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Emergency Rooms Work To Provide Faster Care

If you think ambulances are the only things moving quickly when it comes to emergency medicine, you likely haven't been to a local emergency department lately.

Seeking to lay to rest the painful image of patients warehoused in emergency room waiting rooms for hours, ERs are taking steps to provide not only better but swifter service.

They're creating express evaluations for minor problems and using electronic medical records and software to better track patients, available rooms and lab results, reducing waiting time to as little as a half hour.

They're trying to improve their process to better serve patients and in synch with study by the American College of Emergency Physicians that found perceptions of waiting time were the biggest factor in evaluating care.

While patients said quality of communication by nurses and doctors mattered, satisfaction correlated most closely with speed in being seen by providers.

"We started working on removing the obstacles that prevent patients from seeing physicians quickly," said Joan Faro, chief medical officer of Port Jefferson's John T. Mather Memorial Medical Center. The hospital examined "all the processes they go through before the doctor gets to them. "

By removing unnecessary steps (through a process called lean engineering), Mather has cut the time between arrival and seeing a provider from about 90 minutes to 30 minutes. And other hospitals also are moving patients along more quickly.

A study for the Centers for Disease Control and Prevention found the mean waiting time to see a physician in the ER to be 33 minutes. Nearly 20 percent of patients saw physicians in under 15 minutes and more than half saw a physician in less than an hour.

Hospitals are speeding care in the ER by taking only basic information upfront rather than conducting lengthy interviews that strand patients in a pile of paperwork.

"There's a focus on prompt assessment ... and moving them into the treatment area," said Dr. Andrew Sama, senior vice president of emergency services for the North Shore-Long Island Jewish Health System. "I don't need 52 questions asked of the patient prior to creating a record and getting them an account number or medical record number, if they've never been here before. "

Faro said Mather shaved 45 minutes off waits with its own mini-registration, with additional information obtained only after a patient has already been seen by care providers.

"We get enough to establish a record so we can order tests," Faro said. "That was a big time-saver in terms of patients. "

Mather also is speeding patients through the ER with the help of electronic medical records, which makes information easily accessible to every department,

"It's all electronic," Faro said. "Recording what happens with a patient in a document takes more training and could take longer time. "

South Nassau Communities Hospital in Oceanside, meanwhile, sends patients to the hospital radiology department rather than making them wait until there's an opening for the ER's X-ray equipment, said Chief Operating Officer Joseph Lamantia.

Faro said the ER needs to be judged not only on how it treats those gravelly ill, but also how it treats those with minor problems. A minor problem, she said, is no reason for a major wait.

"In the ER, a lot of time the people with the most complicated things get the most attention first. That makes sense. That's what triage is all about," she said. "But if a patient comes in for a prescription and could be in and out in 10 minutes, we want them out in 10 minutes. "

Sama said even with a wide range of measures designed to speed things up, patients sometimes spend several hours when there's a sudden surge in use.

"You're full," Sama said of those times. "There are a variety of reasons for that. The only reason people wait that long is when every open slot in the ER is being utilized. "



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