ER at The Villages Hospital
 

A few weeks ago, I submitted a Letter to the Editor, Daily Sun, but I have given up hope that it will ever be printed, so I'll share it here...

How is it that in The Villages, where everything is so wonderful, the ER service at its hospital, The Villages Regional Hospital, is so poor? Recently, my daughter was quite ill and waited four hours until the stress of sitting in the waiting room became worse than the stress of being sick at home. We left without having been seen. So did a man and woman sitting across from us. They were in their 80s and had been waiting six hours. And this was when the seasonal residents were gone! Since then, in telling our story, I have come across Villagers who said they spent eight hours or longer in the waiting room. This is appalling. If a business operated like that, it would have no customers. But The Villages Hospital has no competitors, so it does not have to care how long the ill and injured have to wait. With large parcels of land being purchased by The Villages, and the subsequent increase in population, the ability to obtain emergency care in a timely manner should be a huge concern for residents. This is about providing more than just amenities and shopping. This is about meeting life’s emergency needs.

I have heard stories like this too. If you have an arrow sticking out of your belly you will get immediate assistance, but those with lesser injuries have to wait. I have heard that if you go in by ambulance you go to the head of the line but they charge quite a lot per pick-up. Welcome to Rural/Metro of Sumter County - 911 Emergency Medical Transportation, Patient Care, Certified Paramedics - Rural/Metro South

The Villages built the building and leased it to a hospital business. You just can't open hospitals like you do restaurants. They must be permitted.

We are in the middle of a rapidly growing area and we have a population that is fraught with health issues. It would be wonderful if we had a large teaching hospital that specialized in geriatric issues. But like all things that cost money, it has to be funded and supported by greenbacks and has to have a medical community of some standing and merit willing to back it.

I give credit to the Morse family who has tried to fix this deficit by attempting to provide a health organization but it was quickly abandoned by both Moffit and USF.

Health care and insurance are not combatible and the costs, although sometimes warranted are often a football for a not quite as altruistic business as we once thought health care to be.

I am a strong supporter of capitalism. Socialized medicine provides care for all, but not the kind of care that we are used to here in the U.S. It isn't pie in the sky....and talk about waiting..........people diagnosed with breast cancer in Holland and Austria and England often have to wait months for surgery. It is for all, but it isn't as good as we have it here.

Just don't blame the developers. They tried. They failed to fix health care because health care is hard to fix. Scares me. They are good at just about everything.

I know this isn't the answer but go to the new ER on 441 just before Marion Market on the right hand side as your going North. Have heard nothing bad about that one. Leesburg & TV are connected and as others have said if you don't have arrows sticking out your going to wait period.

As one said "I give credit to the More family? even knowing they get a cut of it all. I personally have gone to Ocala in a life or death emergency, willing to take that risk as time mattered, I am alive today.

They rent to the business. They don't get a percentage.
That happens in certain retail businesses if they meet a very high plateau.

If you want to know how common waiting in an E.R. is across the whole continent. Just google "wait in the E.R.

Here, look.

had to wait hours in the e.r. - Bing

It seems to me that this wasn't a real emergency requiring a trip to the Hospital ER if someone could just decide to go home because it was taking too long. Maybe a better choice would have been to go to Urgent Care.
I'm thankful we have a hospital here. I have been in the ER a few times and have had several stays in the hospital. Wonderful care.

An ambulance has had to pick up my Dad a few times because of bad falls. Once with a rather heavily bleeding head wound. He got in right away that time. They took good care of him. The other time he had to wait quite a while. They triage the patients coming in. They do need more nurses IMHO. My nursing friend also used to work there and she seemed to agree that they are understaffed.

We usually go to Urgent Care unless they are not open.

Plain and simple. The coverage and response time at The villages Hospital emergency room stinks. People go there because it's convenient. Then they wait, and wait, and wait. If you have an option, get someone to tanke you to Shands. A UF teaching hospital. After 8 hrs. In the emergency room and finally being transported via ambulance to Shands I can say first hand, I won't go back to The Village Hospital for anything. This is not a Morse issue, it could be a life and death issue. They built a good city but the medical piece of it got lost in the shuffle. Agreed privatization takes over and so do economies of scale. And above all good old fashioned profit. The king of privatization

Very true on both counts.

