‘What’s Taking So Long?’: The Patient Experience and Wait Times

Many healthcare places have someone assigned to oversee “the patient experience.” Patient experience is the currently acceptable term that we use to describe customer service, because in medicine we aren’t really wild about the concept of our patients being customers. Many people feel like that service term cheapens the sanctity of the doctor-patient relationship, and that definitely resonates with me. Look at me- I’m getting off-topic already- back to the person who is in charge of the patient experience. Difficult job. I mean, you have to be classy all the time and deal with complaints and people who are unhappy about their experience. Can you imagine? Tough stuff. I have mad respect for the service/experience person in every company. Anyway, in my organization, I do not occupy that role. (Insert smile) I try to be accommodating, courteous, and compassionate when I’m caring for children and families, but I’m not an expert at determining what makes a positive patient experience. However, in nearly 20 years of working in acute care I can tell you that one of the most important factors that dictates the quality of most people’s patient experience is the wait time. And I have a few things to say about it.

I think everyone knows that if you go to a walk-in anything then there’s likely going to be a wait.

In acute care, it goes without saying that as a general rule the sicker patients get seen first. That’s the whole concept of triage, right— where a healthcare professional (often a nurse) does a quick assessment to determine degree of acuity, and then patients are sorted accordingly. But other than the drama of OMG medicine where people are having chest pain, difficulty breathing, bleeding or other obvious acuity, there are subtleties that go into this severity determination, and I want to highlight a few.

First, people who have weakened immune systems or are newborns are generally taken right away before others.

These are the people who can get a life threatening illness simply by existing in close proximity to others who are sick (especially during flu season). I’m not just talking about people with cancer; there are plenty of other conditions that cause the body not to be fully effective at fighting infection, and many of these patients can look healthy as a horse on the outside. I guess what I’m saying is, try not to make assumptions about people’s chronic health status just by looking at them, and if they get pulled back to an exam room right away out of the reception area/waiting room then it’s a good bet that they’ve got something underlying going on. Newborns are a little different. Because they’re just so darn new to the earth, they also can get real sick real quick from absolutely anything, so they get whisked out of the waiting area as well.

So those are easy to understand, but what other nuances are there that might cause one person to have a shorter wait time, and others to have a longer one?

I’ve polled a few of my nurse colleagues as well, who have some interesting additions here.

One that I found particularly notable is the concept of pallor (which means pale, like sick pale not light skin pigment). This can be a bit of a qualitative judgment call, but over time the experienced healthcare team members get pretty good at telling the difference between someone who doesn’t feel good and someone who looks really UNWELL. And the unwell folks need to be examined more thoroughly right away. One quick test that we do that aids in this determination is a capillary refill test, where we place some pressure on the finger or toe until the skin blanches, then count the number of seconds it takes for the natural color to return. Ideally this should be less than about 2 seconds, but if it takes longer than that then it can be a sign of poor perfusion for a variety of reasons. Then again, it can also be simply that the person has cold extremities, so it takes some good clinical sense to know the difference. But it’s an important one, and an especially unwell child should be seen right away so that if we can catch a serious illness on the early side we could potentially save a life.

Age and fever can be tricky as well.

A general rule of thumb is that the younger the child, the more potential harm the fever can do, so we need to get to those kids as fast as possible, and this may mean that others have to wait longer. I know this can be hard to understand because most young children with fevers actually do just fine: the majority of the time it’s just a virus that causes the fever. But we don’t want to miss the needle in the haystack who isn’t just a simple viral illness, and younger kids are higher at risk.

All hands on deck.

I would be remiss if I didn’t also mention the scenarios where the whole story doesn’t emerge until the patient gets back into the exam room, and then the ENTIRE STAFF is needed in an all-hands-on-deck situation to get treatment started. This of course causes a huge bottleneck in patient throughput, and many times a backlog results and wait times increase. For privacy reasons we can’t announce the reason for the holdup of course, but I can assure you that the clinical staff is working double time to help the patient as well as get the entire situation back to normal.

This post isn’t meant to offer excuses for a negative hours-long patient experience or for why there are sometimes lengthy wait times in healthcare; but rather to lend some perspective that might help you in the moment the next time you see someone get pulled ahead of you as you wait patiently for your turn in line. No one wants you to wait a long time, and everyone wants you to have a positive patient experience in the clinical setting. We are appreciative of the feedback that we get so that we can always work on trying to improve, but it’s always helpful when that comes with a bit of understanding about the care delivery process and some of the complexities that are involved in it.

And remember, many hospitals and healthcare entities do have someone dedicated in the role of the patient experience, and I would encourage you to get in touch with that person or department if you want to discuss your experience. They are there to help!