We live in an era of profound modern technological advances that have brought tremendous efficiency and convenience to modern life. With a few clicks on our mobile device we are able to order a pizza or stream the latest blockbuster film. This quick access to amenities has come into many facets of our life; however, it has been tragically sluggish in entering the field of medicine.
As a country, we have a disappointing track record of offering efficient and timely access to medical care – even in the field of emergency care, which is plagued by overcrowding and long wait times. Texas is leading the way to change this experience because Texas has embraced the freestanding emergency center (FEC) model to allow timely and convenient access for emergent medical care needs.
I am proud to work for Neighbors Emergency Center. I joined Neighbors over three years ago and have witnessed the tremendous culture change and practice of emergency medicine that is happening. Prior to Neighbors I worked at a large Level 1 Trauma Center associated with a University Medical Center. In my personal experience, there is a stark difference in the patient experience at a large hospital-based ER versus an FEC like Neighbors.
Comparing FECs to Hospital-based ERs
Here’s a hypothetical scenario at a hospital-based ER: ‘Little Johnny’ is driven to the ER by his parents. When they drive up to the ambulance bay, they are told they must use the patient parking garage located in the next building. The parents drive to the parking garage, circle up multiple floors and eventually find a vacant spot to park. When they finally arrive at the ER Triage, they are greeted by an overburdened RN who juggles triaging ‘Little Johnny’ while attending to the numerous other requests from patients in the lobby. ‘Little Johnny’ and his parents are then asked to wait in the crowded lobby until a room becomes available. Hours later, when they finally get back to a room, they wait for an overworked physician to see them. The physician evaluates ‘Little Johnny’ while he is also juggling a tremendous patient work load. The physician orders an X-ray. ‘Little Johnny’ waits for his X-ray; the radiology tech is already behind on his list of X-ray studies and will get to ‘Little Johnny’ when he can. Finally, after hours in the lobby and hours of waiting in the room, ‘Little Johnny’ gets his X-ray, which shows a fractured wrist needing conscious sedation to set the bones. The physician consults with the charge nurse to arrange for conscious sedation, but the charge nurse states there are not any nurses to spare for the sedation at this time. It would be barbaric to try to set the bone without conscious sedation, so the physician makes a stronger appeal to get nursing support for the sedation. Hours later, a nurse comes to assist with the sedation so that ‘Little Johnny’ can have his bones set and splinted. The young patient wakes up from the sedation and he has a splint on his arm. The family is told to go to check-out where they have to wait another hour. This hypothetical scenario from arriving at the ER to receiving treatment would take approximately 7 hours.
Here is how the same scenario would likely play out at an FEC like Neighbors: ‘Little Johnny’ is driven by his parents to the Neighbors Emergency Center. They easily find parking in the front of the center and walk 30 feet to the entrance where they are pleasantly greeted. They sit in an uncrowded lobby for a few minutes to fill out their paper work. They are then quickly taken to triage where a RN and board-certified MD greet them. The physician examines ‘Little Johnny,’orders an X-ray, and requests for the team to be prepared for sedation. ‘Little Johnny’ goes directly from triage to X-ray and then to his room where he is prepared for sedation. The physician reviews the X-ray within minutes, performs a timely sedation, sets the bone and applies a splint. ‘Little Johnny’ wakes up pain free with a comfortable splint on his arm. His parents are given a referral appointment to a local orthopedist. The physician spends time answering their questions and addressing concerns, confirms their understanding of the logistics regarding Johnny’s follow up, and educates them on splint care and pain management. The parents are also encouraged to call the facility with any questions or concerns that may arise. ‘Little Johnny’ leaves the freestanding ER with his parents, pain free with a follow up appointment. The entire visit takes approximately 1 hour.
Although the difference in these two scenarios seems quite drastic, it is an accurate representation of what I have witnessed in more than 15 years of practice in Emergency Medicine.
At a large Level 1 Trauma Center, it is well documented that there is a high incidence of burnout and stress. Neighbors has revolutionized the workplace for the ER physician. FECs are clean, comfortable, aesthetically appealing, and equipped with the latest modern technology to handle all major emergencies. The staff is motivated, friendly, warm-hearted, and brings a concierge level of service to the bedside interaction that provides relief to patients and their families.
I am honored to work for a company that strives to change the ER experience for the physician, the staff, and most importantly, the patient. At a freestanding ER, I get to practice the personable and high-quality level of medical care that I dreamed about when I applied to medical school. I am grateful to our patients for welcoming us into their communities where we strive to be the ‘Best Neighbors Ever’.