A busy place

Michael Moore / Sentinel Staff

The entrance to Cheshire Medical Center’s emergency department.

Patient wait times at Cheshire Medical Center’s emergency department continue to exceed state and national averages, according to data from the Centers for Medicare and Medicaid Services.

The statistics — which represent median estimates from patients who responded from October 2017 to October 2018, presented in a database by the ProPublica news organization — show people reported spending three and a half hours in the Keene hospital’s emergency department before being sent home. That’s just over an hour longer than the state average for emergency departments of a similar size.

For patients admitted from the emergency department to the hospital, Cheshire Medical fell even further behind New Hampshire’s average. The median length of time patients spent in the emergency room before being admitted into the hospital was just over seven hours, the second longest in New Hampshire and nearly two hours over the state average.

And for patients to leave the emergency department for an inpatient bed, it took three hours and six minutes, on top of the more-than seven hours before being admitted. This is just over a half hour more than the state average and double the national.

These figures come from an annual standardized national survey commissioned by the Centers for Medicare and Medicaid Services. Statewide and national average times represent emergency departments in a similar size category as Cheshire Medical’s, serving 20,000 to 40,000 patients annually.

Across the state line, Brattleboro Memorial Hospital fared better. The median length of time for emergency department patients to be admitted into the hospital was just over five hours, and they reported being sent home from the emergency department after just under two and a half.

At Monadnock Community Hospital in Peterborough, these times were even shorter — at about four and a half hours and just under two hours, respectively.

In the wait-time data the Centers for Medicare and Medicaid Services released in 2016, Cheshire Medical’s emergency department also ranked poorly.

That year, patients reported spending just under three hours between entering and leaving the emergency department and slightly over seven hours in the department to gain initial admission as an inpatient.

Waiting is widespread

But the issue of long patient wait times doesn’t stop at Cheshire Medical.

In this latest data set, Mary Hitchcock Memorial Hospital at Dartmouth-Hitchcock’s Medical Center’s Lebanon campus had New Hampshire’s longest wait times in the size group, with patients spending just over four hours in the emergency department before being sent home and seven and a half hours before being admitted from the emergency department into the hospital.

Across the United States, the median time it took emergency-department patients to see a provider rose 22 percent between 2003 and 2009, according to a data brief from the National Center for Health Statistics. From 1999 through 2009, the brief notes, the total number of trips to emergency departments saw an even sharper increase of 32 percent.

A May 2019 article for Kaiser Health News examining California hospitals points to one of the problems with this scenario: “As ER wait times grow,” the headline reads, “more patients leave against medical advice.”

But Jessica Lussier, director of emergency services at Cheshire Medical, said the hospital’s latest data show its wait times are improving.

September’s numbers, for example, reveal a slight decrease in the time patients are waiting to be admitted from the emergency department — just under six and a half hours.

And, Lussier stressed, patients aren’t really “waiting” during this time.

“Before a patient can be admitted to the hospital, there needs to be a series of assessments, including tests ...” she said, such as CT scans or MRIs.

Many hospitals admit patients quickly and then administer tests in different departments, according to Lussier, but Cheshire Medical prefers to carry out lengthier testing processes beforehand to determine the most appropriate form of care.

This, she explained, could skew the wait times reflected in the data.

Other factors influencing Cheshire Medical Center’s data include a lack of available beds, Lussier said.

The hospital has 169 beds, but she said the emergency department is typically staffed for about half as many.

“I may have more beds on a unit, but if I don’t have a nurse or [doctor] to take care of them, I can’t put someone there,” she said.

The emergency departments at Cheshire Medical and Brattleboro Memorial share 17 physicians and six associate medical providers to staff them both, according to information provided by Cheshire Medical.

The Keene hospital’s emergency department also has about 58 other staff — nurses, emergency department technicians and health unit coordinators working varied hours.

Lussier said Cheshire Medical aims to increase staffing during typical peak hours, but “unpredictability remains a challenge as a whole.”

In addition to staffing issues, she pointed out that certain beds within the emergency department are allotted for specific types of emergencies. The hospital created a behavioral health area in 2015, after a statewide surge in wait times for mental health patients, according to a 2017 report by The Sentinel.

That surge, according to Lussier, is part of an ongoing crisis in the state and beyond surrounding behavioral health, as well as a lack of resources, which drives more patients to the emergency department for help.

And while she said she’s glad the department has resources available for these patients, Lussier said this can come at a cost to others waiting to be admitted.

“Right now, I have five behavioral health patients in the [emergency department],” she said earlier this month. “I’m a 20-bed [emergency department]. That cuts back on my ability to get everybody in.”

Patient volume has also steadily increased in the past four years. In fiscal year 2019, the department saw 23,358 patients, compared to 22,834 in fiscal year 2016.

But despite this rise, Lussier said Cheshire Medical has made progress in helping patients get care in the appropriate setting.

Cheshire Medical Center’s Doorway program, on Marlboro Street in Keene, for example, has given the hospital additional tools to help people with substance-use disorders.

The center, which opened in January, is part of a two-year, multimillion dollar federal grant for the state to create a “hub and spoke” system to screen, assess and refer people to treatment and support services in the community. The hub aims to link people to resources and follow up with them as they advance through recovery services — the spokes.

Though Lussier said it’s a “bit of a misnomer” that people with substance-use disorders flock to the emergency department to be “rescued,” Cheshire Medical now has better referral resources when this happens.

“For a while, we’ve been stuck with, ‘I want to help you, but I don’t know where to send you,’ and it was just a ‘good luck’ situation. That doesn’t make anyone feel better,” Lussier said.

Cheshire Medical’s Walk-In Clinic, which opened in 2015, is also a step in the right direction, according to Lussier.

The walk-in center has decreased the number of patients at the emergency department for less urgent care, who tend to end up on the back burner when the department is busy.

“If you go to the [emergency department], we don’t say you should go someplace else,” Lussier said, “but it might take a little bit longer, because we are taking care of someone more acute, than if you had showed up at the right place.”

And though getting wait times lower is important, Lussier said patient care is the top priority.

“The [emergency department] team strives to provide great care to our patients,” she said, “no matter what their admission status might be.”

Olivia Belanger can be reached at 352-1234, extension 1439, or obelanger@keenesentinel.com. Follow her on Twitter @OBelangerKS.