Audit Report on the Evaluation of the Efforts to Manage Emergency Department Wait Times by Kings County, Lincoln, and Elmhurst Hospitals

AUDIT REPORT IN BRIEF

This audit determined whether the New York City Health and Hospitals Corporation (HHC) had controls in place to evaluate the efforts made in reducing Emergency Department (ED) wait times.

According to the Center for Disease Control (CDC), ED visits nationwide increased 32 percent between 1999 and 2009, resulting in ED overcrowding and increased wait times in some hospitals.  New York State has the fourth-longest average ED wait time in the nation (6.1 hours).  ED crowding in the United States has been called a “national epidemic” by the Institute of Medicine .

HHC’s 11 acute care hospitals reported 1,190,413 ED visits in 2012.  Since 2007, HHC hospitals have been using an approach called Breakthrough, based on an efficiency process developed by Toyota, to address ED wait time delays as well as to identify inefficient processes, improve patient care, and generate savings and new revenue.

Audit Findings and Conclusion

Kings County, Lincoln, and Elmhurst hospitals failed to provide sufficient evidence to support their claims of reductions in ED wait times.  The limited documentation provided by these facilities generally did not reflect changes before and after the initiatives to reduce ED wait times were implemented.  As a result, we were unable to determine the extent to which these hospitals formally evaluated and measured their wait time reduction efforts.  Thus, while Kings County and Lincoln Hospitals publicly reported reductions in wait times in HHC newsletters, we were unable to confirm the claimed reductions as a result of HHC’s failure to provide evidence to substantiate these claims.

Audit Recommendation

Based on our findings, we recommend that HHC should:

• Assess the effect of initiatives undertaken to reduce ED wait times by collecting adequate supporting documentation and engaging in a thorough and comprehensive evaluation to determine whether goals are being met and resources are being efficiently allocated.

Agency Response

In their response, HHC officials agreed with the audit’s recommendation.