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Monterey County to Study Rapid Medical Evaluation Program

MONTEREY, Calif. -- Natividad Medical Center s busy emergency room in Monterey County may be getting an upgrade.

Two years after the California Emergency Physicians Medical Group took over the county-owned hospital s emergency operations, Natividad managers want to allow the firm to institute a new program aimed at treating emergency patients quicker and more efficiently.

On Tuesday, Monterey County supervisors will consider a contract change that would pay CEP an additional $456,000 to implement a rapid medical evaluation program at Natividad through June 2009.

The amendment increases the amount the county would pay CEP for management of the hospital s emergency department to about $1.7 million over the same period. Last summer, CEP signed an extension to its original two-year contract with the county that will keep it at Natividad through the end of the 2008-09 fiscal year.

Natividad emergency medical director Dr. Jeffrey Bass said he s been working on implementing the program since he took over the department a year ago, and has the support of the hospital s interim management team from Huron Consulting, Inc.

I firmly believe in this process, as does CEP, Bass said. We ve just had so much success.

Rapid evaluation

The rapid medical evaluation, or RME, program would dedicate new emergency department staff members solely to assessing and screening patients based on the acuity, or seriousness, of their illness or injury, as well as offering basic treatment.

The RME team consists of two physician s assistants, two nurses, an emergency technician and a registrar.

The team would work 10 hours a day, seven days a week, and would be the first medical contact for emergency room patients.

The team would work out of a special triage area between the waiting room and the emergency room treatment area. Patients with lower acuity health issues would be treated and released directly from the triage area, while the team would start medical workups on patients with more serious health issues before moving them into the main emergency room treatment area and to medical staff members best able to offer treatment.

The team would also be able to offer both patients and charge nurses critical information, informing patients about what they can expect during treatment, and alerting charge nurses about the number and acuity of waiting patients, the priority of care, and the kinds of treatments already initiated.

The system is designed to improve patient care by decreasing waiting times for evaluation and treatment. The expectations are that more patients will choose Natividad s ER for treatment, fewer patients will leave after growing tired of waiting, and that the hospital s bottom line will improve.

Used widely

According to Bass, CEP has found success with the program at hospitals throughout the state, including Santa Clara Valley Medical Center.

At Natividad, Bass and CEP have already experienced success in reducing patient waiting times by using an immediate bedding policy, which pulls patients out of the ER waiting room and into the main treatment area. The RME program should further reduce waiting times and improve efficiency, Bass said.

Bass said recruiting and hiring have begun for the RME team. Equipment such as new computers will still need to be purchased, so it will be a couple of months before the program can begin.

Remodeling planned

Bass said construction of the triage area essentially remodeling the emergency department is expected to begin in six to nine months. That would allow the RME program to operate at full speed, he said.

Natividad s 19-bed ER is providing care for about 35,000 patients per year, a 20-percent increase over last year, Bass said.

The ER staff has eight full-time doctors, six full-time physicians assistants (PAs), a cadre of part-time doctors and PAs, and a full staff of nurses.

Jim Johnson can be reached at 753-6753 or jjohnson@montereyherald.com.

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