By Cindy George
The Houston Chronicle
HOUSTON — A patient at the Memorial-area emergency department barely warms a seat in the waiting room before a nurse beckons and starts asking questions.
Beyond the desk and behind a thin curtain, the nurse checks the patient’s blood pressure. During a chat, she assesses the medical problem.
To save time, she may process a urine sample instead of sending out for lab results. Minutes later, a chart or a verbal cue from the nurse alerts the emergency physician about the patient’s symptoms.
Such strategies are moving patients more quickly through ERs at Memorial Hermann Memorial City Medical Center and its sister hospitals, a response to a national overcrowding problem that has forced some facilities to divert seriously ill or injured patients elsewhere, sometimes with tragic results.
Memorial Hermann’s program is an attempt to address the overcrowding problem by making the ER more efficient. One national expert said the strategy is being used by perhaps 10 percent of hospitals across the country.
In Houston, the ER overcrowding problem has been the subject of several studies calling for revisions to the emergency system. In 2006, the Harris County Hospital District changed policy to redirect patients who show up at the ERs of Ben Taub or LBJ general hospitals without emergency symptoms to community health clinics or urgent care services.
The goal at Memorial Hermann? To give every patient a “quick look” by a nurse or other health professional within five minutes of arrival, then get the sick or injured person to a doctor within 30 minutes.
So far, the average wait to see a physician at the Memorial City emergency center has been cut by an hour — from 93 minutes last spring to 20 minutes in December, according to Jim Parisi, the system executive who oversees emergency services.
The time frame factors in trauma patients rushed from ambulances to operating rooms as well as those who show up with minor injuries.
The strategy to accelerate ER visits expanded to most of Memorial Hermann’s other eight hospital emergency centers in December.
Adoption of the new procedures followed reports from the National Center for Health Statistics showing an increase nationally in emergency department wait times.
The center’s annual survey in 1997, the first to include such data, put the average wait time to see an emergency physician then at 38 minutes. In the 2006 summary released in August, the average wait was 56 minutes.
Many experts attribute the longer waits to the increased number of people using emergency centers for non-urgent conditions that could be handled in doctor offices.
“Emergency departments are classically good at taking care of the very sick,” said Dr. Jorge Trujillo, medical director of emergency services at Memorial City. “Where we have a problem is taking care of people not perceived to be very ill.”
Like Memorial Hermann, several emergency centers in the Houston area have sped up the ER process.
St. Luke’s Episcopal Hospital in the Texas Medical Center, for instance, opened ER express lanes last year for less-serious ailments, slashing wait times for those patients in half, according to Andrew Eller, clinical educator for the emergency department.
Hospital Corporation of America — which runs The Woman’s Hospital of Texas, East Houston Regional Medical Center, West Houston Medical Center and several suburban hospitals — built free-standing, 24-hour emergency centers in Pasadena and Pearland to relieve its traditional emergency rooms. HCA also turned a former Alvin hospital into a 24-hour ER.
Before the Memorial City pilot project started in May, Trujillo said many people waited three to five hours to see him.
On average, it took 1 1/2 hours to see a doctor. One in 10 people left without being seen, hospital administrators said. Crowding and complaints were frequent. Patient satisfaction surveys placed the emergency department in the bottom 10 percent among those of similar hospitals nationwide.
By August, according to hospital figures, the average time to the doctor was just 29 minutes. In December, it was down to 20.
The system’s Southwest, Katy, Sugar Land, Southeast, Northeast and Northwest hospitals recently started their versions of faster ER service. The program is slated to move to Memorial Hermann hospitals in The Woodlands and the Texas Medical Center early this year.
Under the program, doctors are involved in the beginning, instead of the end, of a patient’s emergency room experience.
“In the past, I never even knew the acute patient was there who had the appendicitis and was waiting for two and a half hours,” Trujillo said. “From my practice point of view, I can deliver quality care better — and sooner.”
Dr. Art Kellerman, a professor of emergency medicine at Emory University and a former board member of the American College of Emergency Physicians, said the Memorial Hermann strategy is useful, though expensive.
A number of hospitals that involved a doctor or nurse practitioner at the beginning of the triage process later dropped the effort, because it could not be sustained financially, he said.
Parisi acknowledged that Memorial Hermann’s program costs a little more. But, for the most part, he said, the new strategy merely reallocates existing personnel.
Kellerman also said the strategy fails to get at the root of the overcrowding problem — that not enough beds are being cleared for patients who arrive at hospitals via ERs.
“Elective surgeries are more profitable — you never hear of elective surgeries being diverted,” said Kellerman, who has written about emergency department overcrowding.
At Memorial City, the new triage process took 13 minutes on average at the start of the program; now it’s down to about three minutes. Today, only 2 percent of patients leave without being seen. Trujillo said complaints have decreased to a few a month, and patient satisfaction has improved significantly.
During the initial “quick look” by a nurse, patients give a chief complaint before a swift move to a room where they will remain, ideally, for 30 minutes or less. Sometimes, the patient reclines in a chair instead of a stretcher.
A half hour after Mary Ann McClintock, 75, showed up at the Memorial City ER one recent day, she was relaxing in a recliner while receiving an intravenous drip. Within minutes, Dr. Trujillo knew about the Katy grandmother’s fever and mucousy cough, plus he was aware of her recent neck surgery.
That same day, a playful 1-year-old with copper-colored curls named Skyler Felix waited for the doctor to treat a gash on her finger. “Her hand was bleeding. and it was nasty,” said her mother, Pepper Felix, 21.
An hour later, the baby left the hospital with her left hand bandaged and both arms secured in adult hospital socks.
Felix said she waited longer in another hospital’s emergency room when she was in labor.
Trujillo could monitor McClintock, baby Skyler and two dozen other patients with a quick glance at a computer screen that tracks patients on a map of the emergency department.
The place was rather quiet for that many patients, the doctor said.
“We’re almost completely full,” he said, “but you don’t get a sense of that now.”
Chronicle reporter Todd Ackerman contributed to this story.