The place to send your letter:
Contact us | The Villages Regional Hospital | The Villages, Florida

The Villages hospital ER relies on triage to see patients. A suspected heart attack will be seen before a broken wrist. The broken wrist does hurt but is not life threatening.

The OP did not say what illness her daughter had but is it something that suddenly appeared after Urgent Care hours or her own physician office hours? Was an EMERGENCY room required? Did she take her daughter to another ER or go home and to the family physician in the morning or what? What was the final outcome?

In order to know if the ER was faulty in letting her sit, more info is needed.

Understaffed
 

"She seemed to agree that they are understaffed". That seems to be the biggest problem with the ER and health care in general in The Villages. I believe it can be fixed by recruiting and marketing nationwide for these needed medical nurses and doctors. JUST DO iT!

While an excellent suggestion, it must be recognized that it will cost them more money.

From what I've seen, the powers-that-be...seem to be allergic to that. :shrug:

Skip is right, someone made a post last month about how quickly they received medical attention. They had gall stones or something similar and was in an operating room in 30 minutes. It has a full setup just like a hospital. It's in the entrance to the Del Webb Community and looks like this.

http://ocalahealthsystem.com/util/im...field-er-3.jpg

I go to Leesburg ER and seen promptly- separate trips for TiA, trouble breathing and heart issues . Great service and caring staff

A lot of this has been posted before, but I guess it is time to write another novel in response.

It seems the main thrust of your post is the waiting time, no mention regarding quality of care, so let's focus on that. Also, it would be nice if DB, a retired hospital administrator and frequent poster on TOTV would weigh in as well

ER waiting times are determined by many factors:
The number of beds in the ER
Staffing
Speed at which ER staff works
Bed availability for admissions
Number of patients that show up
Also, keep in mind, it is not a "first come, first serve" endeavor. I'm truly sorry your daughter was quite ill, but that means different things to patients than it does to healthcare professionals, hence the triage process.

My wife was quite ill last year, probably within hours of leaving us, and was admitted for 2 weeks after coming in through the ER and then spent another month in rehab, so I have first hand experience with TVRH. I also have 30+ years of experience as a board certified internist, professor of medicine at State University of New York, Chairman of our Quality Assurance Committee, and Chief of Staff at our community hospital, so I do have some "vague" idea of what I'm talking about.

At the time my wife was brought to the ER, all the ER beds were occupied and there were about 10 patients in the waiting room. Despite that, it took less than 5 hours from the time she arrived until she was in a bed on the floor, so no complaints from me as to time. Many others have been satisfied with waiting times, many others completely dissatisfied. And then there are the ludicrous posts about 90 year olds waiting 22 hours in pain to be seen by a doctor---you decide if that is credible.

I thought the number of beds in the ER were adequate, and the NUMBER of physicians and extended providers could handle the workload if the were diligent. Unfortunately, ERs tend to get bogged down by the "walking wounded"----patients who would be better served for their minor complaints in an urgent care setting or their doctor's office, but we all know THAT doesn't happen. As I looked around at the 10 patients in the waiting room, 8 of them could obviously be handled elsewhere, so triage was probably appropriate.

So far, so good, but now for the bad news:

From what I observed, the PACE at which work was being done seemed to be pretty slow. There did not appear to be any great rush to get admissions to the floor or get the remainder treated and released. My impression was that myself and one of my ER friends could clear that place out pretty quickly. Apparently the ER is staffed by a sub-contracted group out of the Miami area, and many of their ER docs are locum tenens---temporary employees that travel and generally work 3 months at a given location. My opinion of this situation is pretty low---they have no vested interest in our community, they are essentially nameless, faceless individuals who will soon be moving on, don't have a strong desire to work hard, and in general are just punching a time clock (My apologies to those dedicated locum tenens physicians out there) As a result, the ER tends to back up. Believe me, a stable group of ER docs who live in the community and are treating their friends and neighbors makes a WORLD of difference.

