By Kathryn Boughton
The Litchfield County Times

“When people come to an ER, they think the word emergency means they will be treated immediately,” said Pam George, director of emergency services at Sharon Hospital, “and that is not what it means.”

The nurse acknowledged that there can be a lot of waiting for the patient who “presents” at the emergency room—waiting for tests to be run and their results to be returned—but Sharon Hospital is doing what it can to ease the anxiety and frustration of going to an emergency room. On March 1, the hospital launched its “wait (less) room,” promising patients that they will be seen by medical personnel within 30 minutes.

“Sure, there is always fallout,” said Chief Nursing Officer Kim Lumia, “because we have to take the sickest people first—triage is based on acuity, and a person with chest pains is taken before a person with a sprained ankle—but it has been going very well. Eighty-five to 90 percent of the time, we hit our mark.”

The goal is that the patient never even sits in the waiting room. “The triage nurse wears a beeper and as soon as possible after the patient approaches the desk we want a triage nurse to meet them,” said Jill Musselman, director of communications for the hospital. The patient is escorted to one of 10 private rooms, where treatment will take place. Gone, as part of a more than $17-million construction project three years ago are the former “wards” where up to three emergency room beds were separated by only a retractable drape and patients were privy to whatever was going on with other patients beyond the curtain.

The new emergency rooms are fully stocked with diagnostic equipment, and one room is a double-bay trauma center that can be divided or used as a single unit. “If you have trauma, such as a motor vehicle accident, the higher acuity usually requires more people [working around the patient],” said Ms. Lumia. “So you need more space.”

Near the trauma room is an isolation room designed with a vapor lock and used for patients who may have contagious diseases or have been exposed to hazardous materials. “There is negative pressure, so nothing can leak out into the rest of the area,” said Ms. Musselman, adding that there is also a mobile decontamination unit that can be pressed into duty for emergency personnel who have been exposed to dangerous materials.

The new emergency medicine center, which is shaped like a rectangle, can treat a total of 11 patients at once, while the ER personnel have additional space in offices in the complex and at the spacious nursing station. There is even a quiet conference room where doctors can confer with family members and a room where ambulance crews can fill out their reports.

Equally important is the unit’s placement in the hospital, near the ICU, radiology and the primary stroke center. “Timing is everything with a stroke victim,” said Ms. George, adding that a CT scan is done immediately and that clot-busting drugs can be administered.

All told, the ER at Sharon Hospital is now one and a half times larger than it used to be and still fills up regularly, according to Ms. George. During peak times, which in Sharon tend to be during the days, the emergency wing is staffed by three registered nurses, a mid-level practitioner and a physician. At night there are two registered nurses. There is also a unit coordinator, who during the night functions in more than one capacity.

Ms. George said that all the nursing staff has additional certification in the treatment of trauma cases as well as advanced life support training for both adults and children. They have also taken emergency nurse pediatric courses. She said the latter training is essential because pediatric emergencies, while making up a small percentage of the ER’s experience, are “high risk.”

Amazingly, the emergency room has undertaken its 30-minute promise without an increase in staff. “It was a great motivator to look at new processes,” said Dr. Gene Chin, chief of emergency services. “You get used to doing things one way, but this was a good opportunity to see if we could do things better.”

The changes showed immediate effect. “The very first week we improved our times 10 percent,” said Ms. Lumia.

“We’re trying to increase patient satisfaction in other ways, too,” said Ms. George. “We give the patients updates and try to explain to them what is happening. We give them time estimates—it is easier to wait if you know your lab work is going to take an hour. You are not sitting there looking at your watch and wondering what is happening. It doesn’t take any extra time for the staff to explain what is happening as they go along.”

When the emergency room experiences a quiet period, the nurses are shared with other departments, although Ms. Lumia and Ms. George laughingly admonished, “The ‘Q-word’ is a five-letter word around here.”

Emblematic of the hospital’s determination to become client friendly is the large screen behind the nurses’ station that tracks the progress of each patient from the moment he or she comes to the front desk through to treatment. The line listing the patient changes color as time elapses and five minutes before the 30-minute maximum wait times expires, an alert is given. If circumstances conspire to keep a patient waiting longer, he or she is given a $10 CVS gift card as a token of the hospital’s regret that it has keep the patient waiting.

“People are really surprised when we give them the card, and some of them say, ‘Oh you don’t have to do that,’” said Ms. Musselman. “But, yes, sometimes people do have to wait longer, and it is just our way of saying we are sorry for the inconvenience.”

Those patients who are required to wait longer than 30 minutes also receive a follow-up letter apologizing for the delay the patient experienced.

Ms. Lumia said that more and more hospitals are attempting to deliver this kind of service and that in more cosmopolitan areas patients actually shop for emergency rooms with the shortest waiting times. “Some places are calling it ‘door to doc,’” she said. “There is even an iPhone app where you can check the waiting times at different hospitals, and patients tend to make their choices based on that.”

So does this sparkling new facility, with its new emphasis on efficiency and client service, represent a change in the way the American public and hospitals expect medicine to be delivered? Actually, Ms. Lumia said, the hospital has seen a reduction in emergency room numbers. “I’ve seen the urgent care population decline,” she said, “but the acuity of patients who present here is higher—perhaps because they have been putting off seeing a physician.”

Dr. Chin said he believes the lower numbers are prompted by economics, but perhaps by lifestyle changes as well. Insurance companies are prompting some of the change because co-pays for emergency room visits are significantly higher than going to a private practitioner. “We want people to use their principal physicians,” he said, but then commented that the numbers of physicians going into a solo practice are declining.

Area doctors can apply for hospital privileges at Sharon Hospital but, if they don’t, a “hospitalist,” a doctor who practices only at the hospital, can see their patients. Dr. Chin acknowledged that not all patients are comfortable with not seeing their familiar physician, and Ms. Lumia added that Baby Boomers tend to have the hardest time accepting the concept.

As the nation convulses over the concept of universal health care and the implications it might have for the future of the medical community, the emergency room team at Sharon Hospital is busy concentrating on delivering fast, efficient and state-of-the-art care to patients who come through its doors.