When she thought she was having chest pains, Rebena Tyler didn't think of going anywhere else but University Hospital. Having worked there for 23 years had something to do with it, she admitted, but it was more than that.
"These people are dedicated and they are honest," said Mrs. Tyler, 77, a former supervisor in housekeeping.
She is part of a growing trend as emergency rooms in the Augusta area are seeing more patients, who then are an important driver of hospital business.
In a competitive market such as Augusta-Aiken, hospital ERs seem to have carved out niches for themselves in an effort to attract more patients.
Medical College of Georgia Hospital and Clinics, which has the largest and busiest emergency rooms, is renovating to get even bigger and better to handle different types of patients.
University Hospital, which says it treats more heart patients than all the others combined, is adding a helipad so patients can be brought from farther away.
Doctors Hospital has been stressing its low ER waiting times.
Aiken Regional Medical Centers is embracing its role as a community hospital and focusing on making the services it does provide count.
Trinity Hospital of Augusta relies on community experience and word of mouth that it can quickly get to routine care.
"It is absolutely the front door to the hospital," said Jim Davis, the chief operating officer for University. "An awful lot of folks come through your Emergency Department. It's a busy place."
It is also often a critical first impression most people have of the hospital, said Cathy Robey-Williams, the administrative director of clinical operations for Aiken Regional.
"If people don't have a good experience when they come in for an emergency, they're not going to come back," she said.
It is also an important source of patients. At most Augusta hospitals, half of all patients admitted to the hospital show up first at the ER.
"It's a big chunk of our business," Mr. Davis said.
At MCG Hospital, it is even higher, about 63-64 percent, because the hospital receives so many transfers from other facilities, and they all come through the ER, said Rich Bias, the senior vice president for ambulatory and network services. Its eight rural hospital partners accounted for 1,700 transfers last fiscal year, he said.
Almost everyone is seeing more ER patients: MCG Hospital, Doctors and University are all seeing about a 6 percent increase over previous years, and Aiken is growing at about 5 percent a year, officials said. Some of it might be because of the economy, as unemployment often robs people of health insurance and access to care other than the ER, which has to see them.
"They tend to put off illness until it is to the point that they need to seek emergency care," said Karen Swim, the chief nursing officer for Doctors.
Some of it is the nature of the population itself, MCG's Mr. Bias said.
"We believe between the patient population as well as the changing demographics with the older population that at a minimum we would see a 2 to 3 percent increase every year," he said. MCG Hospital, for instance, saw 77,000 patients last fiscal year but is renovating to handle up to 95,000, Mr. Bias said.
For others, the changes were more focused on the processes for handling patients in order to reduce wait times for getting into a room and seeing a physician. At Aiken Regional, for instance, patients are sent straight to a room if one is available, Mrs. Robey-Williams said.
"If there's a bed in the back, they go straight back," she said, and that has reduced waiting times -- even when busy -- to about 20-30 minutes. Doctors Hospital averaged 26 minutes in December, Mrs. Swim said. The hospital is encouraging patients to text or use smart phone applications to check on its waiting times, she said.
"We know that the public is using the new technology now to find health care providers and to seek fast care," Mrs. Swim said, "So we are trying to take advantage of what methods are used the most."
Trinity's reputation for getting patients through the ER and into a bed if they need it is aided by the fact that the same physician group that staffs the ER also staffs the floors, making quick collaboration easier, CEO James Cruickshank said.
"Our message to the community is come to Trinity and we'll get you in and get you taken care of and get you out as quickly as possible," he said. "I think the patients that have been in the community for a while, they realize that."
In fact, standing out is important for ERs when patients are making that decision, Mr. Cruickshank said.
"When you need an ER, you need an ER," he said. It's like, 'OK, now which one do I go to?' "
Augusta hospitals realize that.
"I would say that it is a fairly competitive market in that the health care consumer has so many choices available, within close proximity," Mrs. Swim said.
In University's case, it comes down to the heart. In addition to the helipad, the hospital will soon be working with ambulance providers to transmit EKGs from the field to the ER so that the catheterization lab can be readied if needed, Mr. Davis said.
The hospital already gets 95 percent of patients from the door to a catheterization in less than 90 minutes but is striving to do better.
And there is a reason for the emphasis: heart and vascular services account for nearly a third -- 32 percent -- of hospital revenue.
"It's a very big piece of our business," he said.
That MCG Hospital and Clinics has the only Level One Trauma Center in the area is well known, and patients come from an hour and a half in all directions, Mr. Bias said.
What is often overlooked, however, is the area's only dedicated pediatric ER at the Children's Medical Center, which also has pediatric subspecialists backing it up, he said.
"From my perspective as a parent, knowing what is available through the only pediatric emergency room in the region, I don't understand why anybody would take their child who is in a true emergency anywhere else," Mr. Bias said. "We are absolutely unique in that respect."
Because it is the premier trauma center, MCG Hospital's adult ER also has ready access to subspecialists when needed, which accounts for a lot of transfers there, he said.
"Basically we're the place where the other hospitals in the region will refer the patients that they aren't able to address," Mr. Bias said.
Aiken Regional has eschewed trying to do everything and focuses on quality services, Mrs. Robey-Williams said.
"Our goal here is to do well at what we do," she said.
The quicker waiting times at Doctors are not just for the patients but aid the rest of the hospital as well, Mrs. Swim said.
"If we can get patients treated and diagnosed faster, we can get their care started quicker and hopefully make the whole process for them go faster," she said.
Reach Tom Corwin at (706) 823-3213 or firstname.lastname@example.org.