
Yelp now lets you see how long the wait will be at the hospital's ER - rgovind
http://mashable.com/2015/08/05/yelp-hospital-data/?utm_cid=mash-com-fb-tech-link
======
jlg23
The whole idea of having patients rate ERs is, to put it nicely, laughable.
And, to put it bluntly, it is a slap in the face of healthcare professionals
who work in one of the most stressful hospital environments.

* How friendly the staff is is absolutely irrelevant when you have a medical emergency. In normal hospital settings, in most countries, what buys you "friendly staff" is paying a premium that allows the staff to actually have enough time to pity you. A nurse who only tends 3 patients can do that, a nurse who has to tend 30 cannot.

* Wait times in ERs depend on the severity of your condition in relation to what other patients have to deal with. Most urgent comes first. A broken leg hurts but it won't kill you no matter how much you moan. The unconscious guy with rapid blood loss would be dead if they prioritized patients according to some fifo or loudest moaner first scheme.

* I'd always chose the bigger ER over a smaller one: The more people they treat, the more experienced they are. Same is true for non-emergency hospitalizations.

The Spudd recently had a great comment on "educated" patients:
[http://thespudd.com/hospital-to-replace-doctors-with-
parents...](http://thespudd.com/hospital-to-replace-doctors-with-parents-who-
have-done-their-research/)

~~~
tertius
To be fair, ERs are being rated, not doctors. They are generally independent
of each other.

" How friendly the staff is is absolutely irrelevant when you have a medical
emergency. "

I disagree, delving into the negative spectrum of interpersonal communication
could cause unwarranted stress which could exacerbate many conditions.

I agree that staff shouldn't be expected to bend over backwards, but there's
no need for negative treatment. And I don't consider saying "no" to a low
priority case as negative treatment. And if as an ER employee you can't handle
the stress of the ER you may need to change departments or get some training.

" I'd always chose the bigger ER over a smaller one "

Which requires research, which most people don't have time for in an
emergency. But I agree completely with this. I live in one of the largest
medical centers in the world and I know where to go.

~~~
kom107
Many empirical studies point out that in fact, the 'friendlier' the staff is
(meaning higher 'patient satisfaction scores') the poorer the actual clinical
outcomes are at that facility.

See: [https://www.advisory.com/daily-
briefing/2012/02/15/patient-s...](https://www.advisory.com/daily-
briefing/2012/02/15/patient-satisfaction)

Longread but excellent:
[http://www.theatlantic.com/health/archive/2015/04/the-
proble...](http://www.theatlantic.com/health/archive/2015/04/the-problem-with-
satisfied-patients/390684/)

As someone who works in healthcare (formerly at the bedside), and who's
partner is a current ED nurse, this infuriates me. Department budgets are
related to patient satisfaction scores, the EDs generally tend to have low
scores because, yes, sorry you've been here for 3 hours, but we had 4 other
patients come in (and HIPPA prevents me from telling you that they were level
1 gunshot wounds) and we can't tend to your constipation right at this second.
If someone actually were to check Yelp for wait times and then have to wait
longer...scores go even lower, reimbursements decrease, staff have higher
patient ratios, lather, rinse, repeat.

I assure you, I have seen many, MANY patients complain and file greivances
with the Department of Health, Joint Commission, etc, that their toothache, or
even general wellness physical, should take prescedence over cardiac arrests.
This is in a top 10 hospital in the United States, and we generally score
above average with patient satsifaction. The public has no clue and this is
not helping.

~~~
tertius
"(meaning higher 'patient satisfaction scores')"

I was not addressing this at all. Patient satisfaction scores are a lot more
broad than "staff was friendly, check".

I even state the following "And I don't consider saying 'no' to a low priority
case as negative treatment."

I have family and friends that are ER physicians (and have done it in multiple
countries), and they can handle the stress of stressed patients without
needing to resort to stress induced interaction themselves. This is all that I
was referring to.

I do not tolerate rude medical staff, and no one should. Again, if you can't
handle the stress, get training or change departments.

