Busy Chicago ER decreasing wait times, increasing quality of care

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CHICAGO -- An emergency room in the city is changing the way patients are cared for. The ER is making simple changes that will make a big impact.

It’s intense in the trauma center; patients with gunshot and stab wounds and victims of serious car accidents are often brought to Mount Sinai Hospital for care. But in the emergency room, it’s a different kind of medicine.

“Every day we see what we call bread and butter community medicine," Dr. Jaime Moreno, Mount Sinai emergency medicine physician, said.

From high blood pressure and heart problems to breaks and sprains, it can seem more like a community doctor’s office.

“We are in a community that is underserved. There isn’t a lot of access to healthcare, so a lot of patients don’t have any other options," Dr. Moreno said.

Dr. Moreno grew up in the Pilsen neighborhood. He came to Mount Sinai to serve the community as an emergency medicine physician. In the last few months, he’s helped change the pace of care by implementing a new system that dramatically decreases what can be up to an eight-hour visit in the ER.

“From the day we started, overnight we saw a difference in our door to doctor times. Overnight it cut those numbers by more than half," he said.

It’s called "rapid medical evaluation." The process starts at the door.

“Somebody lays eyes on them right away. He’s actually hearing the story and writing the quick note," Dr. Moreno said.

The idea is to cut down on the number of patients who walk out the door untreated and frustrated due to long wait times.

“Not everybody wants to come to the ER and wait five hours to be seen for something that is potentially a quick treatment and discharge," Dr. Moreno said.

As a patient is checked in, a nurse or physician’s assistant can get a head start on ordering any tests or imaging studies that may be needed.

“People might need blood work, people might need imaging studies, x-rays, CAT scans. You’re able to see a patient and order that right away," Dr. Moreno said.

Instead of sending patients to the waiting room, where they’d sit out the hours until a critical care bed opens up – even if they aren’t sick enough to need one – they’re sent to triage where their care plan gets rolling.

One man came into the ER complaining of chest pains.

“Let’s get your EKG. We’ll probably need a chest x-ray and some blood work to make sure we’re not missing anything, and then we’ll take it from there," Dr. Moreno said.

Some patients can be treated in triage and discharged from there.

“If you come in and you’re not a critical care patient but you are still seeking medical attention and it’s something we can see you for, possibly just write a quick prescription for you and get you out the door," Dr. Moreno said.

That means beds in the unit stay open for the sickest patients.

“Whenever you don’t get to a patient you’re not capturing that patient. You might be missing something catastrophic, life-changing for that patient. So if you can see patients quicker, faster, decrease the number of patients that will leave without being seen, you’re hopefully able to touch every single patient and make a difference," Dr. Moreno said.

Dr. Moreno calls it a reallocation of resources – simply putting people where there are needed most.

Mount Sinai is the first level one trauma center in the city of Chicago to implement the Rapid Medical Evaluation System.

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