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Diversity of options improves emergency care

Reducing wait times to get into the emergency room is as much about diversifying care options as it is about increasing efficiency when sick or injured patients are rushed through hospital doors.

Durango’s isolation in remote Southwest Colorado makes for a unique situation when it comes to emergency health care.

The region’s largest hospital, Mercy Regional Medical Center, sees by far the highest number of critically injured patients annually. In 2015, Mercy’s emergency room at Three Springs served 19,739 people.

Mercy’s average wait time for a patient to come in the door, have a nurse diagnose the seriousness of the injury and enter a doctor’s room is less than 20 minutes.

However, that number is drawn from an inexact science, said Paul Gibson, clinical director of Mercy’s emergency department.

“People who have serious injuries come back immediately,” he said. “If it’s critical care, there really is no wait time for those patients.”

The issue plaguing emergency rooms across the country is “unnecessary or avoidable” ER visits.

In 2013, a health analytical company released a study that found 71 percent of ER visits either could have been treated in a primary care setting or did not require immediate attention.

This mindset – of going to a hospital for minor colds, scrapes or headaches – was highly criticized in July 2007, when then-President George W. Bush said, “I mean, people have access to health care in America … After all, you just go to an emergency room.”

The problem, critics say, is that it’s extremely expensive for emergency departments to treat patients this way, and it has the adverse affect of ramping up wait times for people with more serious injuries.

In Durango, medical providers have gradually been adding more diverse options for patient care to alleviate some of that demand.

Mercy opened a family medicine facility on its campus in Three Springs and an additional location in Bayfield, as well as a health services clinic near Horse Gulch. A new clinic is being set up in north Durango.

“And of course, the best kept secret is the Purgatory Urgent Care,” Gibson said. “You can go up there and there’s almost no wait time.”

Patients also have options at Animas Surgical Hospital – which did not respond to a request for comment – and Durango Urgent Care, which is open seven days a week from 9 a.m. to 7 p.m.

“People show up to the ER and use it as a primary care and waste that resource for other people who really need it,” Durango Urgent Care CEO Brian Vincent said. “That’s where we come into play and take that burden off them.”

Vincent said Durango Urgent Care helps bridge the gap between ER and primary care. In 2015, Durango Urgent Care saw about 9,000 visits, which is about average when compared with the past few years.

“In Durango, there’s been better access to care the last two, two-and-a-half years,” Vincent said. “Our wait times, which average 15 minutes to see a provider, are better than they used to be. That’s because we’re better on our end, not because we’re seeing less patients. We’re just more efficient as a company.”

Still, Vincent said although most of his staff members are ER trained, there is a point when a patient’s condition reaches such a critical state they require transfer to an ER.

And when the inevitable uptick of patients starts to rush through the door, emergency responders must be ready, said John McManus, medical director of Mercy’s emergency department.

The biggest difficulty, McManus said, is you could have no patients one minute, then 20 minutes later, seven people could come through the door.

“The unpredictability of the ER is a national problem,” he said. “Staffing for surges is something you can’t reliably predict.”

Mercy’s rush hours are no different than national averages. Peak hours tend to be 10:30 a.m., 5 p.m. and 8:30 p.m., with higher in-take on Monday mornings and Thursday evenings.

At any given moment, patients can check wait times on Mercy’s website, which are subject to change, and, as McManus reminded, the more serious the injury, the higher priority to see a doctor.

He said if wait times do increase, nurses can initiate treatment, so by the time the doctor gets there, further care can begin.

“It speeds up the process dramatically,” he said.

And, McManus said, emergency care is always a work in progress.

“That’s our ultimate goal,” he said. “From the time you show up to the time you’re out the door – is decreasing that time.”

jromeo@durangoherald.com



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