Nurses at Good Samaritan Medical Center, (from left) Denise DePinto and Andrea Mahoski demonstrate emergency department procedure.

West Islip — A patient who has to wait too long in the emergency room for treatment might become frustrated and walk out, even though delaying treatment can make the situation worse.

“This is a problem that all hospitals are dealing with,” explained Dr. Adhi Sharma, chairman of emergency medicine at Good Samaritan Hospital Medical Center here. He spoke at a Jan. 21 press conference at the hospital to showcase an innovative program that helps resolve that concern.

Good Samaritan was one of six hospitals chosen last year for “Urgent Matters,” a study of hospital emergency department procedures that addressed overcrowding and delays.

“We were thrilled to be selected,” said Charles Bove, executive vice president and chief administrative officer for Good Samaritan, noting that 150 hospitals nationally applied.

“We are the largest provider of emergency care on Long Island,” Bove said, serving more than 100,000 patients last year. “We hope that other hospitals can learn from our experience.”

Good Samaritan’s program found new ways to use space and medical personnel.
The study found underutilized space in the hospital’s ambulatory surgical unit (for patients who require day surgery and do not need to stay overnight) and put it to work.

The ambulatory surgery unit is busiest from the hours of 6 a.m. to 4 p.m. From 4 p.m. to midnight, some of that space can be used for emergency patients, easing congestion in the ER.

In addition, he continued, the program employs a physician to evaluate certain patients in triage — the intake process that classifies arriving patients according to urgency. In the past, Good Samaritan did not use physicians in triage.

The initial assessment at triage is generally conducted by a nurse at Good Samaritan, which employs a widely-used five-tier classification. The first two tiers are for critically and seriously injured or ill, who must be seen immediately.

Tiers four and five are the least serious of the emergency cases, including problems such as cuts and twisted ankles. “We can fast track them,” assess their needs, treat them quickly, and release them, said Sharma. “They require few resources.”

Cases in the middle tier, Sharma explained, such as severe headaches, nausea, abdominal pain and complications from pregnancy, require more resources, such as diagnostic tests. “We can’t fast track them,” so they generally have to wait to be evaluated and then wait for procedures to determine the necessary treatment.
Under Good Samaritan’s new plan, Sharma said, a physician assigned to triage evaluates tier-three patients to begin the process of ordering necessary tests and assigning the patient for treatment.

“We frontload them,” he said. Any needed tests can begin promptly rather than the patient’s having to wait to be seen first. The study focused on a half-dozen types of tier-three ailments.

The results show that fewer patients give up before treatment, Sharma said. The rate of tier-three patients leaving the hospital before being seen has dropped from 4.9 percent to 3.08, and for the specific types of complaints that the study focused on, the rate dropped from 6.96 to 3.9.

At the same time, ER patients report higher levels of satisfaction with the hospital.
Good Samaritan plans to expand the scope and hours of the program’s operation at the end of the study period, which concludes this month.

“We are always interested in innovations that can help our patient,” said Pat Hogan, senior vice president for nursing. “Whatever sticks, we stick with.”
“This program has also been good for staff morale,” said Susan Dries, vice president for quality care management. “I heard one nurse say that since we adopted this program, ‘the patients aren’t screaming at the nurses.’”