Data shows improved wait times at St. Michael Medical Center ED in recent months

SILVERDALE – Data provided to the Kitsap Sun shows marked improvement in the time it takes both for patients to be transferred from ambulances into the emergency department at St. Michael Medical Center and to be seen by providers inside the Silverdale hospital in recent months, even as the number of patients arriving at the facility for treatment has ticked up over the last year.

The Poulsbo Fire Department began tracking drop-off wait times for ambulances in July last year after they began to stretch out and ambulances began to stack up at the hospital. Data provided by the department showed the average wait time for ambulances reached a monthly peak over the last year in December at 18.9 minutes. That number has since dropped to 10.6 minutes, as of July 2023.

In July 2022, 1.6% of hospital transports waited more than two hours to hand over patients to the facility, a peak over the last year, and the wait time for 90% of fire department ALS (Advanced Life Support) transports, those for patients with more acute conditions, was about 50 minutes, also a peak. As of July this year, those numbers sat at 0.1% and 20 minutes, respectively. About 6% of transports in July this year waited more than 30 minutes, down from 16.5% in December last year.

Meanwhile, the number of daily hospital transports has grown over the last year, from an average of 31.9 in July 2022 up to 46 in May 2023. Figures from the hospital show that the emergency department was averaging 165 patients per day in July last year, a number that has climbed to more than 200 per day last month.

Inside the facility, hospital officials point to improvement in a weekly median arrival-to-triage figure, which has dropped from 15 minutes in December 2022 to two minutes or less as of June 2023.

With boosted staffing levels and some procedural changes, hospital president Chad Melton said he felt the improvements would last.

“We’ve been able to more than sustain the improvements over the course of a year, which gives me belief that we can continue to do so,” he said.

He added: “Just in the past few months we’ve added 60 new core staff members, both emergency room techs and nurses, which allows us to open every bed, every single day and gain that throughput through the system.”

South Kitsap Fire and Rescue Chief Jeff Faucett, who also chairs the Kitsap County EMS and Trauma Care Council, confirmed that wait times have dropped significantly and credited hospital officials for opening up lines of communication.

“The communication now is wide open,” he said. “We call each other, we text each other, we’re given heads-up when they start seeing the loads start to increase in the ER, that they’re making some moves. They’re letting us know, ‘Hey, you might see a little bit of a delay right now, but we’re actively working on it.’ They’re a lot more proactive.”

Said Poulsbo Fire Department Chief Jim Gillard: “The numbers are looking way better. We’re still not quite to what (Tacoma General Hospital) and (St. Anthony Hospital) are, we still have work to do, by all means, but all the work that (St. Michael Medical Center) has done to add staff and improve processes and pay attention to this has really paid off.”

Frustration mounted among Kitsap County's fire agencies last summer as delays kept ambulances waiting at the hospital. The EMS council established a special task force to focus specifically on the situation at the hospital last year, and that sub-group, which included representatives from Kitsap's fire departments, Virginia Mason Franciscan Health and others, met twice a month over the last year to share information and track the situation. With the improvements, that group has stopped meeting, and reports on the hospital will be heard during a standing agenda item at the council's monthly meetings.

Said Gillard: “I think the most base, core, root cause of the increased wait times was just simply staffing, not having enough RNs and LPNs was one of the easiest or simplest things causing extended wait times. We saw that when they made some dramatic changes in January this year, they bought on a lot more staff, we really noticed a big change in the wait times.”

Melton said that staffing has improved but noted that it is still not where he would like to see it.

“I know workforce continues to be our No. 1 priority,” he said. “We’ve seen the numbers come down since kind of the peaks of COVID, but we’re still averaging around 150 contract staff members that are in-house. That number really hasn’t gone up or gone down, but the (patient) volumes have gone up coming out of COVID. There continues to be a need for additional workforce.”

Alongside improved staffing numbers, Melton pointed to some internal processes that have changed, like the addition of certain specialty staff members to the emergency department. The facility also points to the implementation of the Virginia Mason Production System, which uses philosophies from the Toyota Production System and elements from kaizen and lean, at the Silverdale hospital to help streamline emergency department processes.

Additionally, Melton said the hospital has made a commitment to chipping in support to the CARES program in Poulsbo, in a pre-hospital effort designed to keep patients from having to use emergency medical services. The hospital is still working to nail down what support will be needed, a VMFH spokesperson said, noting that it could come in the form of staff like physicians or financial contributions and could expand in the future beyond Poulsbo’s program.

“We’ve made a lot of progress on a lot of different fronts,” Melton said. “We want to make sure that the community knows that we heard the issues and the challenges, and the team has worked exceptionally hard to make those improvements so that we can be the hospital of choice.”

This article originally appeared on Kitsap Sun: St. Michael Medical Center wait times dropping over past year