FORT SILL, Okla. (April 17, 2014) -- Changes are coming to Reynolds Army Community Hospital. The emergency room will transition to an urgent care center July 1, according to Col. Noel Cardenas, Fort Sill Medical Activity commander.
"For many years the emergency room at Reynolds has been in question. Several years ago we closed our intensive care unit here and reduced the number of inpatient beds," Cardenas said.
"So there has been ongoing discussion of 'Why are we still maintaining an emergency room?'" he said. "When you look at the service that we are providing, and who is using it, we want to make sure those services best meet the needs of the [Fort Sill] community."
Cardenas added that of the 25,000 total patients who came through the RACH emergency room in 2013, only 250 patients 1 percent, were true emergencies. A true emergency would be patients who could potentially lose his or her life, a limb or eyesight.
An analysis by RACH staff determined that the best way to meet the needs of the Fort Sill community was to transition to an urgent care center.
For patients who have true emergencies, they will now be taken to Comanche County Memorial Hospital or Southwestern Medical Center, depending on the level of care the patients require.
Other Army facilities have already made this change.
Fort Jackson, S.C., transitioned it emergency room back in 1999 to an urgent care center, and have been extremely successful, Cardenas added.
The second reason for the transition is to save money. An estimated $2 million a year can be saved by making this transition, according to Cardenas.
"We're obviously going to change the staffing structure. We will no longer require emergency room physicians, which can be costly and hard to find. We have had to rely heavily on contracting those emergency room physicians," Cardenas said.
He added that they will put primary care providers in the urgent care center, along with family practice nurse practitioners, physician's assistants, medics and support staff. The urgent care center will be open 24/7, 365 days a year at first. Its hours will be reassessed in the future. There will be no loss of services. If a patient comes in and has a broken arm or a broken leg, we still have the orthopedic services here that can be called in, if they are not here already. And they can come in and assess that patient and then take care of them. We won't have to send them out," Cardenas said.
RACH will also continue to maintain two ambulances with EMS (Emergency Medical Services) paramedics at the hospital to respond to on-post calls. The paramedics can assess the patient's condition, in consultation with RACH doctors and those who handle emergency services here in Lawton.
Dr. (Capt.) Aaron Proffitt, chief of the Emergency Medicine department and ER doctor, said this transition will allow RACH staff to focus more on the needs of the patients who will come to the urgent care center.
"This is really the reason behind the transition from ER to an urgent care center. We will have more time to focus on these patients, while the critical emergency cases will be treated at Comanche or Southwestern. We have a great paramedic staff and have faith that they will make the call where to send the patients," Proffitt said. "That will allow us to devote more time and resources to caring of non-emergency patients,"
Proffitt also said that the makeup of the nursing staff will slowly transition from registered nurses to licensed vocational nurses and licensed practical nurses.
Cardenas added that RACH will still have behavioral health providers on-site and on-call to deal with suicide attempts that come into the urgent care center. They will assess the patient and determine what level of care is needed, whether in-patient or outpatient care at the hospital, or at another facility.
Women who are in labor will continue to go to the labor and delivery ward at RACH and not go to the urgent care center.
"If you are a TRICARE beneficiary living in the community, and you have a true emergency situation, you should call 9-1-1, or if someone can take you, go immediately to Comanche or Southwestern hospitals and not try to come to RACH. Of course we know we try to educate our community, there are going be patients show up here with emergency-type situations. We will assess the patient quickly and move them to the right facility as fast as possible," Cardenas said.
"None of the cost for emergency room visits downtown will be billed to the patient, as well as any medications that are prescribed during the ER visit. The patient will have the option of having the prescriptions filled at Comanche, at a retail pharmacy in town, or they can have it filled at the RACH pharmacy at the earliest opportunity. All of the costs will be billed through TRICARE," Cardenas said. "We do the TRICARE authorization once we know they were down there. Again, it is the prudent decision of the patient or the family member as to what level of care they need, that will take them to the ER."
Cardenas added that, if a patient goes to the emergency room downtown and it turns out to not be an emergency, but they felt it was an emergency, the ER visit will still be covered by TRICARE.
"We want to make sure that the patient is safe and that we're providing them the level of care in the right environment, be it in the urgent care center or the emergency rooms in Lawton," Cardenas said. "Our goal is that our patients are given the right level of care at the right time."
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