ERs trim those long waits

"New management": Changes at Riverside cut the average patient wait time by more than half.

Newport News - Service was so quick Monday morning at Riverside Regional Medical Center's emergency department that Samantha Bright-Burney hardly had a chance to crack the book she brought.

Riverside Regional Medical Center Emergency Department

"I maybe read four lines at the most. I didn't even get to sit down in the emergency room," the 57-year-old Newport News resident said. "That's one of the reasons I like coming here. If you've been anywhere else, you know you'll have to wait."

The service wasn't always that quick, though. Changes at Riverside's emergency department have cut in half the time it takes to see a doctor.

"Sometimes, I think we could've hung a sign out front that said, 'under new management,' " said Gary S. Kavit, Riverside's medical director of emergency services.

Actually, Riverside is under new management.

An out-of-state contract management group ran Riverside's emergency department until about two years ago. That's when Riverside officials, after fielding a lot of complaints, realized there was a problem and decided to take over.

"It takes a long time to come in and get out," said Renee Rountree, Riverside's vice president of trauma and emergency services. "We're sensitive to the value of our customers' time."

Because Riverside's emergency department was run by an out-of-state contract management group, some of the doctors were contracted doctors who didn't live here. Under the new system, the doctors belong to the Riverside Medical Group, live here and are vested in the community, Rountree said.

In February 2007, under the contract management group, it took an average of two hours after walking in the door to see a doctor. Over 18 months, the hospital started building a team of American Board of Emergency Medicine-certified doctors, who came on board last August.

The door-to-doctor time immediately fell to 74 minutes. In November, it dropped again to 45 minutes, while the door-to-nurse number was down to 30 minutes, Rountree said.

The extra money it cost to pay the contract management group — "the middle man" — was reinvested by adding more physicians, increasing physician staffing 30 percent, Kavit said.

"That means I have that many more doctors here each day," he said.

Some of the changes Riverside made were based on the book "If Disney Ran Your Hospital: 9 1/2 Things You Would Do Differently" by Fred Lee.

The color-coded scrubs system came from the book, for example: Doctors wear navy blue, nurses wear red, registration clerks wear green, greeters who are certified nursing assistants wear yellow and paramedics wear khaki. The system met some resistance at first, but it was later embraced as a badge of honor to work toward for those rising through the ranks, Rountree said.

And there are more changes in the works. The emergency department's goal is that within 15 minutes of walking in the door, patients will be triaged by a nurse, who will take their vital signs and help prioritize cases.

"It's not like the DMV, where you can come in and take a number," Rountree said.

They also aim to keep emergency room patients better informed. If a patient needs a time-consuming CT scan, for example, he or she will be told that it's a lengthy process so that the wait isn't unexpected.

Riverside is also testing a new procedure that would further reduce wait times. Riverside is one of 10 hospitals across the state trying out a new emergency department check-in process. Instead of getting duplicated questions from a nurse, followed by a doctor, a patient would be triaged by a doctor and a nurse at the same time. Riverside tested the new protocol a few days in December and again this month.

For the 64 nonemergency patients who were checked in using the pilot procedure Dec. 8, turnaround time — from the time a patient enters to the time the patient leaves — was slashed to 103 minutes. The average turnaround time for all patients, emergency and nonemergency, was as high as 300 minutes in 2007 and down to 214 minutes in November 2008, Rountree said.

It's hard to compare Riverside's wait times with other local emergency departments because hospitals calculate wait times differently.

Sentara, for example, calculates arrival-to-provider time, which could mean a doctor or nurse. At Sentara CarePlex in Hampton in 2008, the average arrival-to-provider time was 43 minutes. It was 39 minutes at Sentara Williamsburg Regional Medical Center in York County and 34 minutes at Sentara Port Warwick in Newport News.

At Mary Immaculate in Newport News, door-to-provider (which could be a physician, physician's assistant or nurse practitioner) time averaged 38 minutes the week of Dec. 21. It was 32 minutes at Bon Secours Health Center at Harbour View.

Riverside officials said it's also hard to compare Riverside to other emergency departments because it's the Peninsula's only level 2 trauma center. That means it's required to have nearly all the major specialists on call, and it's a referral center, taking the region's worst cases.

"All of the bad stuff that happens from Williamsburg to Hampton, Isle of Wight to Mathews, comes here due to the water boundaries" of taking patients to the nearest level 1 trauma center, Sentara Norfolk General Hospital, Kavit said.

Riverside's changes are making it a better place to work and receive treatment, Kavit said.

Before, the long wait time made it hard to retain nurses.

"How would you like to be a nurse in an environment where the patients are all mad because they have to wait for three hours to see a doctor?" he said.

The experience of nurses and patients are closely tied. If patients are happier, then nurses are happier, and if nurses are happier, patients will be happier. That turnaround is starting to happen, he said.

"We're definitely in a different place than we were a year and a half, two years ago," Kavit said.

On Monday, a day when Riverside tested the quicker check-in system, Maritza Rodriquez brought in her 19-month-old daughter, Neffatierre, who had a high fever and was vomiting and coughing.

After being whisked through registration and triage and then being placed in a room, a doctor was there within 15 minutes, Maritza Rodriquez said.

"It was really different. It was real fast," the 32-year-old mother said. "One of the reasons you don't like coming to the hospital is because it takes so long. Thank God it's different. Someone's trying to make it faster and easier."

Published: January 13, 2009



 

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