But they are not the sole reason. Getting admissions out of the ER depends on bed availability on the floors, which is not a monolithic problem either. The attending physicians need to discharge patients as early in the day as possible and in a timely manner. The nurses need to do their discharge paperwork and review it with the patient. The discharge planners need to finalize their plan and explain it. And housekeeping needs to clean the room after the patient leaves. Some of these groups are more motivated than others as well.

Here's how we fixed the problem in NY:
First we asked all attending physicians and hospitalists to do as much discharge paperwork as possible the evening before. Then we had them write a simple order: "Plan for AM discharge". This triggered the evening and night shift nurses to do as much discharge work as possible as well, and the discharge planners to get their ducks in a row.
We also spoke with the nursing homes, rehab facilities, home care agencies and medical transport companies and asked them to help by staggering shifts in such a way that more planning could be done the day and evening before discharge. We were able to get the medical community on the same page and work together to get more beds available earlier so the ER could get their patients to the floor. Believe it or not, the main resistance came from housekeeping. In general these are less educated minimum wage employees, many of whom had the job as a requirement of continued public assistance, with less motivation to put out extra effort.

So, a few final thoughts:

The one thing the hospital cannot control is how many patients show up at a given time. No restaurant, no retailer can staff for peak volume all the time, so sometimes the wait will be longer than others.

I think the ER wait issues are completely fixable, although it could be difficult. If I were in charge I'd be looking at a different ER group. It is probably not possible to build our own ER group with a top notch director and physicians who live here, due to recruiting difficulties. However, I would have the QA committee sitting on the ER and monitoring both wait times and quality issues. Probably 30-40% of the staff in that ER needs to experience "alternative career opportunity enhancement" . I would then try to address the issues surrounding discharges.

Lastly, to the individual who drives 30-70 miles to go elsewhere, even if sick, be careful---your luck may eventually run out.

Good post.

Once again Golfing Eagle writes a great post, as he should because it is his business. Unfortunately, the people that need to read his post and to digest the contents will not do so, they will keep right on complaining.

Experience
 

I will not go through the details but I have been a care taker for 3 cancers with my wives. One was sucessfully cured the other after 2 cancers was not fortunate and passed away. In the process of these I have been to a number of famous cancer treatment centers: Lahey Clinic, Mass, MD Anderson, Huston Texas, Mayo Clinic, Jacksonville Florida Westchester Medical Center, NY,
Cleveland Clinic, Fl.,Moffit, Tampa Florida, Etc. In rating I would give Mayo, Jacksonville as #1, Lahey #2, Moffit#3. and so on.Now to the originial subject. I would guess the Physician that wrote in probably gained some advantages by the sheer fact he was a Dr. That does not distract from his assessments just adds some balance to the input. In one case I had a relative who was held in the Ft Lauderdale Hospital ER for 18 hours in terrible pain. I ordered an ambulance, had her discharged and drove about 2-3 to Stuart Florida Hospital who said she had about 24 hours to live if she was not operated on immediately. She was and she is fine today. The bottom
line is that you are responsible for your care and taking action in the case of neglect. Mayo at Jacksonville is 2 1/2 hours away and has an ER. Rather then tolerate such terrible treatment go to a teaching hospital. I believe Sand's is one although never been there. I have heard some terrible things about the Villages ER and am at a loss why, if someone has 3 hours does not go to Sands or Mayo and get the best treatment?? It is not just the ER but the support team these locations have to ensure more than just bascic treatment. In closing I will add that I just don't understand why the Developer who may not be the final authority but carries a lot of weight in this area does not have a team to study the problems and ensure we have the best medical policies and practices and doctors to treat or to refer difficult cases to the best for treatment. Just some thoughts on a subject that I have spent many years involved in. :cold:

1) Not at all, I never tell anyone there who I am, I prefer to stand back and observe their normal functioning. Only if I spot an impending error do I have a "discussion" with the doctor.

2) I agree----it probably falls to the corporation that runs TVRH as well as Leesburg rather than the developer. This is what QA committees and hospital administrators SHOULD be doing.

