Hospital Care from a Patient
Perspective
May 2008
Issue Brief available at:
www.chanet.org
Many Hospitals. One Voice.
Many Hospitals. One Voice.
A Patient’s Perspective
• A trip to the hospital can be overwhelming to a
patient.
• Hospitals have increasing demands placed upon
them at the same time that resources diminish.
• Providing excellent patient care in this
environment can be a challenge.
• This challenge leads one to wonder, “What is
patient care truly like for the patient?”
• Frank, a hypothetical, typical patient helps
answer that question.
Many Hospitals. One Voice.
Frank’s Story
• Late one evening Frank, the generally upbeat
protagonist of this story, stumbles in his driveway
while taking out the trash. He ignores his aching ankle
until the next morning when he finally decides to head
to the ER.
• Frank is tired because the pain in his ankle left him
tossing and turning all night.
• Frank is hungry because he did not eat before he came
to the emergency room.
Many Hospitals. One Voice.
In the ER Waiting Area Frank Notices:
• It takes longer than he expected to be triaged
and then called to a room
• There are other people there who are called
ahead of him despite their arriving after him
• The waiting area is crowded
• Some of the people in the waiting area do not
seem all that sick
• No one stops to check on him during his wait
• The nurses and staff appear very busy
Many Hospitals. One Voice.
Once in His Room in the ER Frank:
• Waits a long time to see the physician assistant
(PA)
• Feels frustrated because no one brings him food
when he tells them he is hungry
• Receives lab work, a system review, an order
for X-rays, and pain medication
• Is surprised to learn he will need surgery for his
unstable fracture
• Grapples with the possibility that his accident
will affect him for the rest of his life
Many Hospitals. One Voice.
Frank’s Surgery
• The orthopedist on call agrees to add Frank’s
case at the end of his scheduled cases
– Frank waits several hours to be assessed by the
orthopedist who sees him between scheduled cases
– After his assessment he waits again until the
orthopedist finishes the rest of his cases
• No available beds in the short-stay area means
Frank waits for his surgery in the ER
• Frank is released after a 23-hour observation
• He is exhausted and irritable after two
sleepless nights and the stress of his ordeal
Many Hospitals. One Voice.
Factors Contributing to Frank’s Experience
• Wait Time
• Staff
– Nurses
– Allied Health Professionals
– Physicians
• Administrative and Regulatory Responsibilities
– For the Patient
– For the Hospital
Many Hospitals. One Voice.
Wait Time
• Wait Time is on the Rise
– Time spent in the ER before release or admission
grew to 3.7 hours or 222 minutes in 2005
– Only 15 percent of patients visiting the emergency
department in 2005 were seen in 15 minutes
– Time it took to see a physician increased by 36
percent between 1997 and 2004
Many Hospitals. One Voice.
Overcrowding Leads to Increased Wait Time
Source: American Hospital Association: Results from 2006 Survey of Hospital Leaders
Many Hospitals. One Voice.
Reasons for Overcrowding in ED:
• Inability to transfer patient to an inpatient bed
after decision to admit because no available
beds exist
– Leads to “boarding” in the ER
• Use of ED as primary source of routine medical
care
– Hospitals must treat all patients to comply with
EMTALA laws
– Often used by people who are uninsured because
they cannot be turned away
Many Hospitals. One Voice.
Wait Time in Northeast Ohio
• The Center Studying Health System change
– Conducted site visits of EDs across the country in 12
cities
– Concluded that Northeast Ohio hospital patients
moved through EDs faster
– Concluded that added space, renovations and
greater efficiency enabled Cleveland hospitals to
fare so well
Many Hospitals. One Voice.
Staff
• Nurses
• Allied Health Professionals
– For example:
• Physical therapists
• CT technologists
• Radiology technologists
• Physicians
Many Hospitals. One Voice.
Nursing Challenges
• National nursing shortage
• Increasing demands and responsibilities placed
upon nurses
–
–
–
–
–
Taking over for colleagues called away
Managing multiple patients
Filling out paperwork
Conducting satisfaction surveys
Serving on special committees
Many Hospitals. One Voice.
Allied Health Challenge
• National allied health provider shortage
– Allied health turnover and vacancy rates are actually
higher than that of registered nurses when averaged
for the 12 most in-demand professions.
• CHA member hospitals reported 204 vacant
allied health positions in a 2004, fourth-quarter
survey. This equates to an 8.9 percent vacancy
rate.
Many Hospitals. One Voice.
Physician Challenges
• Typically, physicians operate as independent
agents at hospitals
– Physicians who practice by their own rules in their
home practices must conform to the established
culture of the hospital when they are there
• EMTALA
– Physicians report an average of $138,000 in lost
revenue as a result of EMTALA
– This lost revenue makes some physicians reluctant to
work in the hospital at all
Many Hospitals. One Voice.
Administrative and Regulatory Responsibilities
• For Patients
– Quick Registration
– Once in their emergency department room
• Full registration information gathered
• Insurance
• Co-payment if possible
Many Hospitals. One Voice.
Administrative and Regulatory Responsibilities
• For the Hospital
– Documentation must satisfy many entities including
federal, state and local government as well as
independent accreditation organizations.
– There are over 30 different entities involved in
hospital regulation at the federal level alone.
– Ensuring that care is properly documented for the
complex web of entities requires careful and diligent
charting by all members of the healthcare team.
Many Hospitals. One Voice.
Patient Care to Paperwork Ratios
Source: American Hospital Association. “Patients or Paperwork: The Regulatory Burden Facing America’s Hospitals.”
Many Hospitals. One Voice.
Frank’s Story: Part Two
• Frank has now been at home for two weeks
• Frank waits for his bills
– He receives four “your insurance company has been
billed” statements
– He receives four EOBs
– He receives four bills
Many Hospitals. One Voice.
Hospital Billing Is More Complex than Other Billing
Scenarios
• The person receiving service is not the sole
party responsible for payment
– Medicare/ Medicaid
– Private insurance
• Trip to the hospital not one service but several
– Hospital or facility charge
– Ancillary charges
– Physicians, specialists, other healthcare providers
Many Hospitals. One Voice.
Billing: The Hospital’s Perspective
• Nurses, physicians and other providers keep
diligent records of care provided to ensure
proper billing
• The chart is given to a medical coder
– Reviews record and assigns codes
– Submits information in correct format to different
payers
Many Hospitals. One Voice.
Conclusion
• When patient expectations diverge from the
true hospital experience patients can feel
frustrated.
• Understanding how and why care is delivered
the way it is leads to more positive patient
experiences.
• Hospitals are doing their part
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Patient education on Web sites
Signs in hospital waiting rooms
Brochures
Patient advocates