Communication Is Key: In The Emergency Department, Informed Patients have A Better Experience

“Hurry up and wait” could be the slogan for emergency department (ED) visits in the US. The Centers for Disease Control and Prevention (CDC) data from 2017 puts the average ED wait time at 40 minutes, but millions of patients can wait two or more hours before seeing an ER provider —with the DC metro area, Maryland and Delaware clocking in anywhere from three to four hours, or more. And that’s just waiting to see a provider. 

From check-in to discharge (for those not getting admitted), a patient will spend an average of 2¼ hours in the ED. And a long ED visit that lacks clear, consistent communication can be the lynchpin for patient satisfaction, even if providers are delivering high-quality care. 

Per a 2018 study from the Journal of Patient Experience, the biggest contributors to poor patient satisfaction are ED wait times and a lack of communication. Because ED visits are often coupled with an incredible amount of information asymmetry and lack of communication, patients and their families don’t usually have visibility into the ED workflows and don’t know what to expect during their visit. Add Covid-19 protocols and overcrowding to the mix, and health systems face an uphill battle in delivering an acceptable patient experience in the ED. 

To better triage Covid-19 patients and adhere to safety protocols, Dignity Health—part of CommonSpirit Health, a 21-state non-profit health system—looked to Vital. The Vital platform provided Dignity Health’s busy Arizona-based EDs with Covid-19 pre-screening tools, automated communication, and one-way messaging for nurses and patients that helped keep patients distanced, properly screened and well-informed. 

With Arizona seeing some of the highest ED wait times in the country and Covid-19 adding another layer of challenge on top of that, Dignity Health saw immense potential for Vital to make an impact. The health system wanted to not only improve patient communication, but keep patients engaged with their care post-discharge. 

As announced this week at HLTH 2021, over the course of six months after launching Vital’s EDAdvisor program, Dignity Health’s St. Joseph's Hospital & Medical Center saw its “Likelihood of Recommending” Press Ganey score increase from 30 to 98. A year out, the health system saw a 250% score improvement for “Feeling Informed About Delays” and a 150% score improvement for  “Would Recommend.” 

So what is Vital? Vital is an artificial intelligence (AI)-powered software focused on improving patient experience and patient retention in hospital EDs. Vital’s ERAdvisor application gives patients and their caregivers real-time mobile updates about ED wait times, lab statuses, and next steps in the care process for a more streamlined, informed experience. 

In September, Vital secured $15M in Series A funding led by Transformation Capital, with a strategic health system joining the round alongside existing investors First Round Capital and Threshold Ventures. 

How it works: Patients receive a text message invitation when they arrive at the ED to connect to an interface within the hospital’s electronic health record (EHR). In addition to real-time tracking and communications updates, patients are also directed to post-ED care scheduling options within the system; this helps with patient retention and loyalty, as well as care coordination and outcomes. 

“Vital provided a very easy to use yet deeply-personalized approach to keeping a patient informed about their care experience,” said Christine Brocato, vice president of strategic Innovation at CommonSpirit Health. “There’s lots of tools that exist, like texting patients to let them know when they’ll be seen. With Vital, after you opt in, you don’t have to do anything else. It takes you to a webapp, and tells you, based on your specific circumstances, how long it’ll take and what the processes are. This provides a more expanded experience for patients in the ED.”

In addition, Vital can automatically keep friends and family informed about the patient’s visit, where the app also allows patients to digitally flag their needs to caregivers (they can request food, temperature change, assistance to the bathroom, etc). “You press those buttons on the Vital app, and it automatically delivers that request to one of the charge nurses so a caregiver can respond to and address the patient’s needs,” said Brocato. 

A big part of Vital’s success is its product-based approach as a company, with a focus on innovating and iterating quickly. “A lot of healthcare companies are really more service companies versus product-based, which means their code bases can't evolve quickly,” said Vital CEO Aaron Patzer, whose name may be familiar because he is also the founder of Mint.com, a wildly successful financial services startup that he grew and sold to Intuit for $172 million, just two years after its launch, in 2009. 

“We are a product-first company. In some sense, we don't do custom work; we wait for interest from multiple parties, and then focus on configuration,” said Patzer, noting that their custom approach lies in turning certain built-in features on or off, based on what the client needs. 

“We do something that's common in consumer space: continuous deployment and microservices architecture. Custom code bases aren't scalable. At Vital, we make micro adjustments on a daily basis, three to five times per day; there’s no quarterly code release,” explained Patzer, which those in healthcare technology know can be the achilles heel for health system clients of EHR giants like Epic.

While about 50 percent of patients need follow up care upon discharge, only about 10 percent seek it out, says Patzer, adding that when they do seekit, it’s often from a competitive facility.  

“There’s a big advantage for the health system to keep folks connected to care in their network; a  big retention and loyalty component for the health system. We create the rules first, then optimize with AI. So health systems can build a relationship with patients that lasts days or weeks after their stay, get better outcomes and reduce readmissions.”