Harlem Hospital Puts ER Patients on the Fast Track
HARLEM—After often waiting more than 2 1/2 hours to see a doctor at Harlem Hospital's emergency room, many of the medical center's patients leave without being seen.
Those who remain are simply angry, and often take it out on the staff.
So when Executive Director Denise Soares announced a plan to create a Fast Track unit that would allow patients with non-emergency illnesses and injuries to be seen quickly, nurses at the hospital happily agreed to move their lounge to a smaller space to accommodate the effort.
"The nurses figured it was better for the patients who were not happy about having to wait long hours to see a doctor," said Rhea Morris, deputy director of nursing at the hospital.
After a three-week trial run, Soares, who said the idea came from conversations with emergency room staff, snipped the ribbon on the former lounge Wednesday, declaring that the Fast Track unit was here to stay.
"When people are in pain and waiting, they get angry," said Soares. "This is about patients and the community getting what they deserve."
Harlem Hospital is a Level I Trauma Center that regularly deals with gunshot wounds and car accidents. The staff sees more than 56,000 adults in its emergency room each year, along with 25,000 children. It is often the only point of contact some patients have with the medical system because of a lack of medical insurance or knowledge.
For that reason, the emergency room may be the only chance to help patients get on the right track before a problem becomes something worse, said Reynold Trowers, Harlem Hospital's director of emergency medicine.
"If not managed properly, a seemingly minor problem can lead to heart attack, stroke or blindness," said Trowers. "Sometimes, this is our only chance to identify and catch people who have fallen out of the system."
Patients with the flu, back pain or sprained ankles come to the ER because they are experiencing real pain, even though it may not be emergent.
The Fast Track has already produced results during its short life. In September of 2011, 6.6 percent of ER visitors left without being seen by a doctor. From Jan. 17 to now, that rate has been cut in half, to 2.9 percent.
The average amount of time that the 266 patients seen in the Fast Track waited after triage was 12 minutes. That's down from 159 minutes in September.
"For many members of our community, this is the gateway into the health care system," said Stephane Howze, chairwoman of Harlem Hospital's Community Advisory Board. "If we lose them here, we may not see them again for months."
After seeing a triage nurse, those with problems that are deemed non-emergent are referred to the Fast Track, which currently has three beds separated with privacy curtains and a private room for gynecological exams. There, nurse practitioners, under the supervision of a doctor, visit the patients and help them with their problems.
Some people may get a prescription that Harlem Hospital can fill at its pharmacy. More importantly, each patient gets a discharge plan advising them of next steps.
That may mean following up with their own primary care doctor or coming to one of Harlem Hospital's clinics. Medical care is not all that's dispensed. Some people may need to see the social worker to get help with emotional or other problems.
"This changes the way people think about the emergency department," said Dr. Maurice Wright, medical director for Harlem Hospital.
Trowers said it's important for those waiting in the ER to see patients getting help.
"People know they are not forgotten. It brings them closer to the providers," he said.
The hospital has made a financial commitment to Fast Track, in spite of the difficult economic times for the hospital, by hiring nurse practitioners to staff the unit, Trowers said.
The Fast Track is open from 10 a.m. to 10 p.m. Monday to Saturday. The staff is considering keeping it open on Sunday if all goes well. The goal is to begin seeing 100 patients per day.
When the emergency department moves to a new $249 million patient wing that's under construction next door, Fast Track will go along with it.
"The patients come in and say, 'This is nice.' They are very happy because they see we have tailored services just for them," Soares said.