How San Diego's Emergency Room Wait Times Stack Up

Hospital emergency departments in San Diego County show enormous variation in how long patients must wait to get pain medication for broken bones, evaluated for a stroke or admitted to a hospital bed, according to new federal data posted on Hospital Compare.

With this quarterly update, the Centers for Medicare & Medicaid Services added three consumer-friendly tools for evaluating an emergency department, or ED. The speed and efficiency measures have been added to the existing five scoring tools on the website, providing even more ways for patients to decide which hospital they would choose in an emergency.

The three new measures are:

• How long, on average, it took emergency department personnel to administer pain medication for patients with broken bones. The wait times range from 64 minutes at UCSD Medical Center's two hospitals in La Jolla and Hillcrest, to 84 minutes at Paradise Valley Hospital in National City to 82 minutes at Tri-City Medical Center in Oceanside. By contrast, pain medication was administered by Sharp Coronado Hospital's ED within 36 minutes.

• The percentage of patients who left without being seen by a health care professional. The percentages are generally low, but 5 percent of patients left without being seen at Paradise Valley, versus 1 percent at Sharp Memorial, Sharp Coronado, Pomerado Hospital, Scripps Encinitas and Palomar Medical Center.

• The percentage of patients with stroke symptoms who got a head CT within 45 minutes of their arrival. Among the six San Diego County hospitals that reported this measure, the range was 94 percent at Scripps Mercy Hospital to 62 percent at Tri-City Medical Center. Prompt recognition of a stroke through CT imaging of the brain can hasten administration of clot-busting medications that can save lives and prevent disability.

CMS had previously published these three new emergency department wait times, but the data were embedded in complicated federal databases that most consumers would have difficulty finding on the Medicare website, or interpreting.

“It wasn’t in a way that the public and potential patients had access to it,” said Dr. James Augustine, vice president of the Emergency Department Benchmarking Alliance, a panel of ED care experts developing better measures to evaluate care provided by emergency room physicians.

“Now they’re putting this in the hands of consumers, and that is clearly different. The purpose is to create more transparency in the industry.”

Augustine, however, worries that some of the new ED data may be “dangerous around consumers who don’t know how to make use of the information.”

San Diego County hospitals also vary widely in the five other measures that have been reported on the Hospital Compare website, and this update on those scores shows wait time problems remain.

For example, for patients who come to the ED and are sick enough to need an inpatient bed, average wait times for the bed vary between 479 minutes, or nearly eight hours, at UCSD Medical Center's two hospitals, and 463 minutes at Kaiser Foundation Hospital, to 241 minutes, or just over four hours, at Scripps Memorial in La Jolla, 262 minutes at Paradise Valley and 263 minutes at Alvarado Hospital Medical Center.

After a physician determined that the patients needed an inpatient bed, patients waited an average of 352 minutes, or nearly six hours to be placed in a bed at UCSD Medical Center's two hospitals and 180 minutes at Sharp Chula Vista, but 56 minutes at Paradise Valley Hospital and 51 minutes at Sharp Coronado.

For those who did not require hospital admission, Sharp Grossmont took an average of 285 minutes to discharge them home, UCSD Medical Center took 272 minutes and Tri-City took 244. Faster hospitals were Scripps Memorial, at 158 minutes and Sharp Coronado at 110 minutes.

Katie Schoolov

A key issue in emergency room care is how soon after a patient walks in the door that he or she is seen by a health care professional, a measure also called door-to-diagnostic evaluation. Sharp Chula Vista took an average of 102 minutes, Grossmont took 81, but Scripps Memorial Encinitas took 23 minutes, Sharp Coronado, 28 minutes, and Scripps Mercy, 30 minutes.

The last of the remaining measures is ED volume, or how many patients the ED regularly sees. CMS classifies hospital emergency departments' volume as very high, high, medium or low.

Emergency department quality of care has been on the federal radar for expanded public reporting for several years on the theory that when the public, including payers and employers, can compare a hospital's wait times with its competitors, all hospitals will try harder to speed up better quality of care, especially in the ED where delays can exacerbate conditions and cause otherwise avoidable death.

Sharp Coronado Hospital's ED, a low volume center, shows a consistent record of the shortest wait times across most of the measures, as does Scripps Memorial in La Jolla, and Sharp Memorial Hospital, better than California and national averages for most measures.

The period for collecting data, which hospitals submit to CMS in exchange for a two percent increase in Medicare payment, was the 2014 calendar year. Volume data was collected for the 2013 calendar year.

Scores are not shown for Scripps Green Hospital, which does not operate an emergency room, or for VA San Diego Healthcare, which is exempted as a federal hospital and largely sees only veterans.

Augustine said the new measures were expected, and are just a few of many more to come.

But they are not without their challenges, specifically the fact that hospital EDs may have different ways of defining whether they complied, he said.

"The issues on all three of these measures are how they're defined" by each emergency room doctor and hospital, Augustine said. "For example what constitutes a broken bone and what constitutes pain medication? A broken bone is specifically defined as a long bone (an arm or a leg) not a nose bone or knee cap.

"And sometimes patients with broken bones don't want pain medication, and sometimes they already got it by the emergency medical service (that delivered them to the ED). So scoring that may not reflect the true behavior or quality of that emergency room's care."

As hospital EDs gain experience with these measures, many will be refined and definitions made more consistent with future data rollouts.

The new emergency department data was posted along with updates and new measures in many other categories.

For the first time, CMS is releasing key information on surgical procedures performed at thousands of ambulatory surgical centers (ASCs), some of which now perform high risk procedures, including total hip and knee replacements and ankle surgeries.

The new data includes information on 35 San Diego County ASCs, showing whether these facilities' surgeons use surgical checklists to prevent wrong site, wrong patient, wrong procedure surgeries. Additionally, CMS now posts data on how many procedures are done at each center, and how many are done within the following specialties: gastrointestinal, eye, nervous system, musculoskeletal and genitourinary.

The information may help patients and payers know how much experience each center has in doing a certain procedure on the theory that the more a center and a surgeon perform, the better the outcome.

For example, La Jolla Orthopedic Surgery Center performed 3,240 procedures during the measurement period of calendar year 2012, 2,645 of which were musculoskeletal, but it performed 166 nervous system surgeries and 429 eye procedures.

Many surgical experts believe that surgical centers and surgeons see better quality when they focus on certain procedures, leaving others to specialists in those fields. For example, Johns Hopkins Hospital, Dartmouth Hitchcock and the University of Michigan Medical Center now prevent their member hospitals and surgeons from performing any of 10 procedures if they fail to meet minimum volume thresholds.