Together with James Bryant, Vice President for Emergency Services, we discuss the specialized capabilities of Centra Health's Emergency Departments. Learn when to go the ED and when to go to urgent care, what to expect when you go to both and how the triage process works.
We also explore the role of urgent care centers as a vital bridge to emergency departments, highlighting their strengths and limitations compared to hospital resources. We offer practical health and wellness tips to prevent illness and reduce the need for emergency visits.
Cami Smith:
Hi and welcome to and so Much More. I'm your host, Cami Smith, and welcome to a brand new year. It's 2025, as you guys are watching this and I get to have this conversation here with James Bryant. Thank you so much for being here, good morning. Do you want to introduce yourself to those who are watching and kind of tell us what it is that you do here at Centra?
James Bryant:
I'm James Bryant. I'm the vice president for emergency services here at Centra, and so I have responsibility for all four of our emergency departments across our system and also working with all of our partners at Centra to make sure that we're delivering the best health care possible.
Cami Smith:
I love that and that truly is anytime you have a conversation. If you've had the pleasure of having a conversation with James, that radiates from you Like the passion you have for Centra and the ED and these patients that come through, and those are the things I want to shout from the rooftops these caregivers that we have, who they want to provide the absolute best care for people who are coming through the doors of the ED, Because in a lot of cases, that might be the worst day of your life. You don't want to find yourself in an ED. We don't want you to have to come to an ED. We want to be ready when you come and we want to find ways to help you be ready when you come as well. And so for the next few months, we're going to be talking a lot about emergency care and our emergency department here at Centra, but what I want to start with is going to feel really elementary but truly okay. What is our emergency department?
James Bryant:
So emergency departments are 24-7. So they are open around the clock to take care of anything. So what I've always prided ourselves on is the emergency department is a safety net. So if you cannot find care anywhere else, we're always available. But our primary responsibility is for those time-sensitive things. So you're having chest pain, you're having difficulty breathing, you've been in an accident, you feel like you're having a stroke, you're having a mental health crisis, your child is sick and you just don't know where to turn. The emergency department is where you come.
Cami Smith:
Yeah, and so this is a huge community. This is, I mean, lynchburg has a huge imprint and it's Lynchburg and kind of the surrounding areas, and so how many EDs does Centra have total?
James Bryant:
So we have three hospital-based emergency departments and then our freestanding emergency department at Gretna, and that's a great point. We work with 46 different EMS agencies across our system, and so we get a number of deliveries of ambulances every day at all of our sites where patients who have transportation issues or have time-sensitive needs are brought in by those EMS professionals for us?
Cami Smith:
Yeah, what is the main difference between the different EDs?
James Bryant:
So all of our emergency departments can take care of, you know, anyone who's having a life threatening emergency. But the hospital based you could actually be admitted there For our Gretna facility. If you need an admission or surgery, you need to be transferred to one of our other hospitals that offer inpatient or surgical services. But all of us can refer we also we may send someone from Lynchburg General Hospital even to Southside, sometimes when we're extremely busy because of beds. So we work together to make sure that we have open beds at all of our sites. I think that's the power of having a center of facilities.
Cami Smith:
Yes, and that's actually something that I think it's really important to know that that flexibility and that community that is present among the different ADs across the board. It's so easy for us as community members to just look at. You know, sentra ED Lynchburg, over here, and Bedford ED over here, and this one is better than this one and this one, and you guys are all behind the scenes truly working together to ensure that each is operating to the fullest capacity and with the best efficiency, and so it's really one large ED community, just at multiple locations.
James Bryant:
And that's a fantastic point because we recently had a patient who was at our bed facility was having a heart attack and of course they don't have a cath lab there. But that team immediately started all of the IV fluids, giving pre-medications, and then we rapidly transferred them. They still had the opportunity to have a catheterization done within 90 minutes. So their heart attack started, they were seen at Bedford and they were transferred all within 90 minutes by this organized crew. So there's a lot of things that go on behind the scenes to move people. We have helicopters, mobile intensive care units. Those things are all moving our patients between all four of our facilities.
Cami Smith:
Okay, so let's talk about the process from the minute you walk in the door. So a patient comes through the door with an X emergency, we'll say what happens. What process does that put into place?
James Bryant:
So the first thing if you walk into an emergency department, the first thing you'll see is you'll see there's a little place where you give your name and that's just to put you on our list. But that person has also been trained for some very specific keywords Chest pain, the worst headache of my life, I'm having shortness of breath, my child has a fever those things will be brought immediately to the attention of a nurse or a provider who is in the triage area at Lynchburg General In our smaller facilities. That nurse is that conduit to the physician. Once they are registered in, we evaluate the patient, we take vital signs, we may start even drawing some blood, doing an EKG, getting a quick x-ray to begin your care, because we don't want you to wait any longer than you have to, and then we may also give you some medication for a fever or for nausea.
