Staffing shortages and rising costs leave ERs in chaos and even force some hospitals to shut down money-losing emergency departments altogether. Chaotic or closed emergency rooms not only cost lives but cut off a pipeline of new patients that provide income for hospitals and jobs for specialist physicians.
The main driver behind ER chaos and expense is a nationwide shortage of trained doctors and nurses. A single nurse often has to care for ten or more patients in the ED simultaneously, leading to treatment delays and deferred care. Adequately staffing Emergency Departments at today’s operating standards will take years and cost hospitals tens of millions of dollars each, money they simply don’t have.
As healthcare innovators, my company has identified the main drivers behind expensive, chaotic emergency departments and formulated a solution that could help address some of the key issues, enabling better patient care, less stress for providers, and a balanced budget for hospitals: ER Appointment Scheduling.
Setting up real-time appointment scheduling for the ER
When talking to our clients about their challenges with ER departments, we quickly found that one common theme is trying to match the personnel resources with the unpredictable patient demand, which often leads to peaks and valleys in utilization. This results in either low productive times when providers and staff are under-utilized or long waits and high frustration during peak times when patient volume exceeds resource capacity.
This frustration and pressure during peak times not only affects employee wellbeing, but patient outcomes. Currently, emergency rooms are among the departments with the lowest HCAHPS scores, 10% lower than other departments. This dissatisfaction is often due to the long wait times, which have been recorded to range between 180 minutes and 13 hours.
So how can you shorten cycles for managing new, incoming patients and spread the influx of patients more evenly throughout the day? A simple but effective solution is to introduce online appointment scheduling for non-life-threatening cases. Online appointment scheduling allows patients to book and sign up for emergency department appointments on a set schedule, so they can stay home before it’s their turn. Pre-booking takes less time to get patients into the ER system, further reducing waiting times and pressure on employees.
So, how does this work out in practice? Let’s take a look at a few strategies that our clients found most helpful for creating more efficient ER appointment scheduling workflows.
- Pre-screening symptoms
Functional self-service surveys and symptom guides integrated with appointment scheduling help patients assess the severity of their symptoms. One reason emergency departments might produce higher costs than value is the misuse by patients. A significant portion of visits – estimated between 13% and 27% – could be treated outside the ED, saving billions of dollars to health systems and allowing hospitals to focus on true urgent care needs.
This is where your healthcare team needs to work together to identify particularly alarming signs or symptom combinations. Ranking symptoms according to their severity and co-occurring problems (chest pain, for example, requires an emergency call, while a moderate headache is less urgent) helps patients assess the severity of their symptoms and can guide them toward healthcare decisions that meet their needs. This can also prevent vulnerable patients from waiting too long to get help, thus, reducing the occurrence of deadly emergencies.
- Allowing nurses manual oversight
Second, when setting up a scheduling system, give your staff the ability to review the ER schedules and check priority cases. They can take a look at the registered symptoms per patient and manually edit the plan if necessary. Your team should also be able to send automatic messages to patients to come in earlier or even immediately if they feel it is necessary.
Hospitals that work with us often have two to three different messages prepared that they can send to patients on demand. For example, they can use these templates to quickly ask patients who have been classified as urgent during pre-screening to come earlier than planned or to call emergency services immediately.
- Assigning free time slots in between
Emergency department staff must be trained to prioritize patients who have made an appointment online to ensure the tool keeps its purpose and patients stay on schedule. In most cases, the patient should then be treated and/or seen by a healthcare provider within the shortest possible time. However, when unforeseen emergencies occur, the patient who has an appointment should be adequately informed. Most patients understand true emergencies and do not mind waiting a reasonable time if necessary.
By leaving enough time between scheduled appointments and setting aside free time slots of, for example, 10-15 minutes in between schedules for walk-in patients, you can ensure that your capacity is manageable and that you can help both patients with appointments and outpatients alike.
Sometimes chaos still occurs due to a major population health crisis. In such cases, disabling scheduling during peak hours is a helpful option. Decisions like this should be approved by leadership and finalized by emergency department leaders.
- Automating the next step: Triage workflows
Finally, for those wanting advanced capabilities, scheduled patients can be placed into a workflow, such as an ED tracker. Automating the entire patient journey from scheduling to being attended by doctors allows for proper assignment to specialists based on the patient’s symptoms and the desired healthcare professional without the need to manage each patient at the front office.
In practice, this means that patients who arrive at the facility and whose presence has been confirmed can already be included in the registration workflow, and their assignment to the correct physician can be made upon their electronic self-registration at the gate.
Patients in the ED often need follow-up care from a primary care physician or specialist. If these providers are part of the health system (e.g., employed or affiliated medical groups), the scheduling system can also be used to schedule follow-up appointments for patients before they leave. This practice increases the likelihood that patients will stay in-network while improving satisfaction and outcomes.
- Managing patient communications
Provide patients with information and reminders. For example, when patients sign up for an appointment, you can integrate workflows that send them updates about delays or earlier available time slots. This can apply to patients still at home and those in the waiting area. As your scheduling system updates, so will the communication to patients. And, instead of big screens with patient names in the waiting room or calling patients out loud, your OAS can then send instructions directly to waiting patients. Such smart and personalized notifications make your staff’s job easier – and patients’ lives, too.
The transition from reactive to predictive management, combined with a focus on reducing preventable care and implementing innovative scheduling strategies, lays the groundwork for a redesigned emergency department that delivers high-quality care, increased patient satisfaction, and sustainable growth. As healthcare evolves, it’s up to leaders to harness the power of technology and lead their emergency departments to a brighter, more compelling future.
About Sridhar Yerramreddy
Sridhar Yerramreddy is the founder and CEO of Steer Health, a user-friendly AI-powered healthcare growth and automation platform. Coming from a family of esteemed physicians, Sridhar is deeply invested in spearheading efforts to leverage AI to personalize patient care, streamline medical workflows, and transform how we perceive and experience healthcare.
