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Sinai pleased with its ER-7 experiment; Emergency room visits up 30% after redesign of space, services


It was splashy. It was so customer-friendly it was almost aggressive. It was expensive to build and promote -- a $16 million facility with a quarter-million-dollar advertising budget.

But could Sinai Hospital's new emergency room, dubbed ER-7 for its seven care zones, actually attract patients?

Could amenities -- such as private waiting rooms with videophones -- TV ads and high-tech care draw people? Or would patients, in a real emergency, simply head for the nearest hospital?

After a year of operation, the results are in:

Emergency room visits are up more than 30 percent over the previous year, from 52,025 to 67,926.

The hospital estimates its market share of emergency visits in the Baltimore area grew from 6 percent to 8 percent.

ER-7 has attracted patients from areas where Sinai hasn't previously drawn them. Donald Giller, vice president for marketing and development for LifeBridge Health, Sinai's parent, said the hospital has gotten more ER patients from Roland Park, Homeland, Rodgers Forge, Cross Keys and Ruxton. The percentage of uninsured patients in the ER has dropped from 23 percent to 21 percent, Giller said.

Because some of those patients are admitted to the hospital, Sinai officials estimate that the new ER is responsible for about 2,000 extra admissions (in a hospital that admitted 20,000 patients the previous year), pushing occupancy up after three years of decline. Overall, Sinai's ad- missions were up 2.4 percent while admissions statewide were down 1.3 percent.

"It's worked out splendidly. We're very pleased," said Warren Green, chief executive officer of Life-Bridge Health, formed by the merger of Sinai and Northwest Hospital Center. Green was CEO of Sinai during the planning and opening of ER-7.

Charles Orlando, LifeBridge's senior vice president and chief financial officer, added, "I can't give you a hard dollar figure, but I can tell you that ER-7 has had a favorable impact on the hospital's profitability."

In a recent report on hospital emergency services, the Advisory Board Company, an organization that does research for 1,200 member hospitals, wrote, "The Sinai experiment is proving evidence of an unexpected phenomenon -- the mobility of ED [emergency department] market share. Long thought to be determined by proximity first and then only secondly by reputation and other consumer preference factors, ED market share has moved massively in Sinai's direction."

Lots of hospitals are spiffing up their emergency rooms these days, says Cormac Miller, an Advisory Board consultant who worked on the report. A survey by the trade magazine Modern Healthcare found one-third more new ERs designed in 1997 than in 1996.

But Sinai's, Miller said, is "probably the most complete restructuring we've seen." Many hospitals have adopted one of two strategies -- redesigning ER systems for faster service or adding amenities to make the ER more pleasant -- but Sinai did both, according to Miller.

While such a drastic makeover might not bring patients from, say, Carroll County, said Green, it can affect choice, given that about a half-dozen other hospitals are within three or four miles of Sinai.

This applies particularly, Giller said, when Sinai offers a service, such as pediatric emergency care, that some other hospitals do not. The pediatric zone has been one of ER-7s busiest.

Part of the ER's success is in drawing nonemergency patients. Sinai offers a "fast-track" area for minor problems and an "urgent" area for those who are sick, but not critically.

Health economists have complained for years that emergency room visits for minor problems -- illnesses that could be treated in a doctor's office -- were driving up the cost of care. Emergency medicine people argue the opposite -- since the ER is staffed anyway, particularly on nights and weekends, "we can be a resource without adding any more cost to the system," said Dr. Todd Warden, acting chief of Sinai's emergency room.

Warden is an executive vice president of Dallas-based EmCare, a company hired by Sinai last month to manage its emergency department. The same doctors are staffing the ER, but they're now employees of Dallas-based EmCare.

Green said Sinai brought in EmCare for its expertise and national recruiting reach. Warden said EmCare was brought in to improve "leadership and management" and because of its "ability to approach information objectively."

The rest of the ER staff, such as nurses and aides, continue to be Sinai employees. Nationally, EmCare staffs 366 emergency departments in 36 states, employing 4,700 doctors to see 6.5 million patients a year.

Warden said EmCare was excited to get the Sinai contract because it represents "an important part of where we want to go in emergency medicine -- a signature service."

The new attention to emergency rooms is driven by business considerations. "ERs have always been neglected -- frequently cast aside as money losers," Green said.

Now hospitals figure the emergency room is "the community's window into the hospital," says Miller. Green noted, for example, that each ER-7 patient, on average, has 2 1/2 visitors, so 70,000 ER visits mean 175,000 people being introduced to the hospital.

Sinai hopes not just that more ER traffic will yield direct admissions, but that patients pleased with Sinai will use it again. It's too early to tell whether that's working, Green said, and perhaps too hard to measure. Miller said he's heard this theory from other hospitals, "but I've never seen anyone who's able to prove it."

ER-7 still loses money -- more money than the old ER, since it has much more staff -- although Sinai does not release figures for profit or loss by department.

Still, Green concluded, "If you're going to make an investment, our rationale is that that's where you make it. Virtually all ERs lose money; it's in the nature of the beast. But the ER is a powerful admission engine." Sinai, he noted, gets about $200 million a year in revenue for inpatient care -- and 60 percent of those patients enter through the emergency room.

Pub Date: 1/17/99

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