Great post from someone who is more experienced (being a former health-care provider) than most of us who post here. Thank you Golfing Eagles!!!! :BigApplause: Gracie also made some great points!!!

I wonder how many folks actually contact the "powers that be" at TVRH to complain of their experiences??? We've had several stops to the ER since moving here---all were different. Only one was, should I say, not the best? BUT I made it known both to the staff AND later in an e-mail to the director. I've heard 2 times that "they are working on it"...meaning trying to make it better. The hospitals here are like small-town hospitals but with LARGE city needs. I have to wonder if there aren't people in management who read these posts. I still say though...folks need to talk to the source and not keep complaining on social media!

I so agree with this. My husband went to the ER in an ambulance for chest pain and was seen right away. He was admitted and had a stent put in the next day. The following day he was cleared to leave by the Cardiologist in the AM and had to wait until 6PM to be discharged by the admitting physician so he occupied a bed all day for nothing.

Is there not some kind of Villager Survey going on now? We should bring this all up. Survey Login

:BigApplause::BigApplause::BigApplause: I agree. Maybe we can contact "Powers that be" and ask about that!!!!

I agree that all these good posts need to go to several departments and several different people at the hospital; remember about the squeeky wheel. Generally only by many squeeks will the wheel get better. Don't rely on the hospital to read and act upon this.

Absolutely agree, Doc. Well put. Hope someone from TVRH monitors this site.

Last week I went to the new free standing ER (it is not a Urgent Care) on 441 next to Spruce Creek - across from Camping World.
From the moment I walked in until discharge, I was treated promptly and with great courtesy by all the staff members. The doctor explained everything and spent quite a bit of time with me reviewing the results of the tests.
It is owned by Ocala Regional Hospital and is an extension of the ER on the main campus. Ocala Regional is the level two trauma hospital for our area. If you have to be admitted, if possible they will send you to your hospital of choice although they generally admit to their hospital. Again, it is not an Urgent Care but an actually well staffed and equipped ER with scanning capacity, etc.
I asked if they were busy when I walked in and it was affirmative with apologies because I waited about five minutes to be taken to a bed. Within ten minutes I was hooked up for an EKG, Dr in the room, chest X-ray and labs drawn even tho my main complaint was not chest pain.
I am a retired RN and have never seen a unit run as efficiently as this ER. I didn't count them, but it looked like they had at least 10-12 private rooms. It is a large building. Highly recommend.

Poster: It takes better than 3-4 weeks after you are contacted by the Daily Sun before a letter is published, if it is published at all. The Daily Sun mimics much of what goes on in TV meaning the powers want tight control.

The frustration you express as to the TVRH emergency room has been expressed ad nauseam for the 11 years I have lived here.

I can't speak for others but in my humble opinion if the ER was any other business it would have gone out of business long ago.

Personal Best Regards:

Some folks may remember that The Villages wanted to build a second hospital near Brownwood on CR 44 but were denied a permit. They tried to fix the problem. Give them some ctredit for building the hospital in the first place !!!!!

Please, what is the name of this place so I can look it up and put it in my GPS? If my husband were within hours of leaving us, I would not wait around in an ER for 5 hours.

This new ER sounds like a very viable alternative.

Thank you so much. I have been promoting the Ocala health Care network for the 11 years i have lived here.

Lookup Summerfield ER on Goggle Maps

But check the reviews there too... 4 of the 10 there are about poor service.

Google Maps

Just Spent
 

We just spent 6 weeks at Mayo Clinic in Jacksonville and have absolutely NO complaints ! When you have an appointment with a Dr. or other (e.g. Blood work,etc,) you can go to the bank that you will not wait more than 5 minutes regardless of the need. You can be assured you have a "team of Dr's" evaluating your med needs and getting the best professional treatment. If you call your Dr. at 12 midnight from home you can be sure that within an hour they will call back. If you go to Urgent Care you will be seen within 1/2 hour by a Physician. :mornincoffee:

Sounds pretty good. They do have several advantages that make it (and places like it) a more attractive and efficient place

1) They do not have to hold patients waiting for a bed on a floor to open up----just make an ER to ER transfer in accordance with COBRA laws and pack them off in an ambulance.

