Newport Hospital’s emergency department treats more patients more efficiently and effectively, says official

Dr. Anthony Napoli is medical director and chair of emergency medicine at Newport Hospital. / COURTESY NEWPORT HOSPITAL
Dr. Anthony Napoli is medical director and chair of emergency medicine at Newport Hospital. / COURTESY NEWPORT HOSPITAL

NEWPORT – If high patient volume equates to high revenue, Newport Hospital, a Lifespan facility, should be flush with money. According to a hospital spokesperson, its emergency department expects more than 3,100 visits during July, which would make it the busiest month in more than five years. The ED is fielding more patient visits than ever before and doing so more efficiently, while also scoring extraordinarily high patient satisfaction rates, Dr. Anthony Napoli, medical director and chair of emergency medicine at Newport Hospital, told Providence Business News.

Last October – the beginning of Lifespan’s fiscal year, Napoli, along with the hospital’s senior management and other senior staff from the ED, established some very clear expectations about the ED’s operations and processes. One goal was reducing wait times from its then-current one hour to 30 minutes. The Emergency Department Benchmarking Alliance data indicate a national average of 24 minutes for door-to-provider for community hospitals of similar size, said a Newport Hospital spokesperson.

The waiting room was converted into a triage bay and nurses were authorized to implement pre-approved protocol orders – for pain medications, lab work or other tests – rather than needing to have a physician order them, said Lisa Limea-Tessier, director of emergency services at Newport Hospital. For example, if a patient with chest pain comes in, the nurse can order an EKG or another diagnostic tool without waiting for a physician to order those tests.

With a 17-bed ED, processes had to be streamlined, said Napoli. During peak volume times, the ED directs low-acuity patients – those who can be seen and treated in under 90 minutes – to one of three triage bays, freeing up beds for high-acuity patients. Even before that determination is made, patients are evaluated initially by a triage nurse and, if appropriate, a second registered nurse and a physician or physician’s assistant.

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Since launching these new initiatives in October, the ED has made impressive progress, as compared to last year’s data. The median wait time for door-to-provider is 20 minutes, a 70 percent decline, and the percentage of patients leaving without being seen is now 0.5 percent, representing an 86 percent decline. On July 3, the ED set a one-day record with 133 visits; no patients left without being seen and door-to-provider median wait time was 16 minutes, said a hospital spokesperson. The ED typically sees 40 percent more patients in July than it does in February, for example, said Napoli.

The hospital’s ED is not Aquidnick Island’s sole resource for off-hours medical care. In an effort to expand patient access to medical care in the most cost-efficient fashion, Newport Hospital’s four primary care practices (one each in Portsmouth, Jamestown, Tiverton and Newport) now have walk-in “quick-sick” weekday hours from 8 a.m.-9 p.m.; the Newport location also offers Saturday hours for established patients, said a hospital spokesperson. Dr. Stephanie Maryeski was recently hired as Newport Hospital’s director of primary care, a newly created position.

Patient satisfaction – which Napoli identified as one metric that the ED addressed last October – is strong, according to results from recent Press Ganey national surveys, an anonymous questionnaire sent to a random sample of 10 percent of patients, said Napoli. For the last six months, the ED’s results put it in the top fifth percentile of similarly situated hospitals, said a hospital spokesperson. For the April through June 2016 period, it ranked in the 99th percentile in treatment of family and friends, 98th percentile for likelihood to recommend, 96th percentile overall and for its physician care, and the 94th percentile for overall care and for its nursing care.

With ED doctors rotating among Lifespan’s Newport, Rhode Island and The Miriam Hospitals, “there is essentially a ‘brain sharing’ …” said Napoli. “You’ll see … similar results start to happen [there]; Rhode Island Hospital has been able to reduce provider times.”

Beginning in 2017, Medicare reimbursements to hospitals will be affected by their rankings as compared to their peer institutions, said a hospital spokesperson. As such, the departments – emergency and otherwise – of hospitals will need to attend to metrics addressing medical care’s efficiency and clinical processes and patient satisfaction.

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