James Bryant:
If there is a wait, if we don't have a bed immediately available, you may be asked to wait in the waiting room. That's where it gets a little bit more complicated for patients, Because, if you're, we see people based on the immediacy of their need. So people that are having heart attacks, people that are having potential strokes, people that are, you know really having trouble breathing. Those patients need to be brought back, and then we have to ask other patients to wait.
James Bryant:
And as people come in that wait may go down a little bit further, so your wait may be several hours. We try to minimize that as much as possible. We do ask that people understand that we are making those decisions, and the other thing is to talk with your nurse out there. You know where am I at? Are my tests coming back? Because sometimes we've already gotten some tests back and we can make you feel a little bit better. Yeah, hey, we've already got the results back. You know your electrolytes are normal. You're not having a heart attack. You know your chest X-ray looked good, but we want to do some more tests.
James Bryant:
Yes, so we don't want to ever let people go until we've got a good diagnosis for them, and then we can get them feeling better. The other thing is, you know when you are having to wait is, please, if you get worse, if you feel, let us know, because you know your condition can change, and that's what we're there for, too, is we can recheck your vital signs, do some additional tests, maybe move you to the back, because that's what we need to do at that time, because we can all get sick while we're waiting in the emergency department too.
Cami Smith:
Yes and and I love what you're talking about as you're explaining ask for if you can see those test results and communicate when you're feeling worse. Because really, what it comes down to is understanding where you are in that triage process, and not just your triage process, but everyone else who's sitting in that room waiting for you, because, while you may not understand that, your test results may have shown your care team that you can wait a little bit longer than this person over here who it's been determined that their care needs to be a little bit more immediate. And if you haven't seen those test results, if you haven't asked those questions, you might not know that. And so advocate for yourself and work with this incredible team of caregivers who are literally there to make sure that you are going to get the care that you need, but also that everyone in that room is getting the care that they need.
James Bryant:
And I think what I want people to understand too is that we are working very hard to get you back as soon as possible. But some of the tests we've got here at Centro now we've actually moved to a new test called high sensitivity troponin, which is a test that helps us determine if people are having heart attacks, and that test can be done usually within about 45 minutes and that can give us a very good idea. That you're not having a cardiac event at that moment doesn't mean there's other things going on. That's the other piece. Some patients, they get some of their results back and they say I'm feeling a little bit better and they decide to leave before seeing the physician.
James Bryant:
We always discourage people from doing that because you're getting pieces of a puzzle. Medicine is very much a puzzle and we have to put those pieces together. So it's labs and imaging, but the most important part of that is the physical assessment and being seen by that provider and giving us a chance to put ears and hands on you and see how you're doing and have that conversation. So please don't cut yourself short. Give yourself that little extra time to be sure you get the thorough evaluation that you deserve and that we want to give you Don't ever leave without being seen. If you need to do that, let us know so that we can be monitoring your test and then, if something comes back, we'll always get in touch with you and let you know if there was something abnormal.
Cami Smith:
Yes, so the process that you are talking about when someone is arriving at the ED triage process, correct? I want to some maybe not well, yes, education, but a firm definition to what is the triage process.
James Bryant:
So triage is a term that means to sort. So that's really what we're doing is sorting people into different categories. So we use a five level system which was developed by the Emergency Nurses Association, and so level one patients are those that are absolutely emergency, so you're not breathing, you're having severe blood loss, you know you have no vital signs. So those are people that absolutely are number one on the list To a number five, which is someone who may just need a medication refill yeah, that's a need that people do have when traveling, especially during the holidays. So that's a little bit that can wait longer. So that's where we divide you. So everyone else kind of fits between that. You can be moved up and down that as we get more information.
James Bryant:
So it's always a constant evolution of people's care and we're tracking that on a computer system. So we're seeing all of those vital signs. We're seeing you know where you're at in the list and where other people are. The other thing that's important for our patients who are waiting in the lobby with the waiting room is that there are also people coming in by ambulance, and so for Lynchburg General we get about 40 to 60 patients per day by ambulance, and those are patients that you don't see, that are coming in and sometimes those patients have been transferred from other hospitals. Some of them are coming in because we are a trauma center, because we do have a primary stroke where we can intervene and do a procedure, where we can actually remove the clots from your brain through a procedure, or the same thing with our cardiac cath lab where we can take that clot out and avoid, you know, that heart attack.
James Bryant:
So, because we have these specialized capabilities here at Lynchburg General. You may have to wait a little bit longer, because those patients are coming in too that you don't actually see.
