Aiming for the fast track

Munroe Regional Medical Center is moving forward with its $26 million plan to modernize and expand the emergency department at its Southwest First Avenue campus, hoping to increase efficiencies and slash patient wait times amid rising demands for emergency treatment.

Munroe’s move to break ground in January to update its existing ED facility is separate from the agency's attempts to build a new 66-bed, full-service hospital west of Interstate 75 on State Road 200. Competing Hospital Corporation of America hospitals are petitioning Florida regulators to stop that project. As Munroe awaits a final ruling on that project, Florida regulators approved the ED project.

Munroe is leased by Franklin, Tennessee-based Community Health Systems.

Munroe’s ED overhaul plan, which will take two years to complete, is part of an ongoing national trend to design emergency departments to provide care to patients more efficiently and dispel the notion that an emergency room visit can be a grueling, all-day event.

The overhaul will be two-pronged, said the hospital’s new CEO, Jim O’Loughlin.

The first prong will be to create among the ED staff a sense of urgency in which they all focus on not only quality of care, but are keenly aware of how long each procedure takes to complete and how that time effects the patient’s view of the hospital as a whole.

“It’s hard for a patient to say their care was exceptional from a service standpoint if they spent hours on a stretcher (and) waiting for a room,” O’Loughlin said.

To help make sure that does not happen, the plan is to aggressively measure and document the time it takes to provide services, such as getting blood drawn and getting lab results, getting patients to imaging centers, and getting patients admitted and into a room if they need it, he said.

The goal is not just numbers, but improving the patient experience as best the hospital can under the circumstances, O’Loughlin said.

Tracking is not meant to micro-manage ED staff, but to encourage them and enable them to better understand how their department can become more efficient and eliminate problems, he said.

To also help do that, the new ED is designed to have resources, equipment and services close to patients, he said. In addition, the entrance and canopy, as well as ambulance entrance, will be redesigned to improve the flow of patients into and out of the ER, O’Loughlin said.

Munroe currently has 36 ED examination rooms. The new design will have 40.

Munroe serves about 75,000 ER patients annually.

One goal is to get ED wait times for patients who eventually get admitted down to 240 minutes, O’Loughlin said.

Munroe’s current ED median wait time for those patients is 369 minutes, according to Medicare.gov, the federal government’s internet site for Medicare. In comparison, Ocala Regional and West Marion had a combined, median wait time of 303 minutes.

The median among Florida hospitals is 315 minutes. The national average is 334 minutes.

Those wait times, and Munroe’s ED expansion, are important because for many patients who eventually get admitted, the ED was the front door into the hospital.

About 60 percent of admissions at MRMC are patients who first went to the ED, O’Loughlin said, adding that hospitals want to create lifelong relationships with those patients so they return when they need medical care in the future.

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Meanwhile, there have been other pressures to improve ED efficiencies, O’Loughlin said.

The federal government is looking to set ED wait-time goals for hospitals and patients are getting more frustrated about languishing in waiting rooms, he said.

And, competition is heating up from walk-in urgent care clinics and providers specializing in less urgent care and at lower costs, healthcare industry studies show.

There are now more than 2,300 convenient care clinics in the U.S., according to the Convenient Care Association. The first opened in 2000. Since then, about 35 million patients have been served by them, according to the association.

The shift has to be made by many hospitals if they are to remain their patients’ first choice.

The demand for ED services is only expected to increase, according to a recent American College of Emergency Physicians poll.

About half of emergency department doctors participating in the poll reported that their EDs have seen an increase in visits since 2014. Nearly 90 percent said they expect visits to continue to rise and 77 percent said their emergency departments were not prepared for such increases.

In 2014, the number of emergency department visits in the United States rose to 141.4 million, according to the Centers for Disease Control and Prevention. That was nearly half the US population.

ED patients also are getting older, according to the American College of Emergency Physicians. In 1992, people in the US who were 75 years old and older made 558 visits to the ER per 1,000 people in the population. In 2011, that number increased to 682 visits per 1,000 people. During the same time period, seniors 65 to 74 years old utilizing emergency departments increased from 314 to 369 per 1,000 people in the population.

Munroe is setting aside some examination rooms to better serve the elderly. The rooms will have larger print on publications, use of colors to distinguish information, lower beds and restroom facilities to accommodate patients who are less mobile, O’Loughlin said.

That will help with efficiency, but there needs to be more, O’Loughlin said. Part of the solution is determining which patients need immediate critical care and those who need to be observed by medical staff instead.

Like many EDs, Munroe is expanding its use of fast-track observation cubicles that include recliner chairs and basic monitoring equipment rather than fully functioning treatment rooms.

Munroe currently has one such fast-track station: the new ED will have six.

The last time Munroe’s ED saw improvements was seven years ago and those were aesthetic rather than a redesign to improve patient flow and services. The new ED will also have an open concept design with a centrally located nurses’ station where patients can better see staff.

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Munroe is seeing plenty of ED competition from neighboring hospitals.

West Marion Community Hospital recently opened its newly expanded ED. The HCA hospital expanded the department by nine rooms, for a total of 31.

The ED upgrade is part of the hospital’s $40 million expansion, which includes 44 more patient rooms, more operating rooms and a new fifth floor for future expansion.

In October, HCA also marked the one-year anniversary of its stand-alone emergency facility in Summerfield. The $10 million facility, on 2 1/2 acres, boasts 11 state-of-the-art examination rooms, in-house labs, imaging services, CT scan, ultrasound and x-ray machines. The 10,500-square-foot facility serves Lake, Sumter and Marion counties and is expected to serve about 15,000 patients annually.

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Along with emergency departments being front doors to patient admissions, they also turn a healthy profit.

A 2014 Health Affairs study found that EDs had average profits margin of 7.8 percent, translating into millions of dollars for individual hospitals.

Aaron Liberman, professor emeritus with the University of Central Florida's Department of Health Management & Informatics, said the trend of expanding EDs and improving their efficiencies will not end anytime soon.

In large part, ED expansions and redesigns are patient driven, he said.

“Does it matter (in terms of quality of care) whether an ER looks nice? Probably not,” Liberman said.

But patients are getting more frustrated about waiting 10 and 12 hours in an ED before getting released. Hence, the popularity of urgent care centers that provide cheaper and faster service when patients aren’t sick enough to justify a trip to the ER, he said.

“People are getting very picky about the institutions they frequent,” he said.

Most people sick enough to visit an ED will usually stay and wait for treatment, “but they’re not happy about it,” Liberman said.

But, he said, hospitals might be over-reacting and over-spending to appease patients who want modern EDs. Some of that money could be spent more wisely to beef up other service lines and provide better care.

As for Munroe’s investment, Liberman said, “Is it worth $26 million? I don’t think so.”

Liberman said that eventually the spending to enlarge emergency departments and building new hospitals will prove too high. But, for now, the trend will continue as hospitals fight for greater market share of patients and think this is the way to go, at least “until they run out of money,” he said.

O’Loughlin said that when emergency departments such as his are not designed for efficiency or to provide patients with the best possible experience, he is obliged to change that.

“We could continue to operate (with the current ED) but over time we would be less competitive,” he said.

The money the hospital will spend on the new ED is not just an investment in Munroe, but “it is another investment the hospital will make in the community,” O’Loughlin said.

Reach Fred Hiers at fred.hiers@starbanner.com and 352-397-5914.