Emergency Department Care of Critically Ill Patients Loses Out To Corporate Marketing

There are some important time standards that hospital emergency departments should strive to achieve.  For example, fibrinolytic therapy should be received within 30 minutes for stroke victims.  Sepsis should be recognized and protocols instituted within 60 minutes.  Testing for enzymes that show whether a person is having a heart attack should be received within 60 minutes. 

These time standards revolve around evidence-based medicine and result in true benefit to patients.  Emergency Department Physicians and their staff correctly focus on these and other life threatening conditions above less harmful illnesses.  This tried and true system is called triage, where severely ill patients get the attention of the medical staff while less urgent patients are cared for later. 

Modern corporate medicine, however, is very concerned with patient satisfaction and marketing.  When non-critically ill patients wait for long periods of time, they become dissatisfied with their experience.  When survey forms are filled out, patients give low scores. 

Moreover, everything in a hospital is measured, including the time between arrival at the hospital and seeing a doctor, or the time between arriving at the hospital and discharge from the ED.  In corporate hospital speak, these times are called “metrics.”  All hospitals want to tout their favorable metrics: how they have the lowest Emergency Department wait times and fastest service. 

On its surface, this seems like a positive thing.  Hospitals are working to improve patient satisfaction and lower wait times. 

The problem, however, is the goal to lower metrics is not accomplished by increased staffing. Rather, doctors and nurses are constantly monitored and urged to work faster. To lower the metric of initial time until a doctor sees a patient, the same doctor must spend less time with each patient.  Or, she may be forced to leave a very sick patient prematurely just so the “10 minute door to physician” metric is satisfied.  This is true even if the next patient in line is not critically ill.  Finally, this system creates the added risk that the initial physician interactions are perfunctory and done solely to “stop the clock.”

So, to improve their “scores,” doctors must rush through their evaluation of more ill patients to attend to less sick patients.  This artificial focus on metrics, inevitably, results in poorer care to those in most serious need, further erosion of doctor patient relationships, and further stressing of the hospital staff to meet artificial corporate goals.