Cami Smith:
Yes, so it's a, it's a lot about perspective and and I want to even reiterate what you just said, because when you do come into the Lynchburg ED, well, and then also the Bedford ED and other facilities of ours, that emergency ambulance entrance is it, what is that entrance called?
Cami Smith:
Yeah, the ambulance our ambulance entrance, and so you unfortunately entrance called yeah, the ambulance, our ambulance entrance, and so you unfortunately can't always see that, yes, and so a lot of times, and I feel the frustration because I have been in a position where I'm waiting for care for myself or someone that I care for deeply, and you're looking around the room and there's not a lot of us here. What is the holdup? There is an entire another inlet to that emergency care facility and that typically tends to be the trauma level care that comes in, and so you mentioned that we're a trauma center. Can you briefly explain that?
James Bryant:
So trauma centers, where we have dedicated resources available around the clock. So we have surgeons, anesthesia specialists here. So if someone has been involved in a severe accident, a fall or a motor vehicle accident, they can come in and that surgical team is here and we can get you to the operating room within minutes. Sometimes it's just a few minutes in the emergency department, where we'll do a quick look with ultrasound to see if you're having internal bleeding and if we determine that, you just go straight to the operating room.
James Bryant:
We have special processes here too, where large quantities of blood can be delivered to the operating room so that we can volume resuscitate that person. And then also that we have subspecialists here with cardiology and internal medicine and of course our radiologist specialist and vascular specialist who can all be called in to immediately help that patient. And then sometimes, you know, because we're a level two trauma center, you may need some additional resources. Then we work with our partners at UVA and VCU to transfer you out either by helicopter or ground critical care, and that can all be done within minutes. And you know, unfortunately when you have a motor vehicle accident, oftentimes there's multiple victims, so sometimes we can get four or five or more people from that single accident. That all need immediate care. So we have processes in place here to triage those patients so that we give everyone the care that they need.
Cami Smith:
Yeah, all going on behind closed doors.
James Bryant:
It's a very exciting place after 44 years of doing this.
Cami Smith:
I imagine you probably have some pretty crazy stories. I do so when you think about you're having an emergency, something that you would need to go and seek care for. There are other options. So I want to kind of shift gears a very little bit to talk about urgent care, and so the goal is going to be when to know where to go specifically. But first, can you give us a little breakdown of urgent care?
James Bryant:
Sure. So urgent cares are centers that usually have extended hours. So they usually open early in the morning, some as early as 7 o'clock, and then may not close until 11 o'clock at night. So they have extended hours. So they usually open early in the morning, some as early as 7 o'clock, and then, you know, may not close until 11 o'clock at night. So they have extended hours. They don't require appointments, although some of them do let you sign up throughout the day. Yeah, but they typically take people based on, you know, just whenever you walk in you may have a wait, just like the emergency department based on volume or how many patients they're seeing that day, department based on volume or how many patients they're seeing that day.
James Bryant:
But urgent care centers are really vital because they are able to bridge that gap between your primary care provider, where you typically have an appointment, and urgent care, where it's kind of in between that and the emergency department. So if you're having minor complaints like shortness of breath, you know, from a cough or a cold, you've got an ear pain, maybe you you have a small cut that you know, you believe you need stitches for you've sprained an ankle, you have some gi upsets from yawzy or vomiting and or you just need medication refills or treatment for your high blood pressure or something like that. Many urgent cares provide that primary care function also. That's a great option, and so we encourage people to use that.
James Bryant:
The challenge sometimes is, as you know, you do have chest pain. You have a very complex medical condition, so some of our older patients who have multiple problems, they may be on a diabetic or dialysis. Sometimes that's a little bit beyond what our urgent care centers can manage because, unlike the emergency department, they don't always have laboratory and imaging services immediately available. So when you come to the hospital, we have those things immediately available and we'll get those results back within, you know, minutes or to a few hours. Urgent care that may take a day or two to get those same results back. So that's one thing that you need to consider. It's also a great option, you know, if you can, to use a telehealth visit.
James Bryant:
Yes, because telehealth is an option that many of our insurance pay for now and you know it's really a that's come a long way with COVID They've really refined that so you can even have an earache, you know, sinus pressure, a toothache, all of those things can be managed and by that primary excuse me, the tele-visit and that can be a great option for you too. Or if you need a medication refill, or again, nausea, vomiting, those things that are more, you know, controllable. You know that you're not so worried about, but you're very uncomfortable, that telehealth visit. So I always tell people think telehealth, urgent care, emergency department, and then your primary care is getting all of that information from all of those resources.
