The new ERs

Renown Medical Center launches a child-oriented emergency room.

Saint Mary's Regional Medical Center creates a medical laboratory devoted exclusively to emergency-room demands to speed test results.

Northern Nevada Medical Center uses high-tech videoconferencing to allow a neurologist in Seattle to quickly review information about stroke victims at the Sparks hospital a step that can reduce the time to start a potentially life-saving treatment.

Hospital emergency departments in northern Nevada these days are on the front lines of two initiatives. They seek to improve medical care as well as playing a role in improvement of hospitals' financial results.

Emergency departments act a primary point of entrance for hospitals. About 40 percent of Saint Mary's admissions come through the emergency room, and the number is closer to 50 percent at Renown.

Physicians and nurses at Renown's two emergency rooms those at its downtown regional medical center and its hospital in South Meadows will see about 87,000 patients a year, says Kris Gaw, chief operating officer of Renown Regional Medial Center.

The numbers have grown for the better part of two decades. From 1991 to 2007, the American Hospital Association says that emergency room visits nationally grew by 33 percent.

In Nevada, the number of emergency room visits per 1,000 population stayed fairly stable from 1999 through 2007 about 290 ER visits per 1,000 residents, according to a study by the Kaiser Family Foundation. But the state's population growth was so dramatic through the boom years that demand for emergency services grew.

Nevadans use of emergency services, however, runs about 25 percent lower than the rest of the country. Even at that, the emergency room is key point of entry into the health-care system.

"We are the front door to the hospital," says Shelby Hunt, director of the emergency department at Saint Mary's.

And the work of the emergency room affects the financial performance of the entire hospital.

"Emergency volume is the key to every department in the hospital," says Justin Moulliet, charge nurse in the emergency room at Northern Nevada Medical Center.

Because emergency rooms see such a high percentage of patients who arrive, hospital managers have been paying substantial attention to upgrading emergency services.

Saint Mary's, for instance, moved in recent months into its newly renovated 46-bed William N. Pennington Emergency Department in downtown Reno.

"It's absolutely beautiful," says Hunt.

But even as they move into a new facility, Saint Mary's executives look for ways to improve emergency treatment.

The new medical lab dedicated to emergency patients, for instance, will reduce the time formerly required to transport materials to the hospital's central lab.

Also speeding treatment time, Hunt says, is the establishment of a radiology suite in the emergency room, reducing travel time for patients in need of a scan.

Both Renown and Saint Mary's have launched chest pain centers that use proven systems to help physicians identify the early stages of a heart attack.

Ron Laxton, the chief executive officer of Renown Regional Medical Center, said establishment of a chest-pain center in an emergency department has been shown to reduce mortality from heart attacks by 40 percent.

Renown created a dedicated area in its emergency room for patients who arrive with complaints of chest pain, and it provides specialized cardiac training to emergency physicians and doctors.

It further supported the improved emergency care for cardiac patients with installation of new imaging equipment that provides a sharper diagnostic image of the heart within two to four minutes.

The D-SPECT Cardiac Imaging System, the first of its kind in northern Nevada and one of only 30 in the world, was installed last fall.

Along with the teleneurology program for stroke victims, the emergency room at Northern Nevada Medical Center has added a interventional catheter lab for heart patients.

Moulliet says the technologies are important to serve rural areas of central Nevada, for which the Sparks hospital is the closest major facility.

More than technology is getting a close look in the region's emergency rooms.

Saint Mary's, for instance, has installed equipment to ensure its emergency staff can safely and comfortably provide care to obese patients.

Renown invested in the creation of its Children's Emergency Room, which opened in the middle of last year at its downtown Reno hospital, next door to the traditional emergency room.

The children's facility includes 11 children's examination rooms with child-sized medical equipment. A special waiting room, separate from the waiting for adult patients in the emergency room, includes toys and television for young patients. Nurses who work in the facility are certified in caring for children in emergency situations.

"It can be very alarming to be a child in an adult setting," says Gaw.

Northern Nevada Medical Center, meanwhile, has brought back its 15-minute service guarantee for emergency room patients as a way to build its market share.

"People don't want to wait," says Moulliet. "This has been very successful, and we're meeting it almost all the time."