Kent Hospital ends practice of ambulance diversion

WARWICK – Kent Hospital is the first hospital in Rhode Island to end the practice of diverting ambulances from its emergency department, Sandra L. Coletta, president and CEO, announced at an Oct. 4 news conference.

In the past, the hospital had diverted ambulances up to 90 hours a month during very busy times.

The move is part of a complete makeover of the hospital’s emergency procedures, creating a new rapid assessment model of care as part of its commitment to change, a result of the settlement of the wrongful death lawsuit brought by the family of Michael J. Woods.

The changes in policy and practice, first implemented in July, have achieved immediate results, Coletta said, citing the case of a patient, who after waiting for 5 hours in the emergency room at one Rhode Island hospital, called another hospital and was told that it would be a 4-hour wait, then went to Kent and was seen within 10 minutes.

The changes in hospital emergency department practices were developed in partnership with Ximedica, a Providence-based design company, the Michael J. Woods Institute, and Brigham and Women’s Hospital of Boston.

Kent Hospital’s new clinical alliance with Brigham and Women’s in emergency and cardiovascular practices, which began in July, marks the second community hospital in Rhode Island to develop an ongoing relationship with the Boston-based hospital in these areas of care. Memorial Hospital of Rhode Island in Pawtucket has established a clinical affiliation with Brigham and Women’s for its Cardiovascular Center.

The redesign of emergency room procedures began in 2010 with a “deconstruction” of the patient journey in emergency care, working as a team with Kent Hospital staff, according to Kat Darula, director of Design Research at Ximedica. In its place, the new door to doctor model has placed the hospital at the innovative forefront of emergency care in Rhode Island.

The new workflow has drastically cut down on the waiting time, according to Lynne Rivard, the director of Emergency Services at Kent Hospital. Intake is averaging between two to three minutes, and about four to five minutes to when [the patient] is sitting in a bed, to be seen by a doctor, she said. “The patient is in the bed only as long as they need to be.”

In addition, the number of patients who leave the emergency department at Kent Hospital without being seen is 0.7 percent, bettering the national benchmark of 2 percent set by the American College of Emergency Medicine.

“I admit I was skeptical at first,” said Irene Croft, a nurse who has been working at Kent Hospital for 42 years – or longer, she admitted, if her days as a candy striper are counted. Today, Croft, who now serves as the patient advocate greeting patients who arrive seeking emergency care, is an enthusiastic cheerleader for the redesigned process. “I really believe in the new process,” Croft said, who described her new role as similar to that of an airplane traffic controller, directing the patient in a busy environment. “It has a created a new passion and joy in my nursing career.” Before, she continued, “my first greeting to patients used to be to apologize for the wait.”

Dr. Robert G. Dinwoodie, chair of Emergency Medicine at Kent Hospital, said that the changes had dramatically changed the patient experience – and potential outcomes. Before, the average patient’s length of stay was five or six hours, in crowded waiting room, and the wait to be seen by a provider averaged two hours.

“The practice of diversion is not good for the quality of patient care as a whole,” said Dr. Michael Dacey, senior vice president and chief medical officer at Kent Hospital. One of the problems, Dacey continued, is that despite the current push for coordination and sharing of electronic health records, that system is still a work in progress, so that an emergency room treating a diverted patient may have not immediate access to the patient’s medical records and history.

Coletta said she hoped that Kent’s no diversion policy would create a roadmap for other Rhode Island hospitals. “I believe this should become the standard of care moving forward,” she said.

There is also interest nationally in the new model of emergency care. Rivard said that she will discussing the new approach later this fall at the invitation of San Francisco General Hospital in California.