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Tennessee ER Focuses on Empty Waiting Room

Like most hospital emergency-room waiting areas, this one has shiny floors, comfortable chairs, a nurse and paramedic on duty and televisions perched at all angles.

But what the Baptist Memorial Hospital-Memphis emergency department doesn't have - and most others do - is a crush of patients waiting to see doctors. Even on a busy Friday afternoon prior to a holiday weekend, the waiting area is virtually empty.

"You don't find this anywhere," said Mark Ottens, the hospital's director of emergency services. "This is the ultimate goal - to have that waiting room empty."

At a time when emergency rooms across the nation face greater crowding pressures, with longer wait times for patients, Baptist and some other Memphis-area hospitals have streamlined procedures to allow more people to be treated in less time.

Long wait times are a problem not just because of the patient inconvenience and dissatisfaction they engender. They also have health implications, since treatment is delayed and patients can get discouraged and go home, leaving chronic problems unchecked.

Wait times have been rising in recent years as emergency room visits continue to increase - from just under 95 million in 1997 to nearly 117 million in 2007 - at the same time emergency departments have been closing by the hundreds.

In 2009, the average time spent in emergency departments nationwide rose to four hours and seven minutes, up 31 minutes from 2002. And patients waited an average of 58 minutes before seeing a doctor.

But through a series of modifications that began in March, the Baptist emergency department has reduced the average wait time for patients to see a physician from nearly 55 minutes to about 20 minutes. It has shaved the total amount of time patients spend in the department - before they're sent home or admitted to the hospital - from five hours to four, Baptist officials say.

With the improvements, the department has been able to accommodate a 10 percent increase in patient volume.

"What we've done is increase our ability to see more patients by making ourselves more efficient," Ottens said.

The improvements begin at the front desk of the waiting area. There, the nurses and paramedics serve as "pivot" people, making quick assessments as to which of two categories a patient should be placed.

One category involves those whose problems require urgent intervention, such as cases of inability to breathe. They are sent straight to treatment.

Patients in the second category, involving chronic and less urgent problems such as anemia, nausea or diabetes, are routed into an intake area where three medical providers are on duty handling six rooms. Numbers on the doors tell doctors the types of cases in each room, and there is a site in the intake area for patients to receive lab results so they don't have to go back to the waiting area.

In the past, the nonurgent patients signed in at the front desk, then went back to the waiting room. They ended up explaining their problems to two different nurses and making more stops before undergoing tests or treatment and getting results.

"Every time you have someone moved from one place to another, you're losing valuable time," Ottens said.

Then , Baptist's emergency department could treat only about eight of the average 10-12 patients who arrived each hour, leaving a backlog for later in the day. Now, with the backlog eliminated, Baptist has been able to direct more of its staff to the peak times.

"It's all about reallocating resources," said Dana Dye, chief nursing officer at the hospital.

As result of the greater efficiency, Baptist has been able to absorb an increase that has pushed its average patient load from 165 to more than 180 a day.

Baptist isn't the only local hospital that's been able to reduce emergency room waits.

Saint Francis Hospital, for instance, has developed several initiatives, including an "in-quicker" program in which non critical patients may call ahead for appointments and do most of their waiting at home, said spokesman Brent Baugus.

The four adult hospitals in the Methodist Le Bonheur Healthcare system, meantime, use extensive electronic medical record-keeping to ensure that most patients see a provider within 30 minutes and fewer than 2.5 percent of them leave without being treated, said Dr. T.M. Carr, emergency department director. At the same time, patient volumes have been growing 8-10 percent annually.

"It's kind of like the best mousetrap ever," Carr said of the streamlined system.

Other hospitals across the nation are meeting with mixed results using strategies that include separate tracks for non-urgent cases, building free- standing emergency departments and freeing up hospital beds by carefully scheduling elective surgeries, said Caroline Steinberg, vice president of trends analysis for the American Hospital Association.

"Most hospitals continue to struggle on how best to organize and manage emergency care to keep patients flowing through the system," she said.

Back at Baptist, the results are obvious in a waiting room that, for all its space and comfort , doesn't get much use these days.

"It's a nice problem to have," Ottens said.



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