Photo By Marcy Sanchez | William Beaumont Army Medical Center’s Emergency Department is implementing new...... read more read more
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In a single year the Emergency Department (ED) at William Beaumont Army Medical Center will serve around 66,000 beneficiaries. The 24/7 department is one of the most active units at WBAMC.
Recently the department implemented changes to its operations that may lead to shorter wait times for those in need of emergent care.
“The reason why so many (beneficiaries) go to the (ED) is an easy answer: you don’t need an appointment,” said Maj. Joshua Simmons, chief, Emergency Department, WBAMC. “You can just show up. There may be wait times, but you’ll get seen and taken care of.”
Even though the ED may be an answer for beneficiaries seeking care for anything from a gash to a graze, the wait times may be shortened with new department initiatives in place to streamline care.
“Long wait times are not a problem unique to WBAMC or the military,” said Simmons, a native of Savannah, Georgia. “It’s a problem that exists at every ED: Overutilization and inappropriate ED visits lead to increased waiting times.”
Simmons emphasizes that ER visits aren’t based off a first-come, first served basis. Patients are triaged at arrival, and more critical cases go to head-of-line when it comes to care at the ER.
Traditionally, emergency conditions are those which may lead to loss of life, limb or eyesight. This is not all inclusive though as other conditions may also warrant an ER visit such as the need for immediate help to treat severe pain or relieve suffering.
“While we’re talking about loss of life, limb, or eyesight, we also treat heart attacks, difficulty breathing, and other types of acute symptoms,” said Lt. Col. Patrick Marlow, clinical nurse specialist, Emergency Department, WBAMC. “We also see sprained ankles and less critical symptoms here, but if they can go to their Primary Care Manager (PCM) or an urgent care facility it would decrease our emergent visits significantly.”
Dependents and retirees enrolled in TRICARE Prime, TRICARE Prime Remote or TRICARE Young Adult-Prime with non-life threatening conditions may utilize Tricare’s Urgent Care Pilot Program which covers two non-referred urgent care visits at a TRICARE-approved treatment facility, per beneficiary each fiscal year. Beneficiaries can also call TRICARE’s 24/7 Nurse Advice Line at 1-800-TRICARE to determine if they may need emergency care.
An ongoing process-improvement team at WBAMC continues to evaluate evidence-based solutions to adopt at the ER. One development already being implemented in the ER includes a “first-look nurse,” who evaluates patients as they check in to triage.
“The first-look nurse evaluates everyone that comes in through the door, determines how sick the patient is, and captures active-duty Soldiers to get them back to their primary care clinics if they do not require emergent care,” said Simmons. “More importantly (first-look nurses) identify people that have emergency situations that require them to be seen by a provider immediately.”
According to Simmons, the ER has recently implemented a policy to send Soldiers with non-emergent issues back to their Primary Care Managers (PCMs) for appropriate treatment and follow-up with their medical team. By doing so, the ER opens up space for patients with more critical issues and allows Soldiers to report back to their units until their scheduled appointment instead of waiting at the ER.
“Soldiers need to go to their assigned clinic instead of coming to the ER; they need to use their sick call process,” said Marlow, a Milwaukee native. “We’re sending soldiers back to their clinics from the ER. That first-look nurse will triage them, a physician will come out and perform a medical screening exam, and then we’ll call the Soldier’s clinic and send them back to their unit provider team.”
In April 2017, about 33 percent of active-duty Soldiers who came to the ER were scheduled appointments at the Primary Care Medical Homes (PCMH). The intervention is strictly for active-duty service members.
“Thirty three percent is a significant number that we offloaded from the ER. It also results in Soldiers being treated at the right place with the right provider,” said Marlow.
Recently WBAMC’s Primary Care Department achieved six months of “green” status for Access to Care, meaning the department’s PCMHs had appointments available for beneficiaries with acute, non-emergent issues within 24 hours. Access to Care makes it easier for not just Soldiers to receive a scheduled appointment but also other beneficiaries enrolled at the PCMHs.
While these improvements may decrease wait times for beneficiaries, the physical constraints of WBAMC also pose a problem. The 2005 Base Realignment and Closure (BRAC) transformed Fort Bliss from a Training and Doctrine Command (TRADOC) to a Forces Command (FORSCOM) post, causing a significant increase in the post’s population.
“This hospital was built in 1972, and at the time served a much smaller population,” said Simmons. “Our emergency department was not built for the current population.”
The ER’s current capacity includes 33 beds, 20 of which are in the original ER with another 13 in an expanded area of the hospital to supplement the volume of cases. Beds are staffed by emergency physicians, nurse practitioners, and physician assistants. There is always an emergency physician on duty.
The hospital’s role in emergency service for the city of El Paso also plays a factor in quickly facilitating less critical cases. WBAMC provides emergency services to El Paso’s Northeast communities, including trauma services for civilians if it is the closest medical facility.
“There are a lot of reasons people come to the ER. Often, they feel they don’t have an option,” said Simmons. “What patients may not see in the waiting room is the ambulance coming through the back door; they may not see trauma cases coming in, those with critical illnesses going straight to a bed because they have to. Two people may look the same in outward appearance; however, their vitals may not be the same, and one may be sicker.”
“We’re doing things to make wait times better: increasing staffing, first-look nurse out front, referring non-urgent active duty to their unit provider.” said Marlow. “We want to improve the patient experience.”
| Date Taken: | 05.30.2017 |
| Date Posted: | 05.30.2017 10:39 |
| Story ID: | 235695 |
| Location: | FORT BLISS, TEXAS, US |
| Hometown: | MILWAUKEE, WISCONSIN, US |
| Hometown: | SAVANNAH, GEORGIA, US |
| Web Views: | 199 |
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