Dr. Robert Dinwoodie didn’t have a ready explanation.

The area population hadn’t just spiked, yet the Kent County Hospital emergency department is consistently handling about 30 more patients daily. The numbers are about 200 a day.

Rene Fischer detected a difference, too. She picked up on it in the supermarket and in gatherings. People were saying they, or somebody they knew, had been to the Kent emergency room and they hadn’t had to wait a day to see a doctor.

Both Dinwoodie, chair of emergency medicine and Fischer, senior vice president and chief nursing officer, see the information as validating the patient rapid assessment model adopted in July. Also, as of July 12 the hospital implemented a “no diversion” practice, meaning that ambulances would not be diverted to other hospitals because of high volume and limited resources.

On Tuesday, the hospital outlined how it has transformed the emergency department to shave off hours of wait time for patients and the no diversion policy, to its board of incorporators that morning followed by a press briefing that afternoon including a tour of the department.

“What’s the news; what’s happening now” one reporter questioned after learning the procedures had been in place for three months.

It was the one question that probably caught Kent President and CEO Sandra Coletta by surprise.

After all, she and hospital staff had just said the emergency department was handling a greater volume; that the average wait time to see a care provider (physician or physician assistant) had been reduced from two hours to 30 minutes; that the average entire patient visit has been reduced from six to hour hours; that quality of service wasn’t being sacrificed and this is all being done with a minimal increase in staff and cost.

That did seem like news.

She said the no diversion policy officially went into affect Oct. 1 and that Kent is the first Rhode Island Hospital to adopt it. Coletta called on other hospitals to follow Kent, and mentioned that Massachusetts’ law prohibits diversion.

How did the hospital come up with its rapid assessment model?

“We designed a work flow that thinks and acts like humans,” Fischer told the morning assembly.

Kent and The Michael J. Woods Institute partnered with Ximedica and Brigham and Women’s Hospital to implement the changes. The first step was to deconstruct the complete patient journey from the moment they walked in the door. Ximedica, a research and workflow design group, played a significant role in that undertaking.

What is most striking is the elimination of the waiting room.

Now, when someone walks into emergency, they are greeted by a patient advocate and not told to take a seat…and wait.

“They engage the patient, ask them five quick questions and input them into the system, two to three minutes, tops,” said Lynne Rivard, Administrative Director of the Department of Emergency Medicine. Family and friends are welcome and can stay with the patient as they are shown to one of six bays with beds. They are registered, undergo tests and lab work and, depending on the severity, sent to a patient waiting area, which was formerly the patient intake waiting room. This frees up the bed for the next case. Armed with test results, the provider diagnoses the patient and may have them admitted.

Only then do they go through the process of health insurance and other forms that were among the first steps in the old emergency room.

“The idea is, you’re only in a bed as long as you need to be,” Rivard said. “It’s a forward motion for the patient.”

It’s not all procedures.

“You know yucky when you see yucky,” Rivard said, explaining how the staff reacts to situations. There has been a significant decline in walk-outs; from 8 percent to .7 percent, Rivard said. The national average is 2 percent.

Dinwoodie said, Kent, like other hospitals, used a triage system, where incoming emergency patients were assessed and cued up depending on their condition. When there were high volumes of patients, it meant some people waited for what seemed a day before treatment.

Kent still uses that system between 9 p.m. and 9 a.m., when emergency traffic tapers off, although Coletta said rapid assessment model may be expanded to cover some of those night hours further on.

But there’s more to the improvements than the intake.

The department is made up of six teams that work numbered and color-coded stations. Depending on the flow, teams could be working on several patients simultaneously as they compile test results, x-rays and other data to make a diagnosis and determine the next course of action.

Irene Croft, RN, said the change is an exciting development. A Kent nurse for 42 years, Croft said the reward has been the positive reactions of patients and the renewal of the passion and joy in her job.

There are more benefits saving time and giving attention.

Dr. Michael Dacey, senior vice president, said early treatment can have a large impact, particularly when dealing with infection and cardiac care.

“What they do in the ED ripples through the entire hospital stay,” he said.

Dacey and Coletta highlighted other benefits of the policy from the patient’s familiarity to the environment and easy access to medical records, if they have a history with Kent. Prior to July, the hospital was “on diversion” from 60 to 90 hours a month, meaning five to six ambulances sent to another hospital every day. Coletta said those ambulances were leaving the community and diverting a resource. Since July, the single exception to the policy came during Tropical Storm Irene, when the hospital’s CAT scanner was down. In other disasters, natural or otherwise, she said, patients would probably sent elsewhere if needed.

In opening her remarks, Coletta referred to the lawsuit brought by actor James Woods’ family over the death of his brother Michael. As a partial settlement, two years ago, the hospital set aside $1.5 million to create The Michael J. Woods Institute with the goal of improving care at Kent.

Michael died of a heart attack in the emergency department.

“No one will ever know what happened with Michael,” Coletta said, “We do know care is better.”