Long waits prompt University of Chicago to propose new ER for adults

The University of Chicago is proposing to spend $36 million to upgrade and relocate its emergency room for adults, in part because thousands of patients grow tired of long waits to see a doctor and leave without being treated.

Officials at the hospital submitted an application to the Illinois Health Facilities and Services Review Board on Dec. 11 seeking permission to build a new emergency department closer to the university's new hospital building, the Center for Care and Discovery, on its Hyde Park campus.

University of Chicago Medicine has two emergency departments. The other, at Comer Children's Hospital, is a Level 1 pediatric trauma center that treats patients up to age 15, although officials are working to incorporate treatment of 16- and 17-year-olds. The Adult Emergency Department is not a Level 1 trauma center, a source of controversy on the South Side because it doesn't treat gunshot victims, for instance. The new proposal does not include plans to upgrade it to handle such cases, which involve highly expensive care that often goes unreimbursed.

If approved, the project would increase the number of beds to 42 from 36, which hospital officials said will help increase efficiency and decrease the number of patients who leave without being treated. The new plan would also add an additional entrance—walk-ins and ambulance arrivals come through the same door now—and would boost the department's square footage almost twofold.

The emergency department has seen about 52,000 patients this year, and that number has been increasing more than 5 percent annually since 2009. Dr. Linda Druelinger, emergency department section chief, said that at peak times, 10 to 15 patients walk into the emergency department per hour. Although some steps—such as increased staffing—already have been made, it is not enough. According to the proposal, about 6,000 patients leave the emergency department annually without being treated, an average of about 16 a day.

And the patients who do stay are staying too long. The average time a patient who was ultimately discharged spent in the emergency department in 2013 was about seven hours, according to the proposal. Patients eventually admitted into the hospital spent an average of 13.2 hours there.

The nationwide average length of stay in 2013 for patients ultimately discharged was about 3.3 hours, according to a study of 77 adult emergency departments done by the Emergency Department Benchmarking Alliance, a nonprofit organization in Newark, Del., that compiles emergency department data. Patients eventually admitted spent an average of about 5.6 hours there.

“We are at capacity,” Druelinger said in an interview. “Our space is insufficient to care for the number of patients that walk into our emergency department on a daily basis.”

Vikas Ghayal, executive director of emergency services, said the department has undergone several expansions and renovations. But the current space in a 30-year-old building is so outdated and small that it would cost $3 million more to upgrade it than to build a whole new facility.

University of Chicago Medicine opened the 13-floor Center for Care and Discovery at 5700 S. Maryland Ave. in February 2013. With most of the hospital's vital departments relocated there, the new facility has replaced Bernard Mitchell Hospital at 5841 S. Maryland Ave. as the core of clinical operations. The adult emergency department remains in Mitchell. Moving patients to the main hospital takes 15 minutes and two elevator rides.

Officials say that commute is unacceptable and poses perils to patients.

“Some of our most acute patients have a distance to travel from very important procedures,” Druelinger said. “Bringing the emergency department closer to some more critical areas like the (operating rooms) . . . will enhance the patient experience and add to our ability to care for the patients.”

Officials say the modernization process is being done in stages across the medical campus because moving services while continuing care is so daunting. The emergency department's upgrade is the next step.

The new structure would be located on 57th Street, across the street and to the north of the main hospital. The structures would be connected by a tunnel and second-floor bridge, according to the proposal.

Reducing travel time to other departments will do more than enhance patient experience, said Dr. Bret Nicks, who works in emergency medicine at Wake Forest Baptist Medical Center. Nicks is a spokesman for the American College of Emergency Physicians, which represents more than 32,000 medical personnel nationally and is based in Dallas.

“You want to be as close to all of the other aspects of (the hospital) to be as efficient in managing your patients as possible,” he said. “Otherwise, you're looking at a horribly inefficient process.”

Nicks said the wait times must shrink for University of Chicago's adult emergency department to succeed—financially and in patient care.

“If any of those areas are failure nodes, you cannot have an efficient system,” Nicks said. “The patients that can pay choose to go somewhere else because they don't want to wait, and you are basically driving your costs up.”

The emergency department reported a $23 million loss last year, according to the proposal. Ghayal said the main goal of the new emergency department will not be to increase revenue, but to provide better patient care.

“We're the front door to the community, and we're here to be that,” he said.

The health facilities board is scheduled to vote on the application at its March meeting in Bolingbrook. If approved, the hospital hopes to complete the facility by March 31, 2020. The vacated space at Mitchell Hospital would likely become a care center for University of Chicago students.

Other local hospitals have made similar moves. Rush University Medical Center moved into a new hospital in January 2012, taking its emergency department with it. University of Chicago Medicine officials said Rush officials were among those consulted during the preparation of their proposal.

Advocate Health Care proposed an $86 million expansion to the emergency department at Advocate Christ Medical Center in south suburban Oak Lawn in November. The facility sees 100,000 patients a year, twice as many as it was designed to handle.

"Long waits prompt University of Chicago to propose new ER for adults" originally appeared on the website of Crain's Chicago Business.