No more long waits?
At Bon Secours hospitals, ER patients are guaranteed speedy service or free movie tickets

by Paula C. Squires
Virginia Business
November 2006

The clock starts ticking the minute a patient walks into the emergency room at Bon Secours Memorial Regional Medical Center in Hanover County. The staff must hustle to make good on a widely advertised guarantee: Patients will be seen in 30 minutes or less.

Sounds like a takeoff on the old marketing ploy for Domino's Pizza, which used to promise delivery within a half hour or a free pizza. At the hospital, patients who aren't seen within 30 minutes get an apology and two free movie tickets.

Since Memorial Regional began offering the guarantee on July 1, service is trumping movie tickets. "We've had more than a 90 percent compliance rate," says Jill Russell, administrative director for the hospital's emergency services. "Our median door to doc time is 15 minutes." That's 64 minutes sooner than patients used to see a doctor, she adds.

The guarantee — the first among hospitals in Virginia — assures patients at all four of Bon Secours Richmond's acute-care facilities that treatment will begin within 30 minutes. "That means by starting to put in routine protocol orders or to be seen by the physician," explains Russell. There are disclaimers: Service may not be speedy if the ER is already treating many critical patients or if ambulances are diverting patients to other hospitals because beds are full.

In just three months, Russell has noticed a boost in the ER's bottom line. The new process has dropped the overall time spent on an emergency room visit by 32 percent — from four hours and seven minutes to two hours and 46 minutes. Meanwhile, average patient volume and satisfaction scores are up. "People are amazed," says Russell. "I get telephone calls from people saying, ‘I was there a year ago. What did you all do?' Normally, when someone goes to an emergency room, they expect to sit and wait."

Indeed, for patients used to waiting for hours and sometimes even walking out in frustration, the guarantee sounds too good to be true. "We decided to do this, because we received too many patient complaints that the waits were just too long. They could be five or six hours. That's not how we want to take care of patients," says Kim Brundage, director of patient relations for Bon Secours Richmond Health System.

Based in Marri­ottsville, Md., the nonprofit Bon Secours Health System Inc. has 20-acute care hospitals primarily on the East Coast. It has been so encouraged by the revamping of ER procedures in Central Virginia that Brundage says Bon Secours plans to roll out the program at its three acute-care facilities in Newport News. The 30-minute guarantee went into effect at the company's Kentucky hospital this month.

Before implementing the new policy, Bon Secours visited out-of-state hospitals with a similar guarantee. One concern — an uptick in the number of patients using the ER for non-urgent care — hasn't been a problem. In fact, a greater number of sicker patients are coming in, says Brundage. "They know they are going to get the care they need in the most efficient manner."

To deliver on its promise in Richmond, Bon Secours added triage rooms at three of its four hospitals and tweaked staffing so more doctors would be available during peak ER times. "At Memorial, we went through every process in the ER," says Russell. The hospital, which opened an expanded 31-bed emergency wing last February, installed new time-saving equipment and technology, including a CT scanner, an X-ray machine where images can be seen in the ER and a radiology room.

The first hospital to offer a 30-minute ER guarantee was Dearborn, Mich.-based Oakwood Healthcare Inc. It took effect at its four acute-care hospitals in southeastern Michigan in 2001. Five years later, Chief Nursing Officer Barbara Medvec says the company has seen dramatic changes. "In the first three years in our emergency department, we saw a 20 percent increase in our patient volume." Today, compliance with the 30-minute guarantee ranges from 80 percent to 85 percent on a monthly basis, she says.

While some competitors now offer a 29-minute guarantee, Oakwood doesn't plan to play a numbers game. It's in the midst of another redesign of its emergency department. "We're taking it to a new level," explains Medvec. "Our customers are saying ‘Yes, I want to see the physician, and I want to know that I can start getting my care immediately so I can know what's wrong with me."

Immediate care in the ER? Sounds like something patients might see on all those TV shows.