~~~
kom107
I appreciate and understand that they are significantly more broad than the
friendly staff metric. However, patients who feel the staff were friendly tend
to give higher overall ratings. And I know that you stated that you don't
consider saying no to a low priority case as negative treatment, but again, I
promise you, PLENTY of people do. I got it at least once a shift, if not more
frequently. I have literally had patients come up to me in another patient's
room WHILE WE WERE DOING COMPRESSIONS and complain that we weren't getting
them ice fast enough.

I'm sure being an ER physician can handle the stress, because they aren't
interacting with the patients like the nurses and techs interact with the
patients. Have they ever had someone hit them because they didn't get their
turkey sandwich fast enough? Spit in their face because they were made NPO?
Pee on them on purpose? I sincerely doubt it. The scope of practice is
entirely different. I think the nurses and techs do an incredible job of
keeping it together and maintaining a friendly demeanor towards patients when
they have to put up with these things. It's easy for you to say 'If you can't
handle the stress, get training or change departments'. That's exactly the
response that causes nursing to have such a high turnover and burnout rate.

No one is advocating for staff to be rude, I'm advocating, however, for better
ratios for the nursing staff and more patient education on the other side of
healthcare. And frankly, I think that sometimes, it should be okay for
healthcare workers to interact with a patient like they are an asshole because
THEY ARE. You'll get the same standard of care, but I'll be damned if I'm
going to go to another floor to search for some ice cream for you after you
called me every name in the book and pulled out your IV for the third time in
the past 4 hours because you didn't like that I still won't give you another
dose of dilauded...and you're in the hospital because you're diabetic and
morbidly obese.

~~~
ectoplasm
> And frankly, I think that sometimes, it should be okay for healthcare
> workers to interact with a patient like they are an asshole because THEY
> ARE.

Irritability is a part of suffering.

~~~
kom107
I get and appreciate that, but I really don't think it's appropriate to hit
someone over a turkey sandwich. If you're able to eat that and walk around on
your own and watch the ball game, pretty sure your suffering isn't sufficient
to warrant punching a nurse in the chest.

~~~
ectoplasm
Fundamentally I believe non-consensual violence is the result of suffering. I
think isolating violent people and protecting yourself is much better than
meting out arbitrary punishments. Consider that someone willing to punch a
nurse in the chest over a turkey sandwich very likely has some kind of mental
health issues. If the assault is actually a problem on the level of a crime,
then call the police.

------
athenot
Emergency Departments don't run on a "first come, first served" basis. Triage
will assess how critical your condition is and use that to determine how fast
you can be seen, in relation to how many other critical patients are already
in the unit.

If you show up with complaints of chest pain, you get an EKG right away. If
that doesn't reveal any impending doom, you may sit in the waiting room for a
while.

If your situation is deemed life threatening and the unit is full, they _WILL
MAKE_ room for you. Conversely, if you're only in low or mild pain and you're
at the ED simply because it's 2am and Urgent Care is closed, your waiting time
will be high.

I've seen a few hospitals advertise ED waiting times but they tend to cater to
populations who use the ED like an after-hours Urgent Care department.

------
fredleblanc
Do people really check Yelp for hospital reviews? I live in a reasonably rural
area, but even we have a couple of hospitals within reach. It never really
occurred to me to _not_ go to the nearest one for emergencies. I couldn't
imagine a deep gash in my leg or my child screaming and me on my phone looking
up hospitals.

Although then again, I suppose the argument will then become that I can ask
Siri for the closest hospital (travel time) with the shortest wait time total.

~~~
icebraining
You could also regularly check Yelp and put a post-it on the fridge (or even a
marker on your GPS app/device) with the current best. If the difference in
distance wasn't particularly great, I'd consider doing so.

~~~
tertius
And make sure the ones on your list are in-network...

I doubt most people prepare to this degree though. And having the convenience
of finding the best ER that services your health insurance close by is
probably of high value.

~~~
icebraining
_I doubt most people prepare to this degree though._

Well, Yelp could send that suggestion to its users. It'd be a good excuse to
get them to login again.

