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Nurse Jodi Triplett, left, and Rice Memorial Hospital trauma coordinator Mary Nelson perform a check Wednesday of a rapid flow fluid warmer. The instrument is often used in treating trauma patients at the hospital emergency room. The ER is seeing an increase in patients through the first few months of the year. In February and March, the number of people who visited the ER was almost identical to the numbers seen in June, July and August, which tend to be the busiest months for ER staff. Tribune photo by...

Emergency room visits soaring at Rice Memorial Hospital

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Willmar Minnesota 2208 Trott Ave. SW / P.O. Box 839 56201

WILLMAR -- In the past three months, emergency visits at Rice Memorial Hospital have soared, prompting the hospital to add a second emergency-room doctor on Sundays to handle the increasing number of patients.

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Staff first noticed the trend three months ago.

Summer, not winter, is usually the busiest time of year in Rice's emergency room. Visits to the ER peak in June, July and August at about 1,000 a month.

But in February there unexpectedly were 965 emergency room visits.

The numbers surged even higher during March, to 1,086.

"We were like, 'What in the world?' We kept thinking: This is a blip, this isn't a pattern," said Kathy Hunt, director of critical care services for the hospital. High use of the emergency room continued through April, however.

Hospital officials weren't sure why. Were people who had lost their jobs and their health insurance turning to the emergency room as a source of care?

Was a shortage of primary care doctors causing patients to come to the ER instead?

There was speculation that people might have been putting off needed care because of the cost. Or maybe some hitherto-unnoticed demographic change was a factor.

"I have been searching to explain this," Hunt said.

As the numbers were analyzed, however, a couple of key trends emerged. One, most patients were coming to the emergency room for immediate medical care rather than for chronic care. And second, Sundays were consistently the busiest.

On one Sunday in February, for instance, half of the 52 patients who came in were there for chest pain, abdominal pain or breathing difficulties. There were two head injuries and one eye injury. Patients also came in that day with lacerations, fevers and coughs, and nausea, vomiting and diarrhea. Three arrived by ambulance and nine were sick enough to be admitted to the hospital.

"That did validate for me we're not becoming the primary care center," Hunt said. "We're finding that the emergency room is being used appropriately. Most patients are having their problem solved."

Since mid-February, the ER has seen anywhere from 40 to almost 60 patients on Sundays. The norm is around 35.

Hunt has started calling it "the Sunday phenomenon."

"I think our assumption now has been that come Sunday, you've tried to manage and you just can't. The weekend is just one day longer than people can make it through," she said.

The hospital has adopted several different strategies to deal with the increased ER volume.

A second physician has been added on Sundays. Nurse hours that were dropped in January because of a low census were put back on the schedule. An ancillary position, added last year to help the nursing staff with tasks such as getting warm blankets, also has helped, Hunt said.

For patients and families, a busier ER means they might have to wait longer to be seen for less urgent problems.

"The hardest part, even with two physicians, is to see people," Hunt said. "The workups these days include more tests than ever before. Many times patients don't know what's happening two rooms down."

It has helped to bring in a second doctor on Sundays so patients can be sorted more efficiently, she said.

"We've gotten smarter about what hours of the day we need that second doctor," she said. "We've shifted that into the evening."

The addition of a second hospitalist this fall also should help with getting the sickest patients admitted to the hospital safely and smoothly, Hunt said.

Hospital officials have already started planning for the busy summer season.

"As we go into the summer, what do we look like? We keep taking a snapshot," Hunt said. "If we continue on pace, we might top the 12,000 mark and then some. That's providing a real service to the community."

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