It’s unrealistic to believe there will ever be an ER in Westlake Village again for a variety of reasons. The new changes at Los Robles ER will improve the ER wait times, in the short term at a minimum. This is in addition to a new 5-level triage system that has already reduced wait times. The real question is, in the long term, how these new facilities will alter the behavior within the overall hospital system.

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One of the more common questions we’ve been asked about in regards to the old Westlake Hospital property is the desire to have a local emergency room. Typically, this is for two reasons.

1) The problems with long wait times we currently hear about at Los Robles Emergency Room.

2) The feeling that a 15 or more min (non-traffic time) drive to Los Robles is too long when an emergency (like a heart attack) happens.

While speaking to Los Robles’ management over the past few months about the old Westlake Hospital property (the property that Sunrise would like to build on), I took the opportunity and asked them about what they are doing to address the ER wait times at Los Robles.

Jim Sherman, President & CEO of Los Robles Hospital & Medical Center, in conjunction with others at the hospital, gave me a quick overview of what is happening with Los Robles. And, we’ve combined that with other information in the community.

The Reality of Hospitals in the Area

Los Robles has been undergoing and is about to complete major projects that are targeted to accomplishing two things: bringing the hospital up to new standards (e.g., seismic, etc…) and adding capabilities/capacities.

The State of California has laws covering the seismic standards for hospitals. These were updated after the Northridge earthquake. Many hospitals have needed to address this issue, and in some cases, the changes are substantial. There’s no “grandfather clause” for hospitals … so they have to deal with this. Jim confirmed that even if the old Westlake Hospital was still in use today, it would not have passed seismic standards. It’s unclear whether it would have had to be torn down, or just retrofitted, to meet the new standard. Jim indicated that the cost of creating a hospital at the old property would be on the order of $200-250 million.

Many have suggested that what they are most concerned about is having an ER close by for Westlake Village residents. Some have even suggested that we have an ER by itself. California Law prohibits you from running a free-standing Emergency Room. It must be attached to a hospital. Furthermore, there are a number of additional supporting services that would need to be added (e.g., offices for those that need to be in close proximity to the hospital). Think about all the facilities and doctors’ offices that surround Los Robles hospital — that’s just some of what is needed.

So, it may be possible to have some type of limited type of hospital built (like the surgical hospital recently built in Thousand Oaks), but an ER isn’t realistic because of what needs to be attached to an ER to make it legal and viable.

ER wait times: the cause and solution

Los Robles ER has been impacted by 3 relatively solvable problems — in addition to the natural ebbs and flows that can happen to any ER.

The first problem is that if the hospital itself doesn’t have enough beds, then when someone needs to be admitted, they have no where to go. In this case, the patient remains in the ER, taking up an ER bed, until there’s space available. Solution? Los Robles expansion is adding about 40 beds (net) to the hospital’s capacity. There’s also some “shelled space” that could be built out in the future, if needed. That space is designed for an additional 30 beds.

The second problem is that today’s ER is being used by many people as an Urgent Care facility. This too takes up capacity in the ER. Solution? Los Robles is creating a new Urgent Care section in the hospital to handle those needs, in conjunction with a new 5-level triage system it has brought online (see more on both below).

The third problem is that the ER is not big enough to handle the capacity. Solution? Los Robles will ultimately be adding more capacity there as well.

Will this make it so that you can walk in and see a doctor? Probably not as that wouldn’t be efficient for the hospital. This is similar to a doctor’s office where you make an appointment, but then have to wait anyway. You should expect that they would continue to handle incoming patients by the urgency/seriousness of their needs. But, there’s no doubt that the above will help in wait times regardless.

When will this happen? You should expect to see some relief as the new wing comes online this year. The next step is the renovation of the existing wing for upgrades and standards.

Bottom line: by Summer, 2008, you should see improvements to the ER capacities, wait times, etc… at Los Robles’ emergency room.

As the new facilities come online, the community should see significant improvement in the short term as well. It may take 6-8 months to really see what will happen for the longer term. The current 6-8 hour waits may initially come down to a 1-2 hour wait. But, once people in other areas realize that more capacity is there, they may lean on Los Robles. And then, the wait times may go up some. For example, paramedics may decide to go to Los Robles instead of one of the other hospitals (Simi, St. John, etc…) So, the wait and see is about the system as a whole, not just what Los Robles does to offer.

