Urgent, but no emergency

An imminent change at Naval Hospital Oak Harbor that has raised the ire of a portion of the military and civilian communities boils down to a simple name change and truncated operating hours.

Effective Oct. 1, the “emergency room” will be more appropriately renamed “urgent care clinic.”

The difference is more than semantic, said Capt. Colin Chinn, the 25-bed hospital’s commanding officer. The transition from an ER to a UCC will more accurately reflect the base’s true capability and scope of care. With the expiration of the current ER contract, the time for the change was opportune.

The facility lacks an intensive care unit, a coronary care unit and a magnetic resonance scanner. Care for emergency patients has been relegated to stabilizing the person until they can be transported.

“We don’t have the capability to handle patients that come in with emergent conditions,” the captain said.

The designation of ER fits in urban military communities, but rural naval hospitals are in a different category.

“We are a small community hospital,” Chinn said, adding that Naval Hospital Cherry Point in North Carolina will also make the transition.

Urgent care clinics treat illness or injuries that do not require complex diagnosis or treatment, or access to the capability of an ICU or cardiac care unit. They provide an alternative for the patients who cannot wait for a scheduled appointment with a primary care physician, but who do not have potentially life-threatening conditions.

Approximately 22,000 patients visit the Naval Hospital ER annually. Of those patients, 535 exhibit severe conditions. And of those 535, about 300 require transport to another facility. After the transition date, truly emergent patients will go directly to a local ER, either at Whidbey General Hospital in Coupeville or Island Hospital in Anacortes, both at least ten miles from the base.

The facility’s hours will be shortened from 24/7 to 7 a.m. to 11 p.m. on weekdays and from 8 a.m. to 8 p.m. on weekends and holidays. According to Chinn, 90 percent of the patients who visit the current ER do so between the new hours. An analysis of the hospital’s ER patients determined that 97 percent of them do not have life-threatening injuries or maladies.

Hypothetically, if an airplane mechanic were to be seriously injured at 2 a.m., with the current hours, he or she would be stabilized by a base physician at NHOH and wait for an Advanced Cardiac Life Support ambulance from a local hospital. After Oct. 1, a fellow worker or someone in the vicinity of the early morning accident would have to call 911 and wait for the off-site ambulance to arrive. Whidbey General has ambulances based in Oak Harbor.

Grant Schmidt, NHOH emergency room physician, said with the change there will be no medical personnel on base with advanced trauma life support expertise. The facility currently has the capability to take advantage of what ER doctors call the “golden hour,” the critical window of time available to stabilize a patient.

“If they had a disaster on the flight line, the golden hour would be difficult to obtain,” Schmidt said.

NHOH is currently in the process of notifying beneficiaries of the changes and will continue its community education process as Oct. 1 approaches. In addition, articles will run in the base newspaper and TRIWEST marketing communications and a mass mailing will explain the changes and how to obtain emergency care.

Chinn has been playing the role of informational tour guide at the facility as the change nears. Hosting groups as diverse as the media, elected officials and their staffers and local “stakeholders,” the captain has explained in depth the impacts of the transition and reasons for the change.

Congressman Rick Larsen visited the hospital last week and discussed the transition with Chinn.

“As NHOH moves forward with this proposal, the most important consideration is the quality and timeliness of care for service members and their families,” he said. “I will closely track the progress of the proposal to ensure military families receive needed care, local civilian hospitals are not overwhelmed, and routine health care provided on base does not unnecessarily shift to the local health care community as a result of this change.”

Chinn said the decision was not driven by finances. With shortened hours and less required manpower, there will be cost savings, but that was not the impetus, he added.

“It’s not a money issue,” Chinn said. “This is aligning us to where we should be.”

“I think the biggest concern is that people think it’s going to cost them more,” said Sharon McIntyre, hospital patient relations and public affairs officer. “That’s not the case.”

Almost on cue, Adm. James Foxgrover appeared during a tour to sing the praises of Chinn’s abilities as a commanding officer and lauded the facility as a whole.

“This is the best naval hospital I’ve ever been involved with,” he said.

Signs at all four base gates will emphatically state that no emergency services are available within NAS Whidbey. Ambulances may come in to transport a patient in dire need, but the three ambulances on the base will not pass through the gates into Oak Harbor.

The captain said the Navy has worked closely with Whidbey General Hospital and Island Hospital, both currently Tricare network facilities, to keep them abreast of the changes. The chief executives for both hospitals have said the impact on their respective facilities should be negligible, but time will tell.

“At this point we are not really expecting a huge impact on our emergency department,” said Vince Oliver, Island Hospital CEO, last week. “We’re going to keep a very close eye on the situation.”

The transition was a hot topic at Monday night’s Whidbey General Hospital board meeting. Chief of Staff Dr. Chris Bibby was concerned with the lack of communication in the wake of the decision to close the Navy’s ER.

“We’d like to see better communication about what their long-term plans are. In a small community, it makes a large impact,” he said. “It’s kind of one of those nebulous things. What’s going to happen in the future?”

Bibby said he believed the impact on civilian facilities was understated. The Navy threw out the number 3 percent. The doctor tossed back the number 13 percent. In addition, the staffing will change, he said, as the ER doctor working at the base hospital will not be able to continue after the name change.

“That staffing will in some way define what that means,” he said of the questions surrounding the meaning of urgent care. “What you’re going to take care of and what you’re not going to take care of.”

Bibby was troubled by what he perceived to be a lack of details flowing from the Navy to the hospital.

“Time will tell,” he said. “Time will work it out. But we need to be asking ourselves if we can handle that load. And do we want to handle that load?”

Scott Rhine, Whidbey General CEO, said the board and other staff will take a tour of the facility and receive a briefing from Chinn to clear up any confusion.

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