Sinai's new ER Transformation: Sinai Hospital's spiffy new emergency department is far removed from the old accident wards of yesteryear.

December 07, 1997|By M. William Salganik | M. William Salganik,SUN STAFF

A little Nordstrom. A little Disney. A little Mayo Clinic.

In designing its glitzy new emergency room, Sinai Hospital is "trying to marry sophisticated clinical care with an exaggerated sense of caring for the whole family," says Warren A. Green, Sinai's president and chief executive officer.

The $16 million emergency department, which will begin treating patients Dec. 16, will offer valet parking, private waiting rooms and a concierge, who can arrange baby-sitting or dog-walking for harried families (and who can be reached by videophone).

Sinai's new emergency room -- with its splashes of high-end service -- brings together a number of trends already incorporated by other area hospitals that have given their emergency departments face-lifts over the past few years.

Most offer at least some of these features, all of which are seen at Sinai:

More privacy for patients and their families, with treatment rooms replacing curtained-off cubicles.

Bedside registration, to save sick or injured patients from waiting in line to sign in at desks and to get them to treatment sooner.

Creation of discrete areas -- including a pediatric area -- to separate twisted ankles from shootings and psychotic episodes.

Efforts to provide for extended treatment and observation -- lasting from a few hours to nearly 24 -- that can please insurers by preventing a hospital admission. This has become "a very common thing" nationally in the last five to 10 years, said Dr. Michael Rapp, chief of emergency medicine at Arlington Hospital in Virginia and vice president of the American College of Emergency Physicians.

A "fast-track" system for minor injuries and illnesses to get those patients out quickly rather than forcing them to wait while the most serious cases are treated. "If you came in now with a sore throat, you'd probably be in and out in a half-hour," said Dr. Mark King, chief of emergency medicine at Union Memorial Hospital, which opened a renovated ER with a fast-track area earlier this year.

All this represents a transformation of emergency medicine from "the old accident wards we were 30 or 40 years ago" into a specialty with skill at making quick diagnoses and serving as "a bridge between inpatient care and the community side," said Robert E. Roby, chief of emergency services at Maryland General, which opened a new ER in August 1996.

The effect is to produce an atmosphere of calm in an area that "used to be like a Greyhound bus terminal all the time," said King. "The whole ER is much quieter, much less chaotic."

Hospitals are changing their view of their emergency departments, Rapp said. While they used to be seen as necessary but money-losers, "hospitals now realize that a lot of patients come in that way, and that the image people have of a hospital is often formulated by their experience in the emergency department. There's no question that there is much more emphasis on emergency medicine, and hospitals are putting the resources in."

The ER isn't profitable

At Sinai, said spokeswoman Jill Bloom, the emergency department does lose money, largely because of care for the uninsured or for patients for whom an insurer declines to pay because there was not a true emergency.

She said Sinai does not account for its emergency department separately, so she could not say how much it loses or how much unpaid care it provides. Overall, Sinai reported a $6.7 million operating surplus, a margin of 3.5 percent, in 1996. Even with losses there, Bloom said, "about half our admissions come through the emergency department, so it's a net benefit."

Among other area hospitals with recent ER face-lifts, according to the Maryland Health Resources Planning Commission and emergency department staff, are Carroll County General, Harbor, North Arundel and Mercy -- in addition to Maryland General and Union Memorial. University Hospital has a new emergency department in the planning stages.

Source of patients

All of this effort to create a convenient and patient-friendly emergency service can pay off. Hospitals get more than one-third of their admissions through the ER -- more than half in some urban hospitals.

Increasing ER traffic can help fill beds that have been emptied as managed-care insurers press to shorten hospital stays and to push care to outpatient centers.

For example, Maryland General Hospital reported that ER visits in the year ending June 30 were up about 5 percent from 21,892 the previous year. Meanwhile, ER use at comparable hospitals in the city was dropping about 5 percent, said Roby.

Beyond that, an amenities-rich ER can help attract insured patients, said Gerard F. Anderson, director of the Johns Hopkins Center for Hospital Finance and Management.

"You're trying to attract the middle class and upper-middle class to your hospital, and that's how you do it," Anderson said.

Elegance and the uninsured

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