2) National ER admission rates average 13%, their admission rate is probably less than 2%, so less work messing with admissions

3) They do not have ambulances arriving every 10-15 minutes

4) The REALLY, REALLY sick patients tend not to go there, so the severity of illness is less

5) As far as staffing goes, as long as they are running it as a separate entity, they do not have to worry about less than optimal workers with a lot of seniority bidding for the jobs there, which tend to be more desirable, so they can pick and choose who they hire.

6) They are NEW, so the equipment and facility are modern, they can write policies and procedures that suit the place, and there hasn't been enough time for the staff to develop its own "culture", which far too often is a culture of laziness.


As an aside, I've always favored eliminating the solid walls and doors between the waiting room and the ER treatment area. Yes, you need to keep the patient rooms out of sight, but I think the common areas should be in view. If you think the people are angry when they wait in the ER now, just imagine if they could see the staff talking, giggling, sitting with their feet up on the desk, reading a book, surfing the web or even napping while they wait. If you don't think those things happen, think again.

:BigApplause: Totally agree! Think if we didn't have TVRH at all....we'd still be hearing complaints but most likely more because the community has grown since it was built.

Excellent post. And since GE asked, I will weigh in.

Having observed, used, and survived some ERs, not all are equal. Once one is seriously broken, as is TVRH's, it can be very difficult to turn around. I've turned around a couple in my career so I speak from experience.

What I'm posting here has been written and told to the hospital leadership. There are a number of issues that are easily noted for someone like GE so let's see if he agrees with my analysis.

First problem, the ER docs are lazy. They have no skin in the game and act like they really don't give a darn. They certainly aren't oriented toward productivity. SOLUTION: hire a new ER group, and make sure the contract speaks to quality and productivity standards.

Second problem, the hospital employees have a terrible attitude. It shows in the way they interact with each other and patients. I believe the attitude has rubbed off from the docs. SOLUTION: Replace the docs, and have all employees take a mandatory course on customer relations. Disney offers these, and they will teach it on site.

Third problem (and this one is literally a killer), best practice protocols are not being followed. When a patient arrives at the hospital with chest pain, there are practices that must be put in place immediately. Although anecdotal, there is sufficient evidence to believe cardiac and other protocols are not always followed. SOLUTION: Replace the ER group. There should also be a medical staff committee that reviews records to assure QA. I'd recommend that the committee investigate certain protocols to be sure they are being followed. Where appropriate it may be necessary to require education, or restrict privileges.

Fourth problem, they invested millions to the expand the ER...most likely hoping construction would resolve many of the issues discussed here and in other threads. The problems have remained. And IMO, the ER docs are the bottleneck. SOLUTION: fire the ER docs, and bring in a consultant to assess patient flow and staff work patterns.

That's enough for now. What do you think GE?


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When I needed them, They were there....But in retrospect I should have taken him to Ocala...

But..... we got a bill the other day from the ER doctor, that charged us $150 extra on his bill because we got to the ER at 11pm.....

We called him and had it removed, which they did....but the nerve.....

We didn't call him from home, he was on 11-7 shift.....wow.....

I agree 100%, I think I touched on most of this as well. ER culture tends to manifest itself from the top down. I don't know about all the ER docs here, but the one we had , gave at least the impression of laziness. He also seemed to have the knowledge base I expected from my interns and 2nd year residents. Did he do the right thing---yes. Was he happy about being there---no. Did he do it anywhere near as quickly as I could have---not even close. I agree QA needs to be stepped up, as well as a review of admission protocols.

Thank you GE.

I think one additional point I would make is we (TV residents) should not put up with such mediocrity. It's important to speak up - to hospital leadership, first. If you are the recipient of inadequate or dangerous care, and reported it to the hospital (but did not receive satisfaction), then report it to the State Department of Health and The Joint Commission. Both will investigate if you have a legitimate complaint.

Finally, there are really good ER physicians and companies out there, so don't settle. If enough people speak up it will help. I think we all want TVRH to be an excellent hospital. We need it to be one.


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