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Patient wait times at Emergency Room improve, but still well above average

STORY BY MEG LAUGHLIN (Week of January 15, 2015)

Patient wait times at the Emergency Room of Indian River Medical Center showed a small improvement in 2014 over the year before, but were still far worse than Florida and national averages as well as the wait times at Sebastian River Medical Center or Lawnwood Regional Medical Center.

The problem at IRMC appears to have nothing to do with the dedication of the staff or the quality of care, but rather with a lack of places to put patients and treat them, which causes bottlenecks and slows down the admission and discharge of ER patients.

“We are trending in the right direction, but we are not where we want to be,” operations manager Devon Bloom said Friday.

Where ER patients waited an average of six and a half hours to be admitted at Indian River in 2013, this past year they waited an average of five hours and 45 minutes.

Both the Florida and national averages for most of 2013 and a quarter of 2014, according to Medicare, were about four and a half hours. The average at Sebastian – a smaller hospital – was a little over four hours, and at Lawnwood, which is about the same size as Indian River, the wait till admission was four hours.

In 2013, the average wait for ER patients at Indian River until discharge was just under three hours. In 2014, that wait was about five minutes less. The Florida and national averages were about 2 hours and 20 minutes. At Sebastian the wait till discharge averaged two hours and at Lawnwood, it was two hours and 20 minutes.

Perhaps the most striking differences occurred with the time it took for ER patients at Indian River to see a healthcare professional – usually a triage nurse. In 2013, the average time was 46 minutes. In 2014, it was 40 minutes. The Florida and national averages were approximately half that time, or 23 minutes.

At Sebastian River Medical Center the average time to see a triage nurse was 36 minutes and at Lawnwood it was between 6 and 9 minutes.

Indian River’s effort to improve ER waits came to a head in December, 2013, when the hospital replaced a team of ER doctors under contract with Emergency Physicians of Central Florida with a new team from ApolloMD.

But a month into the new team’s tenure in January, 2014, hospital CEO Jeff Susi told his board that the hospital was experiencing “extremely long wait times” because of “a lack of staffed beds.” The goal, he said, was to create more treatment space for the ER and to staff existing beds on the hospital floor in order to get patients out of the ER more quickly.

A month later, in an “open dialogue” posted on the hospital website, Susi reported improvements that, unfortunately, turned out to be short-lived. But, over the course of the year, the numbers did improve slightly.

In an effort to improve those numbers at Indian River, a nurse now stands behind the admissions desk and questions patients as they are getting a wrist bracelet. This information is used to quickly decide how acute their condition is and direct them accordingly.

“Patients are seeing doctors more quickly because of the change in how patients are first received and immediately assessed,” said Devon Bloom, the hospital ER operation chief.

Further, with increased ER staffing, for every eight patients in an ER bed there are now two nurses and one doctor, said Bloom.

A nagging problem at IRMC has been the number of people who come to the ER, get a wrist bracelet and wait so long that they give up and go home.

In 2013, approximately 1,900 patients left the ER at the hospital before being seen by a healthcare professional – or 3.4 percent of 56,538. In 2014, about 30 fewer patients left, or 3.2 percent of 58,337 patients arriving at the ER.

The Florida and national average for patients who give up and leave before being seen by a healthcare professional is 2 percent. At Sebastian River Medical Center 1 percent of patients leave and at Lawnwood, every patient is seen by a healthcare professional and its average of those who leave is 0 percent.

When asked why the national and state averages and the performances of Lawnwood and Sebastian are better, Bloom said it was difficult to say, but said that IRMC “is striving for integrity, service and excellence in all we do.”

To lower the walk-out numbers, however, ER administrators have begun making rounds through the waiting room and ER-occupied rooms to keep patients and their families apprised of what will happen next.

Marketing and Communications Director Lewis Clark said he thinks education is key to improving the numbers, and sees it as his job to better educate prospective ER patients about urgent care clinic choices and preventive medicine so that the hospital ER can better serve people with true emergencies.

“We would never turn anyone away but education is key to better serving our community,” he said.

In the meantime, said Bloom, he, ER chief Roderick Bennett, who is regional manager for Apollo, and the entire ER staff at Indian River Medical Center are doing everything they can to improve patient care in the ER, speed up how quickly it takes place, and give patients a good overall experience.

“Unfortunately,” he said, “there are no quick fixes when it comes to people caring for people.”