What Can The ER Learn From Chili's?

I just want to know what’s going on!

I remember the first time I ever saw a restaurant pager. I was in grade school, and we were waiting for our table at Chili’s.

My cousin gets handed this plastic disc that had red blinking lights. Being a young boy in grade school I was immediately drawn to it like a moth to a flame. I needed to hold this device. Then the most unthinkable thing happened. My cousins said let's wait outside!

Umm…outside? What if we can’t hear them call our name and we miss our table?

They then told me what this magical plastic disc was for. It was going to let us know when our table was ready!

Then it happened, this unassuming piece of plastic started to dance and display a light show I’ve only witnessed during Fourth of July.

Needless to say, my mind was completely blown!

Restaurants have become way more sophisticated since then. Now they have online reservations and text updates when your table is ready.

Why can’t we do this for emergency rooms (ER)?

Before you leave in disgust, give me a chance to explain myself.

According to the Center for Disease Control and Prevention (CDC), 1 in 31 patients will contract a hospital acquired infection. The direct cost to hospitals is estimated at $28.4 billion per year! This study from 2012 found that an emergency room visit resulted in “more than a threefold increased risk of acute infection among elderly people.” I don’t know about you but that is staggering to me.

Just physically being in a hospital you are at risk for acquiring an infection that you did not come in with. And on top of that, you are sitting there in some cases for hours with other sick people. I don’t care how great your air exchanges are; if the person next to me decides today is a bad day to cover their mouth I am more likely to get sick with whatever they have.

Let us break down the ER experience

1. Deciding to go

2. Arriving and waiting

3. Getting a room

4. Seeing the provider and tests

5. Diagnosis and decision

Let’s look deeper into each step for non-life-threatening ER visits.

Deciding to go

This is the part where we are, in some cases, making a monetary decision. Many of us know how much our insurance charges for an emergency room visit and we are deciding how much our life is truly worth. Many people that are not in the medical field do not know what an emergency is and what isn’t. Also, do you want to spend the next six hours in the hospital just to be told you’re in good health, but here is Z-Pak just in case.

Arriving and Waiting

You are stressed out not thinking straight and breaking some traffic laws. Then you get to the ER just to see a sea of people sitting there. You have already made the investment in coming here so now you have to check in and wait…………. You’re thinking to yourself at this rate my PCP office will be open.

Getting a room

The door opens and they say your name! You are overjoyed. You tell your new friend you’ve made in the ER: “I am sure they’re going to call you soon and good luck with everything.” You walk through those doors and are blinded by the fluorescent bulbs and brought to a room and told to put on a gown.

At this point, you haven’t slept or eaten anything and you’re really tired. You think you've made it but, we pulled a fast one on you. You are just going to wait some more, only now you have a bed.

Seeing the provider and tests

The Nurse Practitioner finally walks in and tells you that they are going to run some bloodwork and get some scans. Once they have those results, they will know what you have. Then you wait some more before your labs are drawn. Then the radiology technician comes in and tells you they are taking you to get some x-rays. Then you wait again. This whole time you still can’t sleep because machines are beeping everywhere, and you’re stressed out because you have no idea what is wrong with you.

Diagnosis and Decision

After a couple of hours, the doctor comes in and introduces himself, and says we have your results back and everything is looking good I think we can send you home with an antibiotic prescription. He tells you to make sure you take the full course and to follow up with your PCP if you have any questions.

Hallelujah! You’re not physically better but mentally you are at peace. Even though you and your family just spent ten hours in the ER. You haven’t eaten or slept but you’re alive and that is all that matters.

Improved Experience

Deciding to go

You are deciding if you need to go into the ER. You get online and go to the hospital’s website and find the tool that patients can use to decide if they need to come into the ER. This tool asks you questions regarding your illness and lets you know if you need to come into the ER or if you can wait and see your PCP. This tool also gives you a wait time and an estimated time you should arrive.

This would solve a couple of problems. First, we have less time being spent on unnecessary ER visits thus decreasing turnaround times for the most critically ill patients. Secondly, we decrease the risk of infection just because we don't have a packed ER because people would be showing up at staggered times. Third, our patients are going to be less stressed out because half of the stress is the fear of the unknown. When am I going to be seen? Why is it taking so long? Fourth, your front desk isn’t just answering the question of when my daughter is going to be seen. They don’t know! Stop putting them in the line of fire!

Arriving and Waiting

Waiting would be at a minimum because you arrived when they told you to. You just check in, they pull up your questionnaire and you’re all set!

Getting a room

See arriving and waiting.

Seeing the provider and tests

The provider comes right in after giving you some time to change and get settled. They tell you the lab is on its way and that someone will get you for your x-rays shortly. The ER staff is not overburdened with so many patients all at once they can triage appropriately.

Diagnosis and Decision

The doctor comes in and lets you know your diagnosis and that your prescriptions are at the pharmacy waiting for you!

Let’s say this process still took you ten hours. The majority of that time was spent in the comfort of your own house without the stress of waiting for the unknown. You knew about the time you needed to go to the ER, and you had less exposure to getting an infection from someone else. The wait in the ER was less because the ER staff wasn’t taking care of everyone that walked in regardless of illness. They were able to triage knowing what was coming. The only downside is that you weren’t able to make that friend in the ER, but I have a feeling most of us would be okay with that.

Objection, Your Honor!

Yes, this is not a perfect system. It is an ER. Random things are going to come in and increase wait times. But, that is literally how it is right now. Why not decrease the number of people in our waiting rooms?

What about the patients that do not use the online questionnaire and just walk in? They are directed to a kiosk to answer the said questionnaire and given a wait time. They are then given a choice to wait in the ER or come back around the time they are given. They will not be seen earlier if they wait in the ER and they can get updates via text if they would like.

What if we misdiagnose them and they should have come into the ER? This is always a concern, even in person. As long as the patient is being honest with their symptoms, we should be able to triage them appropriately. If you are uncomfortable with that, just have the estimated wait times and suggested arrival times. That would still be better than what we do now. And if that is not convincing, we could add on a telehealth consult where a real person looks at the patient and triages them that way. The solutions exist it is just about how they are executed.

There is never going to be a perfect solution. Even the best of us will make mistakes. But if we can help alleviate the stress for the patient and the healthcare workers then that is a step in the right direction for me!

Thank you so much for your support! Please do not hesitate to reach out if you have any questions or leave a comment.

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I hope you have a great day!

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