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Illinois ERs Compete for Patients

Springfield-area residents are being wooed to choose one emergency room over another.

St. John's Hospital, which has lost ground to Memorial Medical Center over the past half-dozen years when it comes to the number of patients seeking care in the ER, launched its "ER Care Times" campaign a few months ago, complete with billboards, signs on buses and a prominent spot on the St. John's website.

The St. John's campaign is the first ER promotional effort by the hospital in several years.

Memorial, which is almost constantly advertising its ER, recently kicked off its newest marketing effort - "Memorial ER Stories" - in which it solicits testimonials from former patients for promotional use in exchange for a free T-shirt.

Neither hospital would disclose what it is spending on the advertisements. But the hospitals' tactics to attract more patients to their ERs aren't unique in highly competitive health-care markets across the United States at a time when the population is aging, sicker people are living longer and more emergencies are happening outside doctors' regular office hours.

"It's a primary access point for care," said Caroline Steinberg, vice president for trends analysis at the American Hospital Association.

'The best' vs. 'No. 1'

Rosemary Stuttle, marketing director for Peoria's Methodist Medical Center, which advertises its ER to compete with two other hospitals in that city, said health plans often allow people to self-refer to emergency rooms.

"That's kind of an impulse buy," she said.

Though emergency rooms may not be money-makers in themselves, hospitals know that a large chunk of their inpatient admissions, including profitable heart care and surgeries, come through the ER, so making the ER a friendly, efficient place for patients to use makes sense.

"The emergency department truly has become the front door of the hospital," said Chuck Callahan, vice president of operations for Memorial's parent organization, Memorial Health System.

Hospital officials commonly refer to the ER as the "emergency department" since it's almost never one big room but many smaller, private rooms.

More than 50 percent of Memorial's inpatient admissions come through the ER, and about 20 percent of the patients who enter the ER are admitted to the hospital instead of being treated and released, Callahan said. Memorial officials wouldn't discuss the ER's financial performance.

Memorial's ER, which trailed St. John's ER in 2005, now is ahead of St. John's in terms of ER visits. St. John's is trying to reverse a decline in visits the past few years - a situation that is contrary to the national trend of rising emergency room use.

Regardless, St. John's spokesman Erica Smith said St. John's ER is "the best" in the area. Memorial claims on its website to have the "No. 1 ER."

Statistics from Memorial and St. John's indicate that combined total number of annual visits to both ERs increased by 14 percent, or 15,356 visits, between 2005 and 2010. Memorial appears to have benefited from most of that increase.

Because both hospitals spend alternate years as the city's Level 1 trauma hospital, trauma care, which sends an average of three patients a day to one of the ERs, doesn't play a role in shifting market share.

No 'bypass' here

Overcrowding in ERs is a major problem throughout the country, and both ERs in Springfield have focused on reducing waits for care. St. John's officials said the average wait is 30 minutes or less for a patient to be placed in a room where treatment begins. Wait times in the ER are posted on the hospital website and can be sent out via text message.

Callahan said most Memorial ER patients are "in a treatment bed in 10 minutes." Memorial's average "door-to-door" time between arrival and discharge in the ER is less than 2½ hours, compared with the national average of about eight hours.

But the Springfield hospitals haven't been so busy that they've had to send ambulances to other hospitals. The practice, known as going on "bypass," happens up to 2 percent of the time at many hospitals in the Chicago area and in Rockford, Galesburg and southern Illinois.

The University of Chicago Medical Center was on bypass 23 percent of the time in 2010 - the highest rate in the state by far. That situation is related to the closure of seven hospitals over the past two decades and a lack of primary care on Chicago's south side, said hospital spokesman John Easton.

It's a myth that most ERs are clogged with patients, both poor and middle class, who have non-urgent medical problems, according to the American College of Emergency Physicians. The share of ER patients with non-emergency conditions decreased to less than 8 percent in 2007, the most recent year for which statistics were available.

Callahan said some people use Memorial's ER because they lack a regular doctor, but most of the increase in ER volume relates to the growing number of people, many of them baby boomers and older, whose conditions have deteriorated and need emergency care.

Even during regular office hours, doctors are sending those patients to the ER, Callahan said.

He said Memorial treated 45,000 patients in the ER in 2003 and is on pace to reach 70,000 by the end of the current fiscal year in September - a 55 percent increase he attributed partly to Memorial serving more of the area's patients and to more people using ERs locally.

Memorial's advertising encourages people to use the hospital's ER, he said, but he believes good service keeps them and their families coming back.

Memorial's opening of two new ExpressCare walk-in clinics over the past two years has helped to take some of the load off of the emergency department, he said.

"Because of that, the people who come to the 'ED' tend to be sicker now," Callahan said.

Treated like a 'human'

Memorial has been able to accommodate the growth while actually reducing wait times, Callahan said, noting that the current ER opened in 2000 with 30 beds and was expanded by 14 beds in 2006. A $1.15 million renovation project will add eight more beds to the ER, which will bring the total to 52.

Virden resident Brent Dunn, 47, said he was in an ER treatment bed five minutes after walking into Memorial on Feb. 11 and informing the staff of symptoms he later learned were small heart attacks in the preceding hours and days.

Dunn is an auditor for a regional cable TV company, but said he can't afford the health insurance offered by his employer. He said he chose Memorial's ER because of good experiences he and other family members have had at Memorial in the past.

After the ER staff administered tests and gave him medicine, he was relaxing in a private ER room with his wife, Teresa, and expecting to undergo a diagnostic cardiac procedure at Memorial the night of Feb. 11. He eventually received an angioplasty and stents to open two clogged coronary arteries. He was discharged the next day.

Dunn said he appreciated the attention he received while waiting for test results in the ER.

"They're constantly checking on your progress," he said. "They keep you updated on what's going on. I can't believe the care I'm getting. They go above and beyond. They talk to you like a human being."

Serving the needy

Officials at both hospitals say they have devoted resources to reduce the time ER patients who are admitted to the main hospital must wait for a bed to become available. Memorial's ER, for example, currently "boards" admitted patients for an average of 140 minutes while they wait for a room. The hospital wants to reduce the wait to 120 minutes, Callahan said.

The latest incarnation of the ER at St. John's was constructed 11 years ago, and the hospital's measures of patient satisfaction in the 31-bed ER have shown steady improvement for the past several years, according to Amy Jones, nursing director for emergency service.

The ER itself isn't profitable for St. John's, in part because of the number of Medicaid and uninsured patients seeking care there, but Smith said serving the needy is "part of our mission."

Jones said the hospital receives a lot of compliments for swift and efficient care in the ER.

One thing that "sets us apart," she said, is the fact that the nursing staff also tends to the needs of the patient's "significant other," whether that person needs a meal, a kind word or phone calls to assist with child-care arrangements.

St. John's, which operates a children's hospital within its walls, is preparing to renovate some existing patient rooms and waiting areas in the emergency department so pediatric patients and their parents can have more privacy, Jones said.

The entire ER is expected to be moved sometime after the hospital's $172 million renovation project is complete in 2014. No timeline for the move has been scheduled.


ER visits

FY Memorial Medical Center...St. John's Hospital

2010 68,118...56,858

2009 65,747...57,439

2008 64,698...59,074

2007 60,190...60,314

2006 53,549...60,624

2005 49,215...60,405

Note: Fiscal years end Sept. 30 at Memorial Medical Center and June 30 at St. John's Hospital


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