2016-08-18 / Front Page

Revamped Triage Cuts ER Wait Time

By Betsy Sherman Walker


Daily medicine, l-r: Karen Melchar, Assistant Manager, Emergency Unit; Jamieson Cohn, M.D., Emergency Medicine; and Medical Director of Newport Hospital Emergency Medicine Anthony Napoli, M.D., engaged in a bit of diagnostic "brain sharing" in the hospital's emergency department. (Photo contributed by Lifespan) Daily medicine, l-r: Karen Melchar, Assistant Manager, Emergency Unit; Jamieson Cohn, M.D., Emergency Medicine; and Medical Director of Newport Hospital Emergency Medicine Anthony Napoli, M.D., engaged in a bit of diagnostic "brain sharing" in the hospital's emergency department. (Photo contributed by Lifespan) If summer in Newport means greater numbers of people in the city’s restaurants, bars, streets and beaches, it should follow that numbers should also show a spike for the staff at the emergency room at Newport Hospital. And they do: The hospital these days is busy. Busier, in fact, than it has almost ever been.

In July, according to Anthony Napoli, medical director and chair of the emergency department, the ER logged an unprecedented 3,267 visits, making it the hospital’s busiest month in five years. Summer ailments and injuries have ranged from bike injuries and jellyfish stings to dehydration.


Robert Grocott, R.N., Clinical Nurse II, and Gita Pensa, M.D., at one of the triage stations the Newport Hospital Emergency Department has added to ease the impact of heavier patient traffic during the busier summer months. 
(Photo contributed by Lifespan) Robert Grocott, R.N., Clinical Nurse II, and Gita Pensa, M.D., at one of the triage stations the Newport Hospital Emergency Department has added to ease the impact of heavier patient traffic during the busier summer months. (Photo contributed by Lifespan) Yet thanks to the addition of three triage bays and three staff members during the afternoon (when volume is the highest), the “team triage” approach has resulted in far less time waiting to see the health care professional. In industry vernacular, the expression is “door-to-provider time,” and that variable at Newport Hospital has dropped dramatically in the past year.

On July 3, according to Senior Media Relations Officer Elena Falcone Relvas, the department set a one-day record of sorts, treating an all-time high of 133 patients. They experienced what the hospital says is currently the fastest door-to-provider time in the state: 16 minutes.

Napoli said the day was like the perfect storm. “The emergency department is [always] busier on weekends, and [this was] the Fourth of July. The Fourth was a Monday, and the Third was a Sunday,” he said. “And it was a beautiful day.”

To put it all in perspective, Falcone Relvas says that 16 minutes represents a 70 percent drop in the past nine months. Another improvement was that overall length of stay dropped by 20 minutes, a decrease of 12 percent. It paid off: Providence Business News reported earlier this month that in the last six months, the results of a Press Ganey national survey placed Newport’s ER in the top fifth percentile of peer hospitals for patient satisfaction.

None of this happened overnight. Leading up to all of this was a concerted, well-researched effort to change the face and the pace – and the embrace – of emergency care at Newport Hospital.

“The first thing we had to do,” Napoli said, “was dig the data out.” Last winter, he “took a little time looking at the last five years of visits – monthly, daily, and even day of the week.” What emerged was what he called a “volume pattern.” Longer waits were linked to a shortage of beds, and not everyone who was put in a bed needed to be in one. If accurate assessments about the degree of urgency and treatment could be made at the onset, then unneeded bed time could be eliminated. From theory it evolved into practice.

Napoli is coming up on his first-year anniversary at the hospital after 10 years with the Lifespan group at Rhode Island Hospital. Full-time (and then some) at Newport, he says he still occasionally puts in a shift up at Miriam, if only to shake out the Newport cobwebs.

Also factored in, he told PBN, was the input of doctors from other area hospitals, something he calls “brain sharing” of other specialists rotating among the core groups at Newport and Miriam. He told Newport This Week the process has brought a concussion specialist down to Newport as well as other doctors to observe “the way we do operations.”

The uber-triage is a great Band- Aid for the swell of summertime visitors. The volume, explains Falcone Relvas, increases by about 40 percent from the low in the winter. “It’s not all tourists,” she adds. “A good portion of it is seasonal residents.”

But it is not always peak summer season in the City by the Sea, and for Napoli and his colleagues the other nine months of the year, when members of the community begin to emerge, are equally as important. Collaboration with other hospitals is valuable, he says, but is quick to add that “we also have a core group down here of incredibly committed individuals” with a powerful connection to the community.

The emergency department, perhaps more than any other major Newport institution, must juggle its services. It serves three Newports: locals who live, work and are raising a family here; the visitor unexpectedly in need of medical care; and the uninsured and even more unfortunate. It makes a concerted effort to be all things to all people and still maintain its image as a strong, responsive hospital for the year-round community.

It is viewed as a “great resource,” Napoli says. “People have either been here, work here,” he adds, “or have a friend or a relative who works here.”

Questions surface about those who come in without insurance. The statistics are rather straightforward: According to the U.S. Department of Health and Human Services, since the Affordable Care Act’s coverage expansion began, about 16.4 million uninsured people nationwide have gained health insurance coverage, making it the largest reduction in the uninsured in four decades. In 2013, the uninsured rate in Rhode Island, according to Gallup, was 13.3 percent; according to the Insurance Journal website, by 2015 the number had dropped to 5 percent.

What does raise an occasional eyebrow in Newport are the individuals brought in with alcohol or substance abuse issues who often don’t blend into the ER scenario as demurely as the other patients. Are Newporters too sensitive, or overreacting to something they would rather not have to witness?

Not at all, Napoli says. There is a higher percentage of this, he adds, at Rhode Island Hospital, and more behavioral problems than with alcohol. “But at Rhode Island, once they are seen they are moved to another area. At Newport, the ER is one big rectangle.”

For Napoli and his colleagues, it is not so much a problem as a situation. “We serve the underserved,” he says. “They are part of the community [too]. But they have no insurance, no transportation, and no doctor. And if they are truly homeless,” he points out, “they have no place to go. We are it.”

There is a line in the Hippocratic Oath (which, incidentally, does not include the line, “First – do no harm”) that reads, “I will use treatment to help the sick according to my ability and judgment.” If you were to add triage to treatment, you will get a sense of where Newport Hospital’s ER is heading.

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