Northridge Hospital Tries Experiment to Free Up ER.

Northridge Hospital Medical Center is trying a novel experiment that is being closely watched by other hospitals trying to ease con ditions for thin-stretched emergency room staff.

In January, it opened its new pediatric express care unit, an after-hours division intended to treat relatively minor childhood ailments like broken bones, sore throats, rashes, fevers, cuts and infections.

At Northridge Hospital, like at most hospitals, these cases were putting a major strain on the emergency room. When kids have such problems after working hours, parents usually have no choice but to bring them to an ER -- but ER staff must be available to handle more severe, life-threatening problems.

"This hospital tries to be in touch with the community," said Dr. Paul Karis, medical director of emergency services. "It was obvious that pediatric services were needed, especially after hours."

The express clinic acts like other urgent-care facilities, treating patients who aren't suffering from immediate life-threatening emergencies. Its hours of operation are from 5 p.m. to 1 a.m. on weekdays and 9 a.m. to 1 a.m. on weekends and holidays. (Outside those hours, patients are treated in the ER, like before.) Northridge Hospital is the first facility in the San Fernando Valley and one of few general care hospitals nationwide that has opened an after-hours pediatric clinic.

Not yet profitable

The hospital spent more than $500,000 to build the pediatric unit, and continues to lose money on the cost of staffing it with pediatricians, physician assistants, nurses and technicians, Karis said.

About 15 patients show up at the pediatric express unit on the typical night. The hospital predicts it needs at least 20 patients a night to break even, and more to build up the program. Northridge is a nonprofit hospital, so any money made at the pediatric express would be funneled back into the hospital.

If the unit is unable to break even by Dec. 31, the program will either have to find alternative funding through grants or private donations, or be scaled back or scrapped, Karis said.

But the experiment has gained the attention of health maintenance organizations looking for innovative ways to cut medical costs.

Health insurers tend to favor urgent-care units like pediatric express because they are typically much cheaper than ERs. The average per-patient cost in the pediatric express is $100. The ER, where patents get more-intense treatment and problems tend to be more serious, generally costs patients at least $500 each.

Karis said three HMOs have approached the hospital about signing a contract to send members to the clinic. But Northridge Hospital has no plans to do so because the HMOs are unwilling to pay enough to make it financially feasible for the hospital, Karis said.

"Let's face it, hospitals unfortunately have a bottom line now," said Dr. Seymour Silverberg, chief of pediatrics at Northridge Hospital, who first brought the idea forward. "We presented it to the hospital as something that would pay for itself and something the community wanted."

Silverberg got the idea for the pediatric express after hearing about a similar program at a Denver hospital. He and Karis began researching Northridge Hospital's records, and found that most visits by children were happening at the emergency room after hours, and many of the cases were not severe.

While the pediatric unit doesn't reduce the cost of running the ER (the same number of physicians and staff still work there), it has reduced the ER's workload. And for kids who aren't in need of life-saving care, it's a more tranquil environment than the emergency room, with Winnie the Pooh paintings in the halls and Cinderella posters in the rooms.

It's also considerably more convenient for patients. The average stay at Northridge Hospital's ER is four hours. For the pediatric express, the average stay is an hour. Because of that, Karis said, the clinic has attracted people from as far away as Santa Clarita and Simi Valley.

"Sitting in a waiting room (at the ER) is not avoidable," Karis said. "You see a lot of things even if you're in a room. ERs are high-stress and fast-paced places. There's a lot of noise, a lot of action and it takes a long time."

Northridge's emergency room is one of only two trauma centers in the San Fernando Valley. The 20-person ER staff handles between 140 and 150 patients a night, including everyone from gunshot victims to car accident survivors and heart-attack patients. It can be a difficult scene for young kids to watch. About 30 percent of the hospital's ER patients were under 18 in 1999, before the pediatric express started.

Worried parents flood ER

Most kids come in at around 6 p.m., when many working parents get home and discover their child is ill. While adults may put off going to the doctor for a fever or cold until the next day, when it comes to their children, they tend to be more expedient.

"Parents really worry about their children and they want them to be OK," said Dr. Fasha Liley, one of several pediatricians who staff the center. "Most parents don't want to see their children suffer."

Jim Lott, executive vice president of the Healthcare Association of Southern California, said children's hospitals across the country have been running urgent-care units geared at children for the last 20 years, but the trend hasn't spread to other hospitals.

"The San Fernando Valley has a great need for this kind of service," Lott said. "This is somewhat cutting edge for a general acute-care hospital."

Indeed, other hospitals in the area have begun calling Karis to get more information about the program.

"We'd like to be seen by the Valley as the center of pediatrics and a center of excellence for pediatrics," Karis said. "With this, we're like the Microsoft of pediatric care."