Empty waiting rooms now goal for R.I. hospitals

STAYING PATIENT: Memorial Hospital Assistant Clinical Nurse Manager Jean Fitzpatrick, left, and Physician-In-Chief of Emergency Medicine Dr. Laura Foreman discuss a patient's condition. / PBN PHOTO/?MICHAEL SALERNO
STAYING PATIENT: Memorial Hospital Assistant Clinical Nurse Manager Jean Fitzpatrick, left, and Physician-In-Chief of Emergency Medicine Dr. Laura Foreman discuss a patient's condition. / PBN PHOTO/?MICHAEL SALERNO

It’s been nearly nine years since Michael J. Woods died of a heart attack while waiting for treatment in Kent Hospital’s emergency room, but his death is still having a ripple effect in Rhode Island hospitals.

Woods, brother to famed Rhode Island actor James H. Woods, spent nearly three hours waiting to receive care before he died. His family brought a high-profile lawsuit against Warwick’s Kent Hospital alleging wrongful death, which subsequently resulted in an agreement that altered the hospital’s emergency-department policies to ensure patients receive speedy care.

“It’s empty,” said Dr. Peter F. Graves, chief of emergency medicine at Kent Hospital, when asked what the hospital now uses its waiting room for.

“I do think that [lawsuit] agreement led to a lot of the solutions that are now in place,” he added.

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The changes, first implemented in July 2011, require that patients be treated immediately when they come into the emergency room. Ten hospital beds are dedicated to incoming patients, but they don’t stay long. A speedy turnover moves them to another space once they’ve seen a provider.

Since implementing the new policies, Kent’s emergency department has seen its rating levels rise from being “about as bad as they could get,” as Graves describes it, to now scoring among the highest in the nation in terms of patient satisfaction and experience of care.

And other hospitals have noticed.

Earlier this year, Memorial Hospital of Rhode Island announced its new implementation of a “rapid assessment model,” aimed at cutting in half the amount of time a patient waits in its emergency department.

“We recognize that one of the biggest obstacles to receiving care in the Emergency Department is the wait time,” said Dr. Laura Foreman, chief of emergency medicine at Memorial, in a statement.

Rather than asking for patients’ insurance information upfront, Kent does it on the back end of the visit to further cut down on wait time.

“Other places do it with a bedside registration service, but that can be intrusive,” Graves said. “We treat all incomers so we can collect it at the end of the visit so we don’t delay those incurred.”

Traditional practice is that a patient walks in and receives “triage” care, which is a process in which a patient’s treatment is based on the severity of their condition. If a hospital bed is available, the patient is in luck. If not, the patient is asked to wait in the waiting room.

“[That] is not an ideal process,” Graves said. “It has been tried over the years as the traditional model, but as [providers] want to improve safety there’s been a desire to abandon it.”

Pawtucket’s Memorial Hospital says the average wait time for a patient is more than 40 minutes, but its new rapid-assessment model of care will cut that down to just 20 minutes.

So how does it work?

The hospital says their model streamlines the patients’ emergency room experience. Now, when a patient arrives, he or she is immediately brought into an “intake booth” in the treatment area where the process of registration, bed assignment and meeting with a nurse or health care provider happens quickly.

“Once testing is done, we can decide if the patient needs to be admitted for further treatment or discharged,” Foreman said. “This creates a more efficient and effective Emergency Department.”

Edward Schottland, acting president at Memorial, said in a statement that the hospital is committed to providing high-quality service to its patients and that this model helps them get there.

“Our rapid-assessment model of care not only ensures faster service for our emergency department patients, but means that their overall experience in the [department] is shorter and more comfortable,” Schottland said.

The model comes at a time when hospitals nationwide are trying to find ways to reduce the waiting time in emergency rooms. From 2003-2009, the mean wait time in U.S. emergency departments increased 25 percent from 46.5 minutes to 58.1 minutes, according to a 2012 study done by the Centers for Disease Control and Prevention.

The mean wait time increased along with the increase in the volume of visits. Between 1999-2009, the number of visits to U.S. emergency departments increased 32 percent from 102.8 billion visits to 136.1 million visits in 2009, according to the CDC.

Before the new method of rapid assessment at Kent, Graves said, the wait time was so bad sometimes patients would just up and leave before ever being seen, “because they were sick of waiting.”

Now, patients are assessed in 15-20 minutes on average, which is monitored by the hospital each week, according to Graves. About half of the hospital’s waiting room has been transformed into bays and the other half – if ever used, he added – is for waiting friends or families.

“Patients come in and they are seen because they don’t have to wait anymore,” Graves said. “They get seen by a health care provider and leave happy.” •

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