------
ghufran_syed
The real problem is data quality: 1) hospitals get rated on 'door to doc'
time, so they tie part of compensation to this metric. It is measured based on
the time when the doc clicks on your name in the computer, which is of course,
not the same as when they actually see you, they might physically see you an
hour later. 2) Some hospitals have a doc see you in triage. This is great for
the hospital's wait time numbers, but they are not going to be responsible for
the whole of your care. They usually just order some medications or tests,
then you wait for the 'real' doctor to see you, which might take another hour
or two. If there is going to be a wait, doing things this way is not
necessarily a bad thing, and probably does shorten your overall 'door-to-
discharge' time by doing some of the steps in the process in parallel, but the
point is that the 'wait time' alone is almost meaningless. 3) the times listed
are average times over one year, whereas what you need to make decisions on
are realtime wait times

------
pinaceae
Online reviews of doctors are already useless. People rate their "experience",
rather than actual effectiveness.

Tons of reviews about bad docs that turn out to be hurt feelings of the
morbidly obese when told to diet. Especially women at OBGYNs, which is telling
as the US has a fast growing rate of deaths of mothers during child birth -
completely driven by obesity (heart failure, etc.).

doc didn't give the me wonder drug advertised on tv, therefore one star.

~~~
danielweber
> People rate their "experience", rather than actual effectiveness.

Most people have absolutely no idea what effectiveness is.

I read the post-mortem written by a founder of a effectiveness-comparison
company, and their market research eventually found out (too late, because
otherwise they would never have started the company) that people didn't really
want it. They wanted to feel like they were being treated well and were high-
status and could have someone to blame if things didn't work out. Taking the
path of best expected results wasn't really on customer radar.

------
DanBC
If you're in the UK: Your local health community probably has some useful
information that will help you avoid going to A&E units if you don't need to.

Here's the page for Gloucestershire:
[http://www.asapglos.nhs.uk/](http://www.asapglos.nhs.uk/)

~~~
jon-wood
My experience with anything like that has been dreadful. If it seems like an
emergency, run a mile from things like NHS Direct - the worst case was calling
about our then 8 month old having trouble breathing, and being told a doctor
would contact us within an hour. 18 hours, and an ambulance trip to A&E later,
we had a call from the doctor's receptionist asking if we'd been seen.

~~~
DanBC
Yes, in an emergency go direct to A&E or call an ambulance. The asapglos
website and app give some advice about when to got to A&E or call an
ambulance.

I'm sorry you had such a terrible experience for something so serious.

------
spamlord
I strongly recommend people avoid hospital ERs for anything but a true life
threatening emergency. If you break your foot/arm or something go to an urgent
care place that is 24x7, it will be way cheaper and basically the same care.
Hospitals are a scam.

------
chrisbennet
It sucks to get judged based on things that you have little or no control
over. An ER nurse or doctor cannot control staffing levels for instance. I get
that.

But, if one emergency room has shorter wait times (because the staff aren't
spread as thin) than another, why shouldn't I take that into account when
choosing where to go?

------
bpodgursky
How will they avoid sampling bias by getting reviews from the ones who died?

~~~
animefan
They could encourage people to leave 0 star reviews and update them if they
survive.

------
omouse
Yelp is fucked; they don't seem to have innovated in years and they've been
riding on the whole reviews for restaurants for a while. Expanding into
healthcare doesn't make sense unless they split it out as a separate web site
or app; Yelp is for restaurant reviews, this only dilutes their brand.

------
crymer11
This is mildly infuriating. Maybe it's different outside the small towns and
rural areas I grew up in, but there I would be comfortable wagering the
majority of the people visiting the ER are there to get pills.

I broke my leg from a rock climbing fall and was taken to a hospital in
Tullahoma, TN. The fracture was difficult to see on the x-ray and the ER doc
thought I just had a aprain. While filling out my paperwork, he asked me what
kind of pain medication I wanted. When I told him I didn't want anything, he
jerked to a stop and looked up at me when an incredulous look.

While in college at Johnson City, TN, I ran into a wall head-first diving for
a basketball in a pickup game. My buddy took me to the ER to have them check
on the concussion I had, and while we waited, someone walked in, asked what
the wait time was, said, "that's too long and we'll be back later," and left.
They got us into triage quickly, but we ended up waiting several hours (with a
lot of folks in the ER clearly there to get pills) before my friend told the
receptionists that we weren't there to get drugs, we just wanted to have them
check to make sure my brain was okay. Within a matter of minutes they had me
back to radiology and out the door shortly thereafter.

~~~
dignan
How are you establishing that people are "just there to get pills"?

