FAIRMONT - The word "emergency" can be subjective, varying from one person to the next.
Because of federal law, no emergency room can turn someone away, or even suggest they make an appointment at a clinic instead of seeking immediate care, explained Sandee Vaske, emergency department and trauma manager at Mayo's Fairmont site.
"We've done a lot of coaching. If they feel they need to come in, it's not for us to judge," Vaske said. "We need to give them the best care possible."
GOOD?JUICE?— Nurse Mary Jo Hartmann hooks up fluid for an IV in the emergency room at Mayo Clinic Health System in Fairmont.
Last year, 9,294 visits were made to the emergency room at Mayo Clinic Health System in Fairmont. Many of these visits took place during regular clinic hours.
A basic level 3 visit, for something like a fever, costs $604.25 in the emergency room. For the same problem, a patient could be treated in the clinic for $124, or lesser yet, The Clinic at Walmart would charge $59. The minimum charge for an ER visit is $394. The reason for the difference in cost is due in part to staffing and the operational costs of running a facility designed to quickly treat patients with acute illnesses and injuries.
According to a national database on patient satisfaction, the Fairmont emergency room is improving. Two years ago, the ER was ranked among the top 85th percentile in the country. Today, it's at 90.2.
One patient wrote of their recent experience: "For the size of this town ... these are a great group of dedicated doctors and nurses. They deserve recognition for what they do!"
But Vaske isn't getting too excited yet.
"We need to sustain it," she said.
The improvements in the ER's scores began shortly after a new staff model was implemented. Prior to November 2011, much of the staff in the emergency department were trained only in family medicine. Now it's staffed only by board-certified emergency physicians who divide their time between Mankato and Fairmont, a system devised by Dr. Yo Schugel, the region's emergency medicine director for Mayo.
Board-certified emergency physicians receive an additional three years of training, making them a highly sought commodity. Rural communities rarely attract these physicians, since they need to work in busy trauma centers, simply so they can keep their skills sharp.
"They're highly trained at early recognition and treatment," Vaske said.
Schugel and the emergency physicians also have worked to standardize the way patients are treated and how the department operates. For example, all the rooms are now stocked with the same tools and materials, whereas before staff were interrupting patients to grab items needed elsewhere.
"We're able to balance the flow of patients better," Vaske said. "We've improved the wait time, which was a big dissatisfaction for people."
And more improvements are coming.
Mayo Clinic Health System Fairmont Foundation is raising funds for a future remodeling project. Administration couldn't say when the work will begin or what it will cost, but based on the extensive nature of the proposed remodel, it will run in the multi-millions.
Bob Bartingale, administrator at Mayo's Fairmont location, provided a list of the proposed upgrades:
o Adding a drive-through ambulance garage. The existing garage requires the ambulance to back up and unload patients in the open air, which can be problematic in certain weather conditions, Vaske acknowledged.
o Creating space for behavioral health patients. Emergency rooms are seeing more of these patients, and they often have different needs from other patients. For instance, someone who has attempted suicide should not be placed in a room where medical tools could be used to cause further bodily injury.
o Creating an area for infection isolation.
o Providing more privacy for nurse triage. Only a curtain separates this area from the ER waiting room. The space is used when all the rooms in the ER are occupied and staff need to prioritize patients waiting to be treated.
o Expanding the patient registration space.
o Adding patient rooms to better serve today's population and prepare for future population trends.
o Modernizing the department for efficiency and enhanced patient experience.
o Improving visibility of the nurse station from the waiting area.
Some improvements to the department have already been implemented. The ER now has new IV pumps; monitors that interface with Mayo's electronic medical records; and a ceiling lift to assist with moving heavier patients instead of relying on assistance from volunteer emergency responders.
The upgrades are more important than ever before, noted Vaske, because of pending changes in federal law.
"In the very near future, reimbursements are going to be based on patient satisfaction," she said.