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Hospital looks to improvements at emergency room


While wait times at the Emergency Room of Indian River Medical Center still are longer than both the Florida and national averages, the hospital is hoping a new approach to managing the department will soon reduce ER delays and improve performance.

Hospital president and CEO Jeff Susi, chief medical officer Charles Mackett and director of emergency services Dr. Paul Giasi outlined their plans for reducing patient frustration in an interview coinciding with the hospital’s assumption of full direct responsibility for the staffing and management of the ER.

Less than two years ago, the physician staffing company ApolloMD was brought in to take over from another ER contractor, Emergency Physicians of Central Florida, in a bid to address complaints about long wait times.  Now, the hospital is dumping ApolloMD and taking over direct hiring of ER physicians.

Figures just obtained for 2015 show there were slight improvements in average ER wait times on ApolloMD’s watch, but consultants recommended the hospital move to a directly employed physician model to increase patient satisfaction.

“When you have a company like Apollo and they staff multiple emergency rooms, if they're short someplace else, it's not unusual for them to pull from here to go elsewhere. That's not something we're interested in,” Susi said. “We're only staffing one emergency department. We won't pull those doctors out to go elsewhere.”

While currently between eight and 10 full-time physicians are assigned to the ER, Susi said, ”Ultimately, I think we'll probably staff up to 16 doctors,” though that won't happen right away.

To further reduce wait times, Susi said an expansion of ER capacity through the reconfiguration of existing space is also in the works.

“By the time we reach next season,” Susi said, “not only will we be adding staff, but we'll be adding treatment rooms so we'll be able to handle the volume (of patients) better.”

It is a surprisingly large volume. In 2015 the hospital saw almost 60,000 emergency patients – a 15,000 increase over the number that came to the ER a decade earlier.

As a Duke Health affiliate, IRMC reached out to its Durham, N.C., partner for guidance on restructuring the emergency department. Additionally, Susi, Mackett and Giasi looked to a new hospital board member for advice.

Dr. William (Bill) Baxt, who just joined the board in January, is a former first department chair of emergency medicine at the University of Pennsylvania hospitals. Susi said Baxt had already spent considerable time with Giasi and Mackett to help plan and implement the ER changes.

Giasi says the Vero hospital is looking for a specific personality type to staff its emergency department.

To be an effective emergency room doctor, Giasi said, “you can't be an introvert. You need to be good with people. You need that ability to interact with all walks of life and be able to see every type of patient. That's the crux of emergency medicine: Being able to deal with anything that comes through that door on a moment's notice.”

After pausing briefly, Giasi added, “You have to understand that this is the worst day of (a patient's) life if they're coming to the ED. That's the mentality I want. That's our job. This community deserves a department that will serve them in delivering compassion and quality care.”

Mackett, meanwhile, expressed confidence in the hospital's ability to find the doctors it wants.

“It's clear,” Mackett says, “that talent attracts talent. You start a heart program with a Dr. Cary Stowe and you get (people) like Dr. Mark Malias, Dr. John Linderthal, Dr. Jay Midwall and Dr. Joshua Kieval coming here to join him. That's the same with Dr. Giasi as the ED medical director. People who think like him and work like him will be attracted here and take good service and make it even better.”

And how soon should patients be able to see an improvement at the ER? “Yesterday,” Susi responded.

IRMC posts its most current ER metrics online so Vero residents can track the progress of this new approach. Those can be found at