Stand-alone Provides Saving Grace

Sister emergency center relieves hospital overload and extends care across county.

When a hospital emergency room is consistently overloaded beyond capacity, the last thing it can do is close its doors to patients. In fact, its best recourse may be to open a second set of doors. Fortunately for 275-bed Shady Grove Adventist Hospital (Rockville, Md.), its administration received a go-ahead to open a sister emergency center in nearby Germantown, Md. The new facility – the Shady Grove Adventist Emergency Center – opened its doors in August 2006 to improve access to emergency medical care for residents in Maryland’s fast-growing Montgomery County.

“We had a unique situation,” says Becky Vasse, emergency service director, Shady Grove Adventist Hospital. “Shady Grove Hospital saw over 88,000 emergency patients in its last year [before the stand-alone emergency center opened]. This is very unusual for a hospital of its size.” The new emergency center, which has no in-patient beds, is strategically located to reduce travel times for Montgomery County residents, as well as facilitate speedier transport of patients to Shady Grove Adventist Hospital or north to Frederick Memorial Hospital (Frederick, Md.) when necessary.

Because Shady Grove Hospital and Frederick Memorial are 30 miles apart, and the county’s growing population has led to increased traffic congestion, Maryland’s legislative body agreed to permit the construction of the freestanding emergency center with the condition that it serve as a pilot program to help set standards for future similar facilities across the state. The new emergency center couldn’t have opened at a better time, notes Vasse. “We expected to see 21,000 patients in the first year,” she says. “We actually saw 22,800 patients.” This relieved Shady Grove Adventist Hospital of 30 or 40 patients each day, she adds. “Between the two [Shady Grove] facilities, we will have seen almost 107,000 emergency patients in 2007.” And, another 27,500 or 28,000 patients are expected to visit the Germantown facility in 2008.

High-end care
Shady Grove Adventist Emergency Center may be without in-patient beds, but the facility is fully equipped with high-tech equipment for high-end patient care. The 17,000-square-foot facility, which is housed under the same roof as the 7,000-square-foot Shady Grove Adventist Radiology Center, boasts a 16-slice CAT scan system and a Picture Archiving Communications System (PACS). The PACS provides digital X-ray images that can be reviewed by an on-site radiologist, or sent electronically to a radiologist at Shady Grove Hospital.

“We used American College of Physician guidelines to set up the emergency center,” says Vasse. Although the hospital administration hired new staff and physicians to help run the Germantown facility, half of the emergency center’s staff rotates between Shady Grove Hospital and Shady Grove Emergency Center, she explains. And all emergency center staff members and physicians receive their initial training at the hospital.

On any given day, the physicians and staff at Shady Grove Adventist Emergency Center see a full repertoire of injuries, ranging from minor cuts, strains and fractures to appendicitis, kidney stones and life threatening emergencies. Patients with more severe emergencies generally are transported to other hospitals (including Shady Grove Adventist Hospital), depending on the nature of the trauma. Decisions to transport patients are based on physician and/or patient choice, and the expense is covered under the emergency center’s operating budget.

Of the 21 available rooms at the emergency center, all but one was used during the center’s first year. “We expected to use 17 of the 21 rooms during our first year, but we actually needed to use 20,” says Vasse. The last room was outfitted at the end of 2007 for use in early 2008. “We expect all 21 rooms to be operating by January 2008,” she adds.

“We have no room for expansion, so the key is to use what space we have in the most efficient way possible,” Vasse continues. So, for example, the emergency center includes a “discharge room,” where less serious injuries can be treated. “If a patient comes in with an ankle sprain, we can treat it in the discharge room and free up other space at the emergency center,” she explains. “We also have fully outfitted triage rooms where we can evaluate patients if the back rooms are filled.”

Whether or not Shady Grove Adventist Emergency Center is in a position to physically expand, the freestanding facility has, for now, tempered some severe growing pains for the state of Maryland, at least in one county.

About Laura Thill

Laura Thill is a contributing editor for The Journal of Healthcare Contracting.

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