"It's a really important concept," Roe said. "So we take the actual data on wait times and inflate by 20% so we can meet or exceed expectations. Why not set yourself up to succeed. Why not set yourself a target that you and your staff can meet."
Staff members are also careful not to fall into verbal traps, such as "the doctor will be with you in a minute" and "the nurse will get that medication for you in a second," Roe said.
Methodist Hospital in Memphis has gone to a different extreme by promising patients that they will be seen within 30 minutes, says Michael O. Ugwueke, DHA, FACHE, senior vice president and chief executive officer of Methodist North and South Hospitals. If patients are not seen within that time frame they receive a $20 gift card and a letter of apology.
"The 30-minute guarantee is not the end-all and be-all," Ugwueke says, "but it was our approach to create a sense of urgency around the emergency room and to involve the other departments within the hospital to truly change the culture, making sure everyone understands the emergency room is really the front door of the hospital."
White says Tomball helps set expectations in triage, where often a standing delegated order set may call for the patients' care to begin there rather than later. So if a CT is indicated, then the triage nurse may start the patient on oral contrast.
"We set the expectations that they are cared about from the moment they get there and that we are not going to delay implementing their care, and that the care we are starting in triage is the same care they would receive if they were on a bed in the back."
Eastman cautions against taking the notion of setting expectations at the expense of reducing overall wait times. "It does no good to be completely honest if what you are telling them is that they are going to be here 10 hours," Eastman says. "So you have to go back to the discussion of how to decrease the time they are in the emergency department."