FMH FMH emergency room streamlines patient flow

Aug. 07--The average wait to see a doctor in Frederick Memorial Hospital's emergency room is 32 minutes, and patient flow is meeting targets set by Dr. John Molesworth, chairman of the emergency department.

While the wait to see a doctor is comparable to those of peer institutions, more important is how long patients wait to have contact with their triage provider, Molesworth said. Since early spring, his department has been following a model of having a provider in triage, or PIT, to streamline the department's functions.

Before the doctor sees the patient, Molesworth said, medical staff have the opportunity to order tests and procedures that will make for quicker treatment and discharge.

In the American College of Emergency Physicians 2014 report on the nation's emergency care environment, Maryland ranked 10th overall, with grades in access to emergency care, the quality and patient safety environment, the medical liability environment, public health and injury prevention, and disaster preparedness.

Maryland ranked No. 1 for quality and patient safety, earning an A in that category; nationally, the average was a C, and the only other states that rated an A were Pennsylvania, North Carolina and Utah.

Access to care counted for 30 percent of ACEP's overall grade. It took into account availability of doctors, specialists and treatment centers, cost and hospital capacity. In access to care, Maryland ranked 23rd with a D.

Overall, Maryland rated a C grade for its 10th-place position nationally.

The District of Columbia ranked No. 1, with an overall B grade. Only D.C., Maine, Massachusetts and Nebraska rated a B overall.

The lowest overall grade, an F, went to Wyoming.

ACEP has reported an increase in emergency department visits since the Affordable Care Act went into effect, but FMH has seen a slight drop of 7 to 8 percent, Molesworth said.

He predicted that access to health insurance will increase visits to the emergency room in the future, especially for mental health diagnoses.

In any given hour, as many as 30 patients may come in to the ER, and the average is 174 per day, he said. When Molesworth took over as FMH's emergency department chairman last fall, a new computer system and existing triage practices were not moving patients through the ER as efficiently as possible, he said.

Using the PIT model and getting used to the computer records system have combined to improve his department's functioning, he said.

"I think we're doing everything we can to make the ER efficient," he said.

In the past year, he said, his department put an emphasis on improving stroke and sepsis care. The stroke program received a gold award from the Maryland Institute for Emergency Medical Services Systems.

The department ranks high statewide in getting surgical procedures quickly for cardiac patients, he said.

Patients are waiting on average 21 minutes to get to a bed, according to his data. Before the doctor sees the patient, medical staff assign each patient a category number, 1 to 5, which ranks their level of urgency and their condition's complexity.

A heart attack is a 1, while a 5 is something minor, like a sore throat, that requires little service. Fives and 1s get treated sooner than, say, a case of abdominal pain, which is likely assigned a 4.

Patients assigned a 1 in triage get to a bed in under three minutes.

"That's very, very quick," Molesworth said.

Fives can also be fast-tracked because they require little service. PIT eliminates unnecessary steps, Molesworth said.

"It's just a way to decompress the ER," Molesworth said. "PIT is what progressive ERs do."

Follow Patti Borda Mullins on Twitter: @FNP_Patti.

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