Dr. Michael Olgren in one of the ER waiting areas at Saint Mary’s.

Inside GR's ERs The five local emergency rooms all are striving to optimize their efficiency in handling patients expertly and quickly, with new amenities and well-thought-through processes. By Marty Primeau Photography by Johnny Quirin The surroundings are serene — soft colors, curved hallways, frosted glass and tranquil fountains. Furnishings in the lounge areas are contemporary yet comfy, and guests can help themselves to complimentary beverages. Each room is spacious and equipped with a flat-screen TV. A new resort hotel? Not exactly. It’s the ER at Saint Mary’s Health Care.

Totally renovated two years ago, the new Saint Mary’s emergency department is “more pleasant for patients and families,” said Dr. Michael Olgren, medical director. “The culture is one of really wanting to help people. It’s a nicer place to be.”

The new ER is also designed to improve patient flow, the result of careful planning and input from physicians, nurses, EMS groups and others.

And efficiency is what hospitals around the country, including the five ERs in the Grand Rapids area, are striving to achieve. The hospitals are focused on cutting “door to doc” times — those minutes and hours the sick and injured spend waiting to see a physician.

The greatest challenge is the increasing number of patients.

Anyone who goes to an emergency room has to be screened, according to the Emergency Medical Treatment and Active Labor Act passed by the U.S. Congress in 1986. “The idea behind it was to prevent patient dumping, back when hospitals refused people without the right insurance,” Olgren said.

But most patients are not true emergencies.

“People are using us for convenience, because they can’t get in to see their primary care physician,” says Dr. Helen Berghoef, director of emergency and ambulatory services at Metro Health Hospital. “And we have to figure out how to manage those volumes.”

Increasingly, ERs are handling more primary care cases, everything from sore throats to toothaches. Olgren said emergency departments have become “a last resort” for people with economic troubles. “When people lose their job and their insurance, they go to the emergency room.”

Dr. Todd Chassee, an ER doctor at Spectrum Butterworth and medical director of Kent County Emergency Medical Services Inc., agreed.

“We can give them access to low cost or free care,” he said. “But often it’s just a tune-up. We know they aren’t going to thrive because we can’t provide the long-term care they need. Free clinics already are overwhelmed. We try to give them resources, but in many cases it’s frustrating because we know we’ll see them again.”

Psychiatric disorders also have become more common, Berghoef said. “It’s a real problem. Metro is just one of hundreds of hospitals struggling to find enough beds for psych patients.”

What the hospitals can do is to make patients more comfortable during their ER stay.

The new emergency department at Saint Mary’s — which had 55,000 visits last year — features 44 private rooms, including four trauma or resuscitation rooms within 10 yards of the entrance.

Ambulances come in a separate pull-through, covered driveway with heating devices. “It’s designed to enhance patient flow,” Olgren said. “Within five to 10 minutes, patients are moved to private rooms to decrease the time it takes to see a physician.” There are portable ultrasound machines, specialty carts equipped with everything a physician needs for any situation, and a nearby X-ray room. Saint Mary’s also plans to have a pharmacist station in the ER.

Spectrum’s Butterworth Hospital, one of the busiest ERs in the nation, is preparing to redesign its emergency department to “optimize the process, rather than the structure or physical plant,” said Dr. James Schweigert, Spectrum’s medical director of emergency services. “We worked with MSU on developing evaluation guidelines and state-of- the- art imaging so we can evaluate a patient and get testing done in 12 to 24 hours, instead of two or more days.”

Butterworth and DeVos Children’s hospitals are West Michigan’s only Level 1 Trauma Centers, meaning the ERs staff a required number of surgeons, ER physicians and anesthesiologists on duty 24 hours a day. All Level 1 hospitals also have ongoing research programs. Saint Mary’s, which does not have research, is a Level II.

At Butterworth, the ER has a fast-track system for minor illnesses and injuries to get those patients in and out quickly, Schweigert said. “Backlogged are the urgent but not emergency patients,” he said. “For example, someone with severe abdominal pain, but we don’t know if it’s a case of flu or an appendix.”

The opening of Helen DeVos Children’s Hospital has eased some of the overcrowding at Butterworth.

“When the ER was seeing 135,000 in a year, we had a lot of people in the hallway, and we recognized that’s not optimal care,” he said. “With the new children’s ER, that situation has improved dramatically.”

Above, Child Life Specialist Kelly Newman offers a book to Amaya Nickels, who received stitches in the ER at DeVos Children’s Hospital.

The new Children’s Hospital is designed to treat kids from newborns to 17-year-olds. While some of the equipment in the ER is geared to a child’s size, “it’s really the personnel that makes the difference,” said Dr. Matthew Denenberg, medical director of pediatric emergency medicine.

“We have child life professionals who are specially trained to deal with kids — from something as simple as an IV to a laceration repair or an MRI. Adults take those procedures for granted, but they can be traumatic for kids.”

The trained staffers hold hands, provide stuffed animals — even provide slushies to keep children calm.

Easing anxiety for all patients is a goal of local emergency departments.

“We’ve found that patients with a lot of angst about delays or waits tend to be not as receptive to their care,” said Berghoef at Metro Health. “There is research that shows if patients have less anxiety, they’ll listen better and be more compliant with their plan of care. So that’s part of the focus for us.”

Metro has taken several steps: “Having the right staff at the right times, having ancillary departments nearby, having inpatient units working with us to get patients to admitting so we don’t have to hold them in the ER: It’s the hospital working as a team.”

Recent renovations at Spectrum’s Blodgett Hospital in East Grand Rapids added 132 private rooms and facilitated short ER waits. “For really bad trauma, patients may prefer Butterworth, but for most emergencies, the wait times are shorter at Blodgett,” Schweigert said.

At Metro, the newest tool is a text feature that gives patients the current wait time.

“You can just text ER to 40491, and it will reply quickly with the wait time, updated every five minutes,” Berghoef said. “It also gives the average wait time for the last 24 hours.”

The idea is to help manage expectations, but “not for the patient with chest pain. They should call 911 or go to the nearest emergency room.”

Another new challenge is caring for the elderly, she said.

“As baby boomers age, they’re using the ER with more frequency, so we’re designing key protocols that deal with their needs.”

Lody Zwarensteyn, president of West Michigan’s health-planning agency, The Alliance for Health, says GR’s emergency rooms will continue to redesign and add staff “for things they weren’t built to handle.”

His hope for the future is the concept of medical homes with urgent care clinics that would handle primary care cases.

“What we’re trying to do is go to an era where you use the ER only for true emergency. If it works, it would be a cost savings for everybody.” GR

Marty Primeau is managing editor of Grand Rapids Magazine.

Above, left to right, scenes at Saint Mary’s Health Care: Amanda Wideman, patient care associate, delivers a portable X-ray machine; Dr. Mark Miller answers a page.