Nantucket Cottage Hospital Sees Record Summer Emergency Room Visits

Reprinted with permission by the Nantucket Current

Nantucket Cottage Hospital saw a record number of emergency room patients over the summer of 2022, outpacing the previous highs set just last year.

From June through August, the hospital recorded 5,266 emergency room visits. That number is even more significant considering the hospital reopened its urgent access clinic, which saw another 3,230 patients over the summer.

“In 2021 we had huge volume – we were slammed – and we didn’t have urgent access, so there were challenging times for us and for our patients,” said Chris Glowacki, Nantucket Cottage Hospital’s vice president for strategy, community health, and its chief development officer. “This summer, emergency department volume was still up, and acuity went up.”

And yet, thanks to a number of changes –including better staffing, a revamped triage system, and new nurse-driven protocols – a number of key metrics actually improved compared to the summer of 2021, hospital officials said.

Internal data shared by the hospital with the Current showed that the average patients’ length of stay was down sharply, as was the average time from arrival to be triaged and seen by a provider. The number of patients who left the emergency department without being seen also decreased significantly compared to 2021.

“I’m proud, I think we did a really good job,” said Amy Beaton, the nurse director of the emergency department who joined Nantucket Cottage Hospital in February. Beaton came to NCH from a much larger institution - Reading Hospital in Pennsylvania – where she worked in a 110-bed emergency department with 16 pediatric beds, and 10 psychiatric beds. But from her first day she said she heard what a challenge the summer of 2021 had been for the emergency department team at NCH.

Beaton said she lobbied for additional seasonal staff – a request that was granted – and listened to the emergency department’s nurses about what had worked and what hadn’t in the past. She set out to revamp the NCH emergency department’s triage system, to get patients triaged faster and more efficiently.

“An untriaged patient is the sickest patient, and until you have a set of medical eyes on a person, you don’t know how sick they are,” Beaton said. “So that was my personal goal and one of the things I’m proud of. Everyone was triaged. We had a plan in place, and my goal for my team was to have patients be seen by a clinician with a triage time of 10 minutes.”

Beaton said they established a “fast track” section of the emergency department to address patients with more minor ailments, and got on the same page with other hospital departments like the laboratory and radiology.

“Everyone was on board,” she said. “The structure worked. It was a great, great team.”

Beaton added that they also had buy-in from Bluewater Health, the firm that holds a contract with NCH to staff the emergency department with medical providers, including physicians and physician assistants.

Cynthia Winston, the program director for NCH’s urgent access clinic, said the operation at the Anderson Building was similarly busy over the summer, seeing 55 patients per day. Both Winston and Beaton said the service was invaluable in diverting some of the volume that would have otherwise gone to the emergency department.

Rather than operate the clinic on a walk-in basis as it had operated before the COVID-19 pandemic, the hospital chose to run the urgent access service by appointment only. At midnight, they would open up half of the appointments for that day on the Patient Gateway – the online portal used by Mass General Brigham –while keeping the other half available for people to book by calling the hospital.

While they acknowledged there was significant competition for those appointments and frustration among some patients who would stay up late or set their alarm to wake up and make an appointment at midnight, Winston said “we did everything we could to make sure the people who wanted an appointment got one and got seen.”

The urgent access clinic was typically staffed with two providers on a daily basis. Winston said the hospital plans to keep the clinic open on a year-round basis.