Local hospitals work to speed up emergency room stays

As the amount of time patients are spending in hospital emergency rooms creeps higher nationally, the region's three hospitals are working to keep their average patient times well below the national averages, even as patient visits increase.

Across the country, patients spent an average of four hours and seven minutes from the time they came into a hospital emergency department, received treatment and were either discharged or admitted to the hospital, according to a report released last week by Press Ganey. The firm conducts patient satisfaction surveys at hospitals nationwide. The 2009 averages were four minutes longer than in 2008, and the highest since the emergency department survey was first done in 2002.

In response to the report, the American College of Emergency Physicians said it is "very concerned about patient safety being jeopardized by long wait times," and that national health care reform efforts must address the growing demand for emergency medical services. Health care coverage, it said, "is no guarantee of health care access."

The group's president, Dr. Angela Gardner, said "nobody can possibly call a national average of more than four hours in the emergency department something to cheer about."

The average time for Connecticut hospitals, the same as the national average, ranked 29th longest. Rhode Island hospitals ranked 43rd longest, at four hours and 42 minutes. Iowa had the shortest averages, at just under three hours, and Utah had the longest, with just over eight hours.

The data is based on evaluations of more than 1.5 million patients treated at 1,893 hospitals in 2009. It represents the total time patients spend in the emergency department, not just the time in waiting rooms.

L&M: 'Triage doctor'

At Lawrence & Memorial Hospital in New London, the average time a patient spent in the emergency department in 2009 was four hours and 12 minutes - five minutes longer than the state and national averages - but now stands at three hours and 36 minutes for the first six months of 2010, Nicole Porter, nurse manager of the Emergency Department, said Wednesday.

This has been achieved despite increasing numbers of patients using the emergency department, a national trend also noted in the report. In 2007, L&M's main emergency department in New London saw 41,450 patients; in 2009, it saw about 47,000. Porter said that by the end of 2010, the number of patients is likely to reach 50,000.

"We're having to see a larger volume of patients, so we've had to get real efficient," Porter said. "We anticipate it will continue to grow."

More patients are using the emergency department, she said, because of layoffs that have left them without insurance, or because there are too few primary care doctors.

L&M has been able to cut more than a half hour out of the average emergency department stay by assigning a "triage doctor" to do a quick assessment of a patient within a few minutes after arrival. The doctor orders key lab work, diagnostic tests and medications the patient will need at that time rather than waiting for the complete exam.

"What people want is to see a doctor right away, instead of having to jump through all the hoops first," Porter said. "We are very proud of what we've been able to do."

The creation of a "fast track" area where patients with relatively minor conditions, such as sore throats, can be seen has also help quicken wait times, she added.

Westerly: 'Bedside registration'

The Westerly Hospital has also been able to dramatically reduce the time patients spend in the emergency room, cutting the average stay nearly in half. In 2009, said Brian Jordan, hospital spokesman, patients spent an average of three hours in the emergency department. Thus far this year, the average is one hour and 38 minutes.

"Two things that we've done are primarily behind the decrease," Jordan said in an e-mail message. "First, when possible, patients are brought into the ED for bedside registration."

Second, as soon as patients are in the triage area, protocols related to the ordering of X-rays, labs, EKGs and other tests are ordered by doctors and nurses, he said.

Backus: 'Parallel processing'

At The William W. Backus Hospital in Norwich, the average patient stay in the emergency room was two hours, 58 minutes in 2009, said Shawn Mawhiney, hospital spokesman. Thus far this year, patients are staying longer, about three hours and nine minutes. This occurred as more patients are being seen - 63,648 in 2009 (from 58,993 in 2008). The trend thus far for 2010 indicates the patient total will reach 67,000 by the end of the year, Mawhiney said.

"That's good, considering the fact that the numbers are as low as they are, considering the increased volume," he said. "Everybody's working to be as efficient as possible."

Like the other local hospitals, Backus has increased the efficiency of the emergency department by changing patient flow patterns and using "parallel processing." That means a patient doesn't have to wait to be registered to be moved into a room and begin being examined by a doctor.

"We bring the registration to you," he said.

Backus also has begun using its data from past years to determine the busiest times, and schedule staff accordingly. Electronic medical records are increasing efficiency, too, he added.

Because it anticipates emergency patient volumes will continue to increase, Backus recently submitted a request to state hospital regulators to open a free-standing emergency room in Plainfield. That will help take some of the pressure off the main emergency department, he said.



Length of visit:

2002: 3 hours 36 minutes

2008: 4 hours, 3 minutes

2009: 4 hours, 7 minutes

Patient volumes:

1990: 90 million

2008: 123 million


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