By Carol Cole-Frowe
The Norman Transcript

Serious aches and pains that required emergency attention used to call for a scary trip to the hospital and hours and hours in the waiting room and emergency department.

Much of that has changed in the past decade, and especially in the past few years. The reason for needing the emergency department may still be an unhappy occasion, but care from the time a 911 call is placed has gotten better and much, much faster.

Norman Regional Hospital System, which covers the Norman Regional Hospital and Moore Medical Center, has quietly become one of the busiest, most efficient and effective emergency departments in the region, according to the numbers and quality indicators.

"I feel pretty comfortable saying that we are probably the best in this region," said Dr. Robert Frantz, NRHS emergency medical director.

Last year, the Norman campus saw 65,114 patients in its emergency department, making it the third busiest emergency room in Oklahoma and among the top 3 percent of busiest emergency departments in the nation, Frantz said.

Norman's emergency department has a 34-bed major side and a 10-bed fast track, with double triage speeding the process and shortening waiting times. Registration is done bedside.

About 20 emergency physicians from Norstar Emergency Physicians have been employed since 2004 in the Norman ED, with an average physician coverage during 2007 of 72 hours per day. They saw an average of 2.49 patients per hour.

Add the Moore campus, which saw 20,787 patients in its ED in 2007, and you have an emergency system ranked in the top 1 percent among the busiest in the country with almost 90,000 patients annually.

Compare that to just five years ago, in 2003, when the Norman campus saw 51,073 patients in its emergency room.

The average stay in the NRHS emergency department is 83 minutes for patients treated and released, compared to about three hours nationally. That doesn't include time spent in the waiting room.

That time can vary depending on when the patient comes to the emergency department. The peak period daily is in the evenings, topping out at about 7 or 8 p.m. The slowest period in terms of number of patients is about 5 a.m.

In February, the system set new records for seeing patients, with about 6,500 people through the Norman emergency department, 3,000 in the Moore ED, 1,000 transported by EMSStat and 5,000 seen at Urgent Care centers.

"In my mind, it was sort of a perfect storm scenario," Frantz said.

Two widespread entiroviruses, a rotovirus, respiratory illnesses and flu vaccines that missed the mark translated to the busy emergency departments.

"What these things did is they caused pretty profound nausea and vomiting and you just couldn't stop," Frantz said about the entiroviruses. "You put all these things together plus our weather and it was just a perfect storm scenario and there were lots of things that were conspiring to keep people in emergency departments."

If those numbers had continued, the system would have seen 158,000 people during the year, Frantz said.

"We have incredible people. We have incredible docs. We have incredible nurses. We have incredible medics. And they are able to stretch and make it work pretty much no matter what's handed to them," said Eddie Sims, manager of the EMSStat ambulance services.

Many factors contribute

A collaborative and quality attitude starting with the community and extending throughout the health system lends itself to better outcomes.

"It's not just one factor," said Frantz, who said he provides "fierce support" for his team. "And everything is up for review. We look at everything. And everybody's excited about doing it."

He said the American Heart Association calls it the "chain-of-survival" -- what happens to the patient from the time an event occurs.

Frantz gave an example of what happened last year when a York employee became ill.

"We had an individual who suffered a sudden cardiac arrest at the York plant a little over a year ago and his coworkers recognized it and applied an external defibrillator. It recommended shock and they shocked him," he said. "And then the firefighters were there and they started provided oxygen and other supportive care, and suddenly the paramedics are there and they are establishing IVs and giving medication and every one of these little links in the chain sort of serve as a safety line for that patient. And they are all critical."

Norman's EMSStat paramedics, who are employed by NRHS, are trained to read electrocardiograms or EKGs. They do prep work, put in IVs and draw blood, so the lab work can start immediately upon arrival.

The paramedics were featured in the November 2007 trade magazine Hospital and Health Networks for their training, which can save heart muscle when every second and minute counts. They have the highest published "code" survivability rates, or for sudden cardiac arrests.

"I tell patients this all the time. (Paramedics) do exactly what I would do if I were there. They give the exact first-line care that I would give if I were in the truck. Because I have been in the truck," said Frantz, a former paramedic. "They are having one-on-one care while they are sitting there."

Sims credits the community for being the first link in survivability -- educated and civic-minded residents.

"If they don't get any care until they get to the hospital, their chances of surviving is close to zero," Sims said of a sudden cardiac arrest. "We're talking seconds and minutes in providing CPR, initial defibrillation if it's indicated and a secure airway. And one of those things that has helped our survivability here in Norman is because we have a lot of people trained here in CPR."

Frantz said that comes from good preplanning.

"And that's the thing that people kind of forget. It didn't just happen. The paramedics have decided they are going to be standby on high school football games. And that's a pretty good congregation of people there too. Of course, there is a huge presence at OU football games. There are people at these big plants who have been trained where these densities of people are," he said.

And many health clubs like the YMCA, high school and University of Oklahoma sports venues have Automatic External Defibrillators or AEDs. CPR training is also required when a facility has an AED.

"And another thing that's come about in the last six or seven years is that the (Norman Police) dispatchers are all medically trained in CPR. So if you call 911 and you don't know CPR, they will instruct you how to do CPR over the phone. Your first practice will be on the loved one you called about. And that's just as good as having training beforehand," Sims said.

A rare combination

With Norman Regional Hospital and Moore Medical Center being "public trust" hospitals, and being committed to the wellness of the community, it creates a different attitude throughout the system that contrasts to a situation where the hospitals and various agencies are commercial and with a profit motive.

Frantz gives an example of problem solving in the emergency department, saying "it's a Norman thing."

It starts with a question.

"Hey, how do we solve this problem" And everyone will have an idea," Frantz said. "And no one is put off by it. It's like that's a good idea, let's try that. And it's extremely interesting to me. It's not like any other hospital I've ever been at."

Sims gives examples of how things work in Norman at accident scenes and how they are different.

"We have better scene multi-agency response and getting along and focusing on the patients' good or focusing on the situation without territories," he said. "Because even though we are a hospital system, we are so intertwined with the other public safety agencies. ... It creates something much greater. This is so rare in this country."

He tells stories about other cities, which would be laughable if they weren't so sad. "There are so many other communities where the police are going to write a ticket to the ambulances because they came with lights and a siren. Or where the police department is going to throw the fire department off scene. Where the fire department is going to squirt the police department to get them out of their way," Sims said. "They don't talk to each other and they are all out to get their own glory. ... It's not like that here."

In Norman, there are medics who are part of the NPD's SWAT team and medics who are part of the medical response.

"So it's an incredible system and you just can't duplicate it," Sims said.
When the NRHS HealthPlex at Tecumseh Road and 36th Avenue NW is finished, there will be another 10 emergency cardiac beds, which will enlarge Norman's emergency abilities and response.

Frantz said there is also more "community push" for excellence in the Norman area. In his first year as emergency department director, he had contact with the OU medical director, the former mayor who was a physician, police, fire and EMS. His colleagues only deal with their own departments.

Cheryl Parsons, board chairman for the Norman Regional Hospital Authority, began attending the weekly 7 a.m. emergency department meetings when she first joined the board. Parsons educated herself on the workings of the department, which has helped her communicate with board members about the needs of the ED.

"And I thought, 'This is great,'" Frantz said.

The board, Frantz and Sims are also aware that as the emergency department goes, so goes the hospital.

But in the end, it's all about the patient and improving their outcomes.

"I live here and the community matters to me," Frantz said to NRHA board members at their March 24 meeting. "I want it to be a great hospital."

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