Hospital refines ER unit process

Baltimore Washington Medical Center says its new system cuts hours off long waits


Six years ago, the Baltimore Washington Medical Center opened a new emergency room with the ability to treat 60,000 patients a year.

But within a short time, the capacity of the new facility at the hospital - then called North Arundel - was exhausted. Last year, the ER was treating about 219 patients a day, well above its capacity of 165. As numbers grew, so did waits, which ranged from one to four hours, according to the hospital.

With the hospital nearly full, emergency patients could not be checked in to rooms, and patients often sat in the waiting room until a bed became available. For as many as 155 hours a month, area ambulances had to be diverted from the hospital because it was not taking emergency patients. Almost 4 percent of patients left without being seen.

Lately, the hospital has seen drastic improvement after implementing a new system for receiving and treating emergency patients, officials say. With help from a consulting firm, the center has an average wait of less than an hour, ambulance diversions are down to 22 hours a month and about 1 percent of patients leave without being seen.

"When we looked at the system, we decided there were no sacred cows," said Larry Linder, chairman of emergency medicine at Baltimore Washington Medical Center. "We tried to eliminate every step from when a patient arrives in the ER to the time they see a provider. We changed from a model of eventual care to a model of now care."

Unlike the systems in place at some hospitals, which assume there will be a delay and often have patients go through triage, X-rays, blood tests and registration during their wait, the hospital's new method -dubbed "InstaCare" - assumes no waiting period.

Now at Baltimore Washington Medical Center, a screening nurse asks patients their name, date of birth, and problem and then sends them to a main area if they have more urgent needs or a staging area if they have more minor problems. Patients in both groups are sent to rooms almost immediately, Linder said, and don't register with billing or insurance information until they leave.

"Patients were waiting for two or three hours to get into a room, and that whole time was wasted time," he said. "Now we put the physicians together with the patients at the beginning of the process to eliminate any unnecessary procedures."

Anne Arundel Medical Center treats more than 70,000 patients annually in its emergency room, and despite opening a new center of its own in 2001, the hospital "tries to keep wait times to three hours" said spokeswoman Margot Mohsberg. To reduce the wait, Anne Arundel has added staff and tried new ways to handle patients, she said.

Linder said two Rhode Island hospitals are using "InstaCare," but he wasn't aware of any others in the country.

To implement the new system, MS2, the Rhode Island-based consulting firm that advised the hospital, worked with a team of doctors and staff to ensure that the restructured emergency department, which is often reliant on other departments like radiology, would work cohesively.

"We're not anywhere close to where we want to be, but we're thrilled that we've been able to improve the care for our patients and that we've been able to provide that care in a more timely manner," Linder said.

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