By Kira L. Schlechter
The Patriot-News
HARRISBURG, Pa. — At a time when more people are visiting emergency rooms, and those emergency rooms are expanding to treat them, Penn State Milton S. Hershey Medical Center hopes it has found a way to get patients in and out quickly and efficiently.
The hospital has redesigned its emergency department to ensure that patients see doctors quickly. The revamped department opens today; another phase of the project opens in July.
The goal is to ensure that everyone coming into the ER gets some care right away, with less waiting and no real waiting room. The process is intended to make hospital beds available to patients.
“It’s a flexible space with flexible staffing — it’s getting the resources to people who need them,” said Dr. Christopher DeFlitch, Hershey’s chief medical information officer and emergency department vice chairman. “We’re challenging the paradigm — you come here for care, not to read old magazines.”
The hospital worked with Microsoft Corp. and Orlando Software Group to develop the new ER. The approach applies advanced information technology, commercial software and new strategies to get people treated quickly.
The science of flow — how people or things get from one place to another efficiently — is common in automotive factories and amusement parks, but hasn’t been applied to health care, DeFlitch said.
“Not everyone needs a room, but everyone needs to see a physician. This is a change in approach to health care, not just the ER. We are using information technology to enhance delivery,” he said.
But DeFlitch and company also realized they had to do more with less, considering the economic climate.
Hershey Medical Center’s emergency department gets more than 50,000 visits each year in an area designed for less than 30,000 visits. Initial projections called for expanding the ER by 20,000 square feet, at a cost of $20 million.
But by making the delivery of care more efficient, the facility only needed an additional 7,000 square feet at a cost of less than $5 million. The process began three years ago and the money was allocated then, before the economy forced some projects to be postponed.
So how does the new ER work? Here’s what happens:
When patients walk in or arrive by ambulance, they don’t go into a waiting room. They check in at a small registration desk, where their records are pulled up on a computer. Patients can be registered in their rooms if necessary. Patients then enter a more open room with several treatment areas and are seen by a triage nurse. A doctor or physician assistant with computer access to their records is on hand to hear the patients’ problems and provide treatment suggestions. Doctors evaluate patients and order or perform tests. Then patients move to one of eight treatment and evaluation stations for further treatment, such as receiving crutches. Once treatment is complete, patients register at the check-out desk and can go home. If patients need to be admitted, they are fully registered and transferred to rooms.
This is all accomplished via a tightly organized, linear design in which one area moves seamlessly into another. A short hallway connects all the treatment and evaluation stations.
After treatment, patients and their families pass into the registration/check-out area and family waiting room. Entrances to the ER rooms are just off that area.
The new approach has been tested through computer simulations and in the ER. One run-through produced “fairly dramatic results,” DeFlitch said.
A woman from North Carolina was visiting Hersheypark last summer and came down with a sore throat, which she feared was strep. She was registered, evaluated, given a test for strep and given a prescription. The process took nine minutes.
The ER has 27 care areas, an eight-bed observation unit, and two resuscitation bays. The expansion includes a decontamination room and an isolation/treatment room.
The next phase of the project will include seven more rooms, a private waiting area and a family lounge.
DeFlitch said that the new ER is a good start, but overcrowding in hospitals is still a problem.
“ER departments are crowded because patients are taking up emergency department beds,” he said. “We still need to look at crowding in hospitals, but using flow can make a big impact.”