QUESTION:
We are seeing Emergency Department wait times of several hours.  Can we post these wait times publicly, like, for example, online or at the entrance to the hospital?  And before a patient is formally logged in, can staff tell the person how long the wait is?

ANSWER FROM HORTYSPRINGER ATTORNEY FISHER FILIPPAZZO:

This is a great question and one that hospitals are asking with increasing frequency.  As a general rule, posting ED wait times should be approached with caution because of the potential implications under the Emergency Medical Treatment and Labor Act (EMTALA).  The concern is that publicly posting or verbally sharing estimated wait times may unintentionally encourage patients to “self triage” and decide to leave before receiving the medical screening examination required by EMTALA and needed by the patient.  The Federal Regulations and EMTALA Interpretive Guidelines emphasize that hospitals must not delay or discourage a patient from remaining for their medical screening examination.  (42 CFR 489.24 Tag A-2408/C-2408) Another concern with posting wait times is that these estimates also may not reflect sudden changes in acuity or patient volume.

Once an individual has arrived seeking care, it becomes even more sensitive.  While staff may answer a patient’s questions, proactively telling a patient the wait time or suggesting that they might prefer to seek care elsewhere can be viewed as discouraging them from staying.  That raises EMTALA risk.  Staff should focus on reassuring patients that they will be evaluated and treated.

Professional organizations, including the American College of Emergency Physicians (ACEP), have issued guidance for hospitals that choose to communicate wait times.  ACEP recommends that:

• ED wait time be defined consistently as “door to qualified medical provider” time;

• Disclaimers clarify that wait times do not apply to those with potentially life-threatening conditions;

• Posted times be updated frequently and remain as accurate as possible; and

• Public communication be accompanied by clear educational messaging so patients do not misunderstand their ability to receive timely care.

Overall, because of the EMTALA implications, posting or discussing ED wait times should be done very carefully, if at all.  If your hospital chooses to display wait times, make sure the information is accurate, updated regularly, and accompanied by appropriate disclaimers.  It is also important to reinforce that anyone with a potentially life-threatening condition will be evaluated immediately.

If you have a quick question about this, e-mail Fisher Filippazzo at ffilippazzo@hortyspringer.com.