Up and Running Mercy’s Expanded, Renovated ER Is a Statistical Success

Flow’ and ’flexibility.’

There were and are many goals and ambitions behind the $1.3 million expansion and renovation of Mercy Medical Center’s Emergency Department, but those two words pretty much tell the story, said Dr. Louis Durkin.

He’s the medical director for the Department of Emergency Medicine at Mercy, and while he didn’t actually design the ER improvements, he worked hand-in-hand with the architect to blueprint a facility designed to enable the department to move patients in and out more quickly (the ’flow’ part of the equation), due in large part to space that can be used for many different purposes and to treat patients with various levels of emergencies (there’s the flexibility).

Ready for business starting early this fall, the expanded and renovated ER is already yielding improvement in some of many barometers used to track performance in the ER, said Durkin, citing both the “door-to-provider” measure — the medical center is now averaging under 30 minutes, the industry benchmark — and the stat known as “door to door,” which is now under four hours, another industry standard.

“For fast-track patients, it’s usually under 90 minutes,” he said, referring to those with less-serious issues. “But for our total population, which includes the patients that are admitted to the hospital with large workups, there is now a turn-around of under four hours, which is pretty good.”

Meanwhile, there’s also been improvement in another measure, the so-called “left without treatment” measure,” which, as the name suggests, denotes people who have left the ER for one reason or another — the wait was too long or the simply changed their mind, for example. At Mercy, that number has come down from 6{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} to 2{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} over the past several months.

The renovated ER passed a significant test during the recent late-October snowstorm, said Durkin, noting that resulting power outages taxed the facility and its personnel because many patients couldn’t be discharged to homes without power. And it will get another test in the flu season due to start later this month.

But he is confident the facility will bear up to those challenges because of the detail that went into the design, and also because of that level of flexibility, which enables the ER team to continually tweak and improve the facility and its operations.

Durkin told HCN that the enhancements to the ER have been in the planning stages for more than two years now, and were made necessary by escalating numbers that were not an aberration but a trend expected to continue for many years.

Elaborating, he said that ER volume, which was averaging just over 70,000 several years ago, has been escalating steadily, peaking at 79,000 in 2009, and averaging more than 75,000 the past few years. The reasons for upward movement of the needle are many, he explained, citing two important trends — a significant rise in the number of people who have health care insurance (thanks to reform measures in the Bay State) coupled with stagnancy in the number of primary care physicians — as primary drivers.

“You have more people with insurance, but you have the same number of primary care physicians,” he said, adding that the bottom-line result is more visits to all ERs, and especially Mercy’s, one of the busiest in the state.

In response to the trend and its impact on some of the statistics referenced earlier, Mercy blueprinted a project that would increase the number of ER beds from 32 to 43, said Durkin, adding that this would yield significant improvement in another industry barometer for emergency departments. This would be the one using an official target of one bed for every 1,200 patient visits per year.

Mercy was well above 2,000 per bed before the expansion, and is now much closer to the industry goal, Durkin continued, adding that it is not only the number of beds that is improving overall statistical performance, but also that aforementioned flexibility in how they can be used.

To illustrate, Durkin provided a quick tour of the new ER, which is the result of a project that involved expansion, consolidation, renovation, and modernization. There are now five color-coded pods, or areas designated for specific types of patients. These include the so-called fast-track, or less-serious cases; acute cases (those more serious); and those involving patients with behavioral-health or substance-abuse issues.

Before, the ER had just one bed designated for behavioral-health-related cases, he said, adding that capacity for such cases has quadrupled, and even those expanded facilities are usually at or near capacity.

While each pod has a specific use, there is a large amount of flexibility that is part and parcel to emergency-room operations, and the new ER provides more of that commodity.

“The ideal flexibility comes when any patient can be seen in any bed, as opposed to having specialized beds and specialized rooms,” he explained. “We still need to have those, in that we have acute-resuscitation pods, but for the most part, we have more flexibility; if we start getting a higher number of more-acute patients, we can treat them in the fast-track area, and vice-versa.

“Soon, we’ll be able to treat almost any patient anywhere in the department no matter how acute they are,” he continued, “and that’s important, because most bottlenecks occur when you have specific rooms that you can only use for suture, for example. The ratio of acute to not-so-acute patients changes from day to day and hour to hour, so you have to be ready and make sure you can evenly distribute the workload.”