January 22nd, 2021

Silence in the ER Waiting Room

Justin Schrager
Written byJustin SchragerChief Medical Officer

In the middle of this pandemic, the hospital staff, especially those of us who work in the ED, are stretched thin. The smallest things can make the difference between a “good” day and a “bad” day. More often than not, these little things are courtesies: from patients to providers, providers to one another, and between the ED staff and the people they are caring for. Everything runs smoother when people are compassionate. The catch-22, of course, is that friendliness tends to suffer when it is needed most. In healthcare wellness circles they like to call this “compassion fatigue.” The healthcare industry, with an eye on patient experience and staff retention, has made it a point to address this problem head on. The truth of the matter is that efforts to curb compassion fatigue always require interventions, buy-in from clinical staff, and maintenance--in other words, it requires staff attention at a time when attention is at a premium.


It was within this context that my software startup, Vital, and my ED (Emory University Hospital) crafted an intervention meant to vastly improve the patient experience in the ED while at the same time asking the staff to effectively do nothing extra. We set out to create EHR-connected patient experience software that required no training, maintenance, reporting, or other headaches for the already overworked staff. One of our founding goals was to improve the experience of giving and receiving care in the ED. To that end, we couldn’t ask the staff to sacrifice what is left of their attention and effort in order to maintain our software and ensure the patients were able to use it. The software, which we call “ER Advisor”, had to be net-positive for both providers and patients. It had to make things “good” for the patients and their families and keep things “good” for the ED staff.

We launched our software in early 2020, just prior to the start of this global pandemic, and it has now been running unabated throughout the pandemic, interacting with tens of thousands of patients and their families with great success. I was a bit nervous about how patients and providers would accept the software in those first few days. I truly didn’t know if what Aaron and I had spent years building would succeed. I remember the first few days vividly. I planted myself at the registration desk in the waiting room, and hoped against hope that it would achieve our two-part goal. Patients signed up without extra effort or fuss, and the staff were able to do their normal jobs.

Fortunately, everything worked out, and it was during those first few days that I knew we were on to something. Not because patients were effusive in their praise of their care experience with our software, or that the clinical staff found it helpful. No, I knew we had succeeded when I heard nothing at all.

The ED waiting area was busy, but no one was coming up to the desk. No one asked about their wait times or any of the other common waiting room questions. The registration staff were able to complete their clerical work, while the patients had their questions answered on their phones, and the triage nurses were able to efficiently and quickly conduct their work without interruption. In the words of the waiting room patient access representative who sat next to me in the waiting area for the first few days:

I find it particularly fascinating that no one has asked me about wait times. Not one person has walked up here since I have been working to ask about their wait.

For those of you who have worked in an ED waiting area, this is an almost unheard of statement. The nursing and registration desks in an ED waiting area are, for the most part, high stress, high touch, and high risk from a patient experience standpoint. For those unfamiliar with this space, imagine something like the boarding desk at the airport if every flight was always delayed and the passengers weren’t even sure when they were supposed to have left in the first place.

After we turned on Vital, things just got quiet.

We estimate that in a typical ED, Vital is decreasing the need for staff to answer general questions by about 1500 interactions a month. In my ED, the difference in attention, the ability for staff to focus on the most pressing customer service needs, has had a truly positive impact on our staff and patient population.

We were able to harness technology to provide answers, to keep the patients and their families informed, and possibly most importantly, we were able to free up precious attention for the clinical staff to focus on the most important part of their job: caring for patients.