The hospital announced in November that the emergency department would begin operating under a new model as of Jan. 3, 2017. Under the new model, the ER will be staffed with providers and nursing staff from 8 a.m. to midnight but the remaining eight hours will only be staffed with mid-level providers like a nurse practitioner or a physician’s assistant.
Without a physician on staff during the overnight hours, many have expressed concern about the level of care that will be provided at Swain’s ER and whether county EMS services will have to transport more people to Harris Regional Hospital in Sylva because of the change.
Steve Heatherly, CEO of Swain and Harris, said the change needed to be made because of the low overnight volumes in the ER and the need to expand services in other areas of the hospital to best serve the community’s needs. He said so far the implementation — though not complete — has been seamless and unnoticeable to the public.
“We were confident going in that there was not going to be a significant — or any — disruption in how people receive care,” he said. “But we’ll keep our ear to the ground to make sure we continue to assess the situation.”
However, he and Swain Hospital Administrator Lucretia Stargell are still struggling to make people understand that the ER will still be open to the public 24 hours a day, seven days a week with no exceptions. They said the problem stems from a Nov. 17 “erroneous headline” in The Smoky Mountain Times stating the hospital was eliminating its 24-hour in-house ER service.
In an attempt to overcome that misperception, the hospital has invited residents to attend focus groups, but participation from the community has been low.
The most attended session was last Wednesday when newly elected Rep. Mike Clampitt, R-Bryson City and Swain County Commissioner David Monteith attended. Dr. Dave Zimmerman, who is retired from Swain Community Hospital, and Bryson City resident Joe Hayes also attended the session.
After talking to commissioners and emergency service personnel in Swain and Graham counties, Heatherly said they were also concerned with possibly having to divert ambulances to hospitals that are farther away. Given that the hospital sees an average of 3.4 people per night in the ER, he said overcrowding and diverting ambulances was highly unlikely unless there was a major disaster.
On average, Zimmerman said an ambulance arrives at the hospital during overnight hours once every three days and even out of those 3.4 people coming in overnight, it’s rare that the cases are an actual emergency situation.
He also wanted to address the concern that PAs and NPs aren’t as qualified to run the ER overnight shift. He assured the group that the hospital’s mid-level providers are highly qualified and capable of the task. The PA or NP will also be supported by an offsite physician, which he said is a fairly common arrangement in an emergency department.
“These will be ER trained PAs,” he said. “I don’t think in that period of time care is going to suffer,” he said.
Heatherly said the hospital is still searching to hire specially trained providers to run the emergency department and that the ER staffing changes wouldn’t be changed until those people are on board.
The main focus has been on the change in ER operations, but Heatherly said little attention has been given to the improvements that will be able to be made by reallocating resources.
A new provider has been added to Swain Family Care to increase primary care services for families and new CT scan equipment will allow more residents to get certain tests done in Swain instead of traveling to Sylva or Asheville.
Swain is also in the planning stage of constructing an endoscopy suite on its campus and recently added two sleep study beds that are likely to stay full every night because of the huge demand for sleep studies.
Looking more long term, Heatherly said the hospital is evaluating how to best utilize the old east wing of hospital and adding up to 10 more behavioral health beds could be a possibility. If the ER ever does have to divert ambulances, Heatherly predicts it will be because they run out of behavioral health beds.
Heatherly said the hospital is also looking to offer “swing bed service” to patients having major surgeries at other hospitals. This in-between care would be for people who may have a hip replacement done in Asheville and need somewhere to continue to heal before they’re ready to be on their own at home.
Zimmerman said there is also a misperception that patients may have to wait a long time to be able to see a doctor at the hospital, but after speaking to other physicians, he found out many people are able to get a same-day appointment. Physicians on staff are actually blocking out time in their day specifically for that purpose, which he said is a major benefit to the community.
Healtherly and Stargell hope to continue their efforts to inform the community about the services available locally to encourage residents to support their local hospital.
“If you take a 20-year look at access to health care in Swain County, it’s better today than it was 20 years ago, but there are always going to be ebbs and flows,” Heatherly said.