For many people, trips to the emergency room often mean long, frustrating waits.
But in recent years, two Southern Maryland hospitals have implemented procedures to reduce time spent in waiting rooms - a change that hospital officials say safeguards patients' health and reduces aggravation.
The changes have also allowed St. Mary's and Calvert Memorial hospitals to buck national and statewide trends of long emergency room visits.
Both hospitals streamlined admission processes and upgraded technology to get patients treatment faster, including altering their systems so registration, assessment and treatment can run simultaneously, hospital officials said. Now, workers at the two hospitals assign new patients to exam rooms as soon as possible. Nurses then do registration paperwork at the patients' bedsides.
The hospitals also have adopted protocols that allow triage nurses at the hospitals to order some procedures and tests so that diagnosis can proceed before the patient has seen a doctor, officials said.
The protocols, created by physicians, dictate the nurses' decisions, said Dawn Yeitrakis, director of emergency services at St. Mary's Hospital in Leonardtown.
At Calvert Memorial Hospital in Prince Frederick, officials last year introduced a process called "rapid medical evaluation," said John Schnabel, chief of emergency medicine at Calvert Memorial.
"At times when we can't pull someone directly back to a bed we put a [health care] provider up front just after triage to make sure labs and X-rays are ordered as soon as possible. . . . It really does reduce the amount of time you're in the emergency department and that's been well-received by patients," Schnabel said.
Calvert Memorial also has instituted a "fast track" in which a doctor is assigned to the least urgent cases, so people whose lives are not in danger but who do need treatment can receive timely help, said Schnabel and Stephanie Cleaveland, director of the hospital's emergency department.
The procedures have reduced the amount of time emergency patients have had to wait to receive treatment, hospital officials said.
At St. Mary's Hospital, during the first quarter of fiscal 2009, the average time it took an emergency room patient to get to an exam room was 45 minutes; in 2010, it had fallen to 17 minutes.
In the last quarter of 2008, 6.3 percent of people who came to the hospital's emergency room left without being seen; that number dropped to 1.1 percent during the same period last year, Yeitrakis said.
At Calvert Memorial, in the third quarter of 2010, more than 90 percent of ER patients were triaged - or categorized according to severity of the complaint - within 30 minutes of arrival, while the average wait before triage was 11 minutes, hospital spokeswoman Kasia Sweeney said.
Officials of CMH, a privately owned hospital, declined to release statistics on how long emergency room patients must wait before reaching an exam room.
In Maryland in 2009, emergency room patients waited an average of nearly five hours to be seen - 30 minutes longer than in 2008 and longer than patients in 44 of 50 states, according to a 2010 report, "Emergency Department: Patient Perspectives on American Health Care."
The average wait nationwide in 2009 was four hours and seven minutes - four minutes longer than the previous year.
The report, which was compiled by Press Ganey, an Indiana-based company that consults with hospitals to improve performance, also notes that wait times have an impact on patient satisfaction: 89 percent of those who waited two hours or less reported feeling satisfied with their experience, compared to 77 percent of those who waited for six or more hours.
The gains in efficiency seen at St. Mary's and Calvert Memorial hospitals have occurred as patients have increased.
The number of patients arriving at Calvert Memorial and St. Mary's emergency rooms has spiked in recent years, hospital officials said. In fiscal 2010, the Calvert County hospital had 40,309 visits, a roughly 55 percent increase from fiscal 2003, Sweeney said.
In St. Mary's County's only emergency department, visits increased by more than one-fifth between fiscal 2009 and the second quarter of fiscal 2010, according to the most recent statistics available.
The department saw 73,729 patients during that time, hospital spokeswoman Holly Meyer said. Before then, the hospital recorded its data in calendar years, making direct comparison difficult, Meyer added.
Population growth is a factor in the increase in visits, officials said. The number of people living in Charles, St. Mary's and Calvert counties has risen by about one-fifth - from 282,887 to 334,437 between 2000 and 2009, according to the U.S. Census Bureau.
Hospital officials also noted that the number of emergency room visits has risen because of a shortage of primary care physicians in the region that causes people to seek treatment at emergency departments for ailments that a family doctor could handle.
Technological changes also have accelerated treatment at the hospitals, officials said.
At Calvert Memorial, ambulances can transmit the results of an electrocardiogram, which monitors heartbeats, to the hospital before the patient arrives. The program, called Lifenet, began in January.
St. Mary's does not use the program but is considering it, Meyer said.
At Civista Medical Center in La Plata, officials declined to describe specific changes made in the emergency department. Dr. Mark Dumais, Civista's chief medical officer, said in a statement that the hospital has added emergency technicians and developed a "fast-track service known as ED Express" for patients with less severe problems.
Without releasing figures, Richard Ferraro, medical director of the hospital's emergency department, said Civista has been seeing more people coming to its emergency room, "and we certainly want to see as many as we can. We don't see the increasing volume as a burden."
Emergency room workers have been worrying about wait times for more than a decade, but the problem gradually is reaching public prominence, said Leigh Vinocur, a clinical assistant professor in emergency medicine at the University of Maryland School of Medicine and a spokeswoman for the American College of Emergency Physicians.
The danger comes from patients having to wait for care they might need more urgently than staff can provide it, Vinocur said.
"I think there has been [an increase in public concern], Vinocur said. "I think emergency room doctors have always known how potentially dangerous it is."
Long emergency room waits can stem from a number of factors, including a nursing shortage, a shortage of internists and an increase in the proportion of Americans needing medical care as baby boomers age and rates of obesity, diabetes and other chronic illnesses rise, she said.
Vinocur described as "a myth" the notion that long emergency room wait times are due to uninsured people "clogging the system."
A bigger culprit is the hospital practice of "boarding" patients in the emergency room who are set to be admitted to the hospital because beds are not available in the relevant departments or because beds are being held for patients scheduled for elective procedures, she said.
As boarded patients take up emergency room space and staff time, others have to sit in the waiting room, Vinocur said.