In addition, there are other issues beyond the hospital’s physical structure. Wait times can be affected significantly by whether physicians are coming in, or not coming in, in a timely fashion. Wait also depends on equipment (CT’s, etc…) as well as the staffing in the ER.

Los Robles’ New 5-level Triage System

Earlier this year, Los Robles ER implemented a new 5-level triage system. Triage, if you don’t know, is “the sorting of patients according to the urgency of their need for care.” It’s from an old French word, trier, meaning “to sort”. Historically, this has been a 3 or 4 level system.

The goal of this new 5-level system is to reduce the wait times and handle patients more efficiently without compromising quality of care. The five levels breakdown accordingly:

Level 1: Resuscitative
Level 2: Emergent
Level 3: Urgent
Level 4: Semi-Urgent
Level 5: Non-Urgent

In addition, Los Robles now has an “Express Care” program (similar to urgent care) designed to treat the 88% of ER patients that are non-emergent (i.e.,non-life-threatening illness or injuries). Los Robles will be opening its own hospital-based urgent care center, which they will call Fast Track, sometime next year.

According to Los Robles, with these two changes, wait times have already dropped from an average of 72 minutes to an average of 50 minutes. This is an average number, and will vary greatly depending on when and the severity of the needs.

New Wing Expands Heart Care

According to the recent reports from Los Robles and in the Ventura County Star, “The new wing will house a cardiovascular department with three high-tech catheterization labs to help doctors pinpoint the cause of heart problems. The new digs will also be home to respiratory therapy, admissions, outpatient services and a gift shop. A telemetry unit will house specialized equipment used to monitor heart patients or people who have developed complications.”

All of these may not necessarily do anything for wait times, but it will give Los Robles more capabilities and more modern equipment. As part of this, Los Robles just received the only dual-county STEMI designation in Southern California. This means that if someone suffers a heart attack, the paramedics have the equipment to work up an evaluation on the scene, transmit it to Los Robles. That gives a cardiac team time to get ready for the patient, and treat them more quickly upon arrival for the specific heart issue. This aids in increasing response times at the hospital, which (according to Los Robles) are among the fastest in both LA & Ventura Counties.

Agoura Solution?

While it’s very unlikely that Westlake Village will ever see a hospital again, the area may very well see services available in the Agoura area … some time in the future. This may not be in the form of a hospital, per se, but instead a “Health Care District”. This is a special area that voters define with a set of elected officials. It has the same powers as a school district or county, including the ability to levy taxes on the area to support services. Some research has shown that the residents would be willing to pay additional taxes for a hospital with an emergency room in the area, so this may make a lot of sense. Given the proximity of other hospitals, a new facility would probably best serve by being located in Agoura.

Health Care District Hospitals have precedent. For example, Pleasant Valley Hospital was a health care district hospital. Desert Hospital in Palm Desert is another example. Antelope Valley Medical Center is still another. So, the concept is proven and there’s an association of these types of facilities.

This might be a smaller hospital … maybe 99 beds, that could be self sustaining. A 100 or more bed hospital has different requirements, so this smaller size may make the most sense. Some estimate are at $1-1.5 million per bed to build (in other words, $100-150 million). Other estimates are as high as $250 million.

That all said — we’re a ways off from this being a proposal, let alone a reality.

Quality and Timeliness of Care

For many injuries, the 15-20 minute drive (non-rush hour time) to Los Robles is not going to change the outcome. But for some items, like a severe heart attack, it could. The reason is that there’s only so much that paramedics can do in the field, and if you need a full cardiac unit, “time is muscle” when it comes to dealing with the heart. At this point, all you can do is act as quickly as possible in those scenarios.

An interesting thing to note is surges of people in the ER do happen on Fri and Sat nights … the “surge times”. This is caused by things like drunk driving accidents, and sporting incidents that tend to happen more on the weekends.

In the end, if you have an emergency, you call “911” and do the best you can. But, if you are in a situation where you can control the timing of your visit to the hospital, or you can use an Urgent Care facility instead of a hospital ER,
you may want to consider that.