By late afternoon, the daily rush has hit the Johnson Memorial Health emergency room.

Patients dealing with flu-like symptoms, mothers holding ill babies and people suffering from sprained ligaments and broken bones filled the waiting room. With only 14 beds at Johnson Memorial Health, there was an inevitable wait to be seen.

Extra nurses and doctors helped ease some of the burden. Emergency room director Joey Hollis and his team had set a goal: for every patient to see a doctor within 25 minutes of walking into the hospital.

“With our size, we could have six or seven really sick people, or one really sick person, and that all affects your times depending on what each involves,” Hollis said. “It all depends on the individual patient.”

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As emergency rooms see more and more patients every year, leaders at local hospitals are constantly searching for improvements to treat people more efficiently and quickly. Changes ranging from adding extra nurses and doctors to department-wide shifts in how patients are assessed for treatment have yielded decreased wait times and better flow of patients.

Going to the ER is always going to require some waiting, officials say. The goal is to figure out the best way to treat both life-threatening situations and less serious illnesses at the same time.

“When you poll emergency department patients about what their expectations are, there are typically two responses: Patients want to know what is wrong with them, and they want to know how long it will take to get that accomplished,” said Sarah Knisely-King, chief operating officer for Community Health Network’s south region. “So we really prioritize those two things within our emergency department.”

Over the past decade, the emergency rooms serving Johnson County have seen more and more patients. The three major hospitals in the area — Johnson Memorial Health, Community Hospital South and Franciscan Health Indianapolis — treated nearly 179,000 patients combined in 2015.

Handling that influx of people has required specific strategies that in some cases completely changed the makeup of the ER.

At Franciscan Health Indianapolis, a plan to better manage the hospital’s ER load of about 74,000 annually started four years ago.

Officials started examining what could be done to streamline the emergency department process without expanding the hospital or adding more beds, said India Owens, Franciscan Health director of emergency services for central Indiana.

Previously, every person in the ER went through triage, had their vital signs taken and was told to wait until a room became available.

The problem was that all patients were waiting in one lump group. If a serious life-threatening emergency presented itself, those patients had to be seen first.

“What we had was a scenario where sick patients and patients who were less sick were competing for the same beds, and the sick patients always won,” Owens said. “The less acute — the earaches, the vomiting, the lacerations — would continually get pushed down the line.”

Not every patient who comes the emergency department needs to lie down in a bed to be seen, Owens said. Instead of having patients sit in a large waiting room to see a health professional, each one is assessed by a doctor right away during the intake process.

That initial assessment can help officials group patients, and lets hospital staff create a treatment plan, Owens said.

Serious conditions are kept in the core emergency room, where beds are available for them. Those with non life-threatening situations are moved into a special section of the emergency department known as Now ER, where they can be treated efficiently and quickly, Owens said.

“The idea is you get your pain or your problem addressed right away by a practitioner, where in the old model, you might have waited out in the waiting room for two or three hours,” she said. “In the meantime, you’re sicker and sicker and sicker, and no one even knows what’s wrong with you yet.”

The goal at the Now ER is to get patients seen, treated and out the door in less than two hours, and the hospital is achieving that 70 percent of the time, Owens said.

Getting people to a doctor as soon as possible was also the goal of Community Hospital South’s emergency room changes. Starting in 2012, officials implemented a policy to bring patients back to an open room right away to meet with a health care provider, Knisely-King said.

This way, patients don’t have to take time to fill out forms and get signed in, then wait for an open room.

“As long as there is a bed open and available, we’ll bring the patients straight back to a room to complete giving that information while in the room, allowing that patient to be triggered to be seen by the physician or the advanced practice provider,” Knisely-King said. “We tried to reduce some of that time for information gathering.”

Even with the changes to the emergency department, busier times do mean that both systems reach mass capacity and people have to wait, Owens said. But the adaptations ensure those waits are less than an hour, rather than three or four.

According to statistics compiled by the Centers for Medicare and Medicaid Service, a part of the U.S. Department of Health and Human Services, the average time Indiana patients spent from arriving to being sent home was 2 hours 7 minutes.

Franciscan Health Indianapolis patients had an average of 2 hours 42 minutes in the emergency room, while those at Community Hospital South were there 2 hours 30 minutes.

Patients at Johnson Memorial Health spent an average of 1 hour 49 minutes in the ER, according to the Centers for Medicare and Medicaid Service.

To shave waiting time off that number, Johnson Memorial Health has increased staffing during the busiest times — the block from 4 p.m. to midnight when the heaviest rush of patients come to the hospital.

With a 14-bed emergency department, one of its largest challenges was just having enough people to handle the flow of patients, Hollis said.

“That seems to be the major problem at any emergency room. You get a patient in, great. You get them in a bed, great. Now what’s the next step?” Hollis said.

Organizational processes, such as taking patients to get X-rays or other tests while waiting for a bed to become available, helps speed up the system as well, Hollis said.

The changes implemented in local hospitals have shown results. But with more people coming to local emergency departments every year, hospitals are making preparations to better serve patients.

Franciscan Health is planning a microhospital — a 24-hour emergency room with a limited number of inpatient beds — in White River Township. A Texas-based company had filed permits to build a pair of similar facilities just north of Greenwood and in the Center Grove area, though the statuses of those projects is unknown.

The new emergency room at Johnson Memorial Health’s proposed $42 million Franklin campus is anticipated to be finished in 2018 or 2019, Hollis said.

“We’ll be doubling the beds we have available once it’s finished, so that will definitely help,” he said.

At a glance

Here is a look at the average amount of time patients spent local emergency rooms, from the time they arrived to when they were sent home:

Indiana average: 2 hours, 7 minutes

Franciscan Health Indianapolis: 2 hours, 42 minutes

Community Hospital South: 2 hours, 30 minutes

Johnson Memorial Health: 1 hour, 49 minutes

SOURCE: Centers for Medicare and Medicaid Service

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Ryan Trares is a reporter for the Daily Journal. He can be reached at rtrares@dailyjournal.net or 317-736-2727.