Cami Smith:
Yes, so it's all a part of a large system, and knowing and really making that discernible choice of this is where this is where I am and my telehealth and my urgent care and my AD, and I love we talked a little bit about this before we started. I love that you talked about things like an ear infection. So I have two younger children and I don't know if I can call them children anymore. One of them is a teenager now. But, um, for an ear infection specifically, I would have thought that is something you need to be in person for someone to look into your child's ear, but the result in a lot of cases is the same you're going to need antibiotics, and that can be done via telehealth, and so that's so helpful just knowing that that option is actually still an option for me, dependent upon what it is I'm looking for and it's because they ask questions over COVID and other times we've really learned how to ask questions like do you have pain coming down the bone here?
James Bryant:
that you know? That's sometimes very common with infections, you know. So they're just asking you questions to understand. So they may not be able to see inside, but they're getting the same information and making that decision where, whether an antibiotic is going to be helpful or not, yeah, so you always give that, and usually those are only a few bucks too. So usually I know for us it's only $10 for the copay, which is nice, and you get those prescriptions called right in. It's really amazing now how interconnected all of your health care is, and we do encourage people to sign up for Healthy you, because then you can see all of your Centra lab results are fed into that report that is so nice.
James Bryant:
So you can have that record and you always be able to take and know what's going on with your health and your child's, yes.
Cami Smith:
And for those of you who are like, wait a minute, stop. What is Healthy you, so Healthy you is essentially your patient portal, and so all of your test results, all of your physician's notes for, regardless of whatever treatment you're in there for, they are all in one place for you to access and maybe get some questions answered. You can submit a question to your physician within that portal. It's just really an incredible resource that's available. So, okay, I see a common theme here among all of you, maybe with the exception of telehealth, because that's pretty immediate, but you're going to be waiting of telehealth, because that's pretty immediate, but you're going to be waiting.
Cami Smith:
It is inevitable in a lot of cases, unless you are one of those extreme trauma cases that is, that needs to be taken care of number one. And so, as you're anticipating coming in to the ED or even urgent care because I have spent some time in an urgent care waiting room and it's a lot, especially if you're there with young children or elderly parents how can we prepare for that? So, maybe something as simple as like bring some water, you know, bring. I don't want to minimize, but bring a book, bring something to do. It brings something that is going to help, but how would you advise our patients to prepare for a long wait in an ED or urgent care?
James Bryant:
And that's really important now as we go into our busy season.
James Bryant:
So this is when we have lots of colds, flus, you know, those things are those respiratory illnesses. So the waits are longer at not only the emergency departments but our urgent care centers. I think the biggest thing is try not to bring anyone other than just having maybe one other advocate with you or a visitor, because if you bring all your children they're going to get very, very bored and it can be very crowded. It can be very scary to have other people in there because you are going to see other people that are sick. So I try to encourage people not to bring the entire family but bring someone that can be your advocate and support person. And then the other thing is is you know, if you want to bring something to eat or drink, please feel free. We do have vending machines, but you know you can always bring your own snacks. But do check with the nurses first, because sometimes if you eat or drink something that can delay a test or it can change those test results.
James Bryant:
I used to tell people the favorite thing is Cheetos and giving someone who has a sore throat Cheetos. It's really hard to see that you have redness at the back of your tongue after a bag of Cheetos.
Cami Smith:
Yeah, so no Cheetos.
James Bryant:
So things like that can be very difficult. So ask before you eat some of those things. And then the other part is again pack some patience, pack some understanding, look around and see there are other people that are suffering just like you are, and we are trying to see everyone. We see every single patient, no matter what. We will see you. You know that is what we're there for, but please understand that we are making those decisions about who needs to come back, but we want to be your partner.
James Bryant:
So if you are feeling worse or you feel like you have a question. Please don't be afraid to ask. That's what we're there for. And then the other part is just make sure that you're doing things to try to prevent getting sick in the emergency department urgent care other places, which is, you know, try to avoid touching things so much, Wash your hands frequently, cover coughs and sneezes.
James Bryant:
Those things are just so, so important because we give it to each other and that's why during the holidays we see such a spike in these flus and GI illnesses is because we're all close together.
Cami Smith:
We're all giving each other a hug or a kiss.
James Bryant:
We love that, we love touching and we love eating a lot, and so you know, unfortunately those things can pass these very, very quickly, and so you can see whole families get sick over the holiday which is very, very uncomfortable for that family, so we want to try to avoid that and make you a really nice holiday.
Cami Smith:
Yes, because our ultimate goal is for you not to have to come to the ED or urgent care or telehealth. We want this community and really everyone, to just be as healthy as possible. But we want to equip you for, if you find yourself in these situations, all of this wonderful information, because I think it really is so important to just have an understanding of what you're about to step into and to come, like you said, with grace and patience and understanding, like we're all. We're all here to get you healthy and that is the goal that we share. So I appreciate your time. Thank you so much for coming on and thank you for everyone who has joined us on, and so much more all right, thank you for everyone who has joined us on, and so Much More.
James Bryant:
All right, thank you.
