 2009, and 21 days in 2004. The survey also included appointment wait times in 15 mid-sized metropolitan areas of 90,000 to 140,000 people and found the average wait time for a new-patient appointment in those markets is 32 days.
For doctor visits, Sunbury Community Hospital spokeswoman Barbara Aucker said "Same-day appointments are often available."
"We saw close to 1,700 patients in our ENT (ear, nose and throat) clinic in 2016, and we are on track to exceed that number this year," she said. "Our family medicine practice (Community Care of Sunbury) saw over 6,600 patients in 2016 and we anticipate we will see close to the same number of patients by the end of this year."
Urgent Care of Evangelical, which opened in late November 2016, has seen an average of more than 30 patients a day since January, or more than 10,000 patients. Hollenbach did not have figures for the family practice clinics.
Urgent care facilities meet the needs of patients with minor ailments when the patients may not be able to get an appointment within a couple of days.
Geisinger's urgent care and family practice clinics saw 295,000 patients in the last year.
'A 1980s facility'
Patient volume in the Geisinger system of 13 hospital campuses spanning 45 counties in Central and Northeastern Pennsylvania is much greater than other hospitals, especially at the home-based medical center in Montour County, where it surpasses other Valley hospitals.
But that home-base's E.R. is showing its age, said Montour County Commissioner Trevor Finn.
"I think there have been some improvements, but it continues to be a problem because they need to address the fact they have a 1980s facility," Finn said. "It's still inadequate for their needs. Our Careworks (urgent care clinic) needs be larger and better staffed, and that would go a ways toward alleviating their problem with their emergency room."
During a commissioners meeting in March, Finn was vocal about Geisinger's need to increase services "in primary care, urgent care and emergency care, to our constituents.”
Geisinger officials said they realize their space limitations, and they have been doing some renovations, but they don't want to delay making changes that will improve access.
Finn said the Careworks staff was "fantastic," and he sees more improvements ahead.
"I think they are now listening to the community under Dr. Feinberg," Finn said. "He wants the Danville community to be taken care of, as are other communities where Geisinger is. That is what we, as a board of commissioners, want. We want the community to be taken care of."
The problem of long wait times was something Feinberg had said last year was patients' top criticism, especially when it comes to the emergency department.
"Being sick comes with a lot of suffering," Feinberg wrote. "We complicate that by adding more suffering. Our ultimate resolution is to reduce the wait time in the emergency rooms at Geisinger facilities to zero minutes and I really think we can accomplish this in two years."
Finn said that among the changes, moving the Family Medicine Department to the Woodbine Lane clinic was a great improvement because it has helped patients get appointments quicker.
He also has noticed he does not have to wait as long for appointments. He previously waited months for an appointment. That wait is now a few weeks for an eye appointment and a week or less to see his primary care physician.
Geisinger's urgent care facilities also offer online registration, so patients can wait at home before showing up at the center for treatment.
Former Commissioner Jack Gerst, a member of the Geisinger Authority, a county board that finances certain capital projects of the health system and other nonprofits, already was happy with Geisinger's patient service when he scheduled appointments in ophthalmology and dermatology.
"I never have a problem," Gerst said. "I get it when I want. They'll swing with me on hours and time. Usually, I call a week ahead when I want it."
He blamed the backlogs and waits in the emergency department on people who go there who don't need to be there.
"You get people who have an ACCESS card, they have a sore throat," Gerst said. "They'll take an ambulance in there, if they could.
"It can't totally be blamed on the Geisinger ER. They're doing the best they can."
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