In recent weeks, two hospitals have publicized their ways to speed emergency department processing: MountainView Hospital has decreased waiting times in the lobby; Spring Valley Hospital has streamlined its procedure for admitting patients brought in by ambulance.

As the valley grows, these practices become more important. Emergency departments here are facing an exaggerated version of problems affecting the rest of the country.

A report published in July through George Washington University's National Health Policy Forum cited that 62 percent of emergency departments at urban, community hospitals were overcrowded. Total visits to emergency services increased by 18 percent to 110 million between 1994 and 2004, the report also said.

Federal policymakers should be interested in this issue, the report said, because the government picks up the tab for Medicare and Medicaid patients.

Locally, the case for improvement was much more visible.

The hospital put to use the creative ideas of a former nurse-turned-manager to see wait times fall.

Natalie Seaber, director of the emergency room at the HCA-owned facility, has been implementing her plans since she took over in 2003.

Average wait time from the door to the doctor is an hour and 45 minutes, down from the three or six hours that patients would wait a few years ago. The "walkout rate" — those who leave before being treated — has gone from 10 percent to 3 percent.

Once patients get into a bed, they see a doctor in an average of 14 minutes, a number that was not tracked previously.

Much of the improvement comes from ordering tests for patients early on. Seaber put two triage nurses in the waiting room to assess patients.

If someone comes in with abdominal pain, for example, they may go into the hospital for bloodwork, an EKG, an ultrasound or a pregnancy test. After the tests, the patient goes back to the waiting room.

"What used to happen is people would just wait (to start tests) until they got a bed," Seaber said. "Now, when they get a bed, everything's back already. Then the doctor may or may not have to add another test. He may make a disposition for home."

Seaber more recently launched a practice she affectionately calls "Doc in the Box."

An ER physician sets up a makeshift exam room behind some portable curtains, in the corner of a triage area, from 1 p.m. to 11:30 p.m. at night. Patients with heart attacks or massive wounds still go back immediately, but this doctor treats some of the sicker patients in the waiting room, giving an exam and medication.

"If I were a patient, I wouldn't care if I'm in a waiting room or a room in the back when I'm seen and treated — if that's happening quicker," Seaber said. "It's kind of the old way of measuring how well an ER does. Ten years ago, that's what we used to look at. Now they're starting to change: What are the times to be seen by a physician or receive treatment by a nurse?"

The UHS-owned hospital happens to have the fastest ambulance offload times in the valley — without making major changes to its procedures.

Officials recently reached a breakthrough: On average, patients get off the ambulance and into the hospital in under 10 minutes.

"We've always been pretty fast," said Dr. Kevin Slaughter, medical director of emergency services for Spring Valley. "Our goal has been to just get the medics through as quick as we can."

When the state Legislature in 2005 ordered Clark County to find a way to improve overall offload times, many hospitals had work to do. On average, patients taken by ambulance would wait around an hour to get into the hospital, but there were cases of patients waiting up to 10 hours, said Rory Chetelat, Emergency Medical Services manager for the Southern Nevada Health District.

"The really sick people were getting seen," he said. "These were more the ones who were marginally sick or the mentally ill It still didn't matter, because it was a problem for EMS. We can't put 911 on hold."

A county task force decided to record offload times for nine months, starting in March of this year. The valley's 13 hospitals and nine EMS agencies chipped in $1,000 each for computer software, to be placed in ERs, that keeps track of how long it takes for a hospital to take control of a patient.

But before the tracking started, the Health District made a bold move to shorten times. Ready or not, ambulances would start to leave after 30 minutes.

"We did that literally New Year's Eve weekend," Chetelat said. "We didn't have to do it very often before hospitals found out we were serious. All of a sudden, they started ramping up and changing their processes."

Most hospitals are down to 36 or 38 minutes, according to the most recent reports from June, he said.

He would not divulge detailed information about offload times at other hospitals, but did say that the top three included Spring Valley, followed by its UHS sisters, Valley and Desert Springs hospitals

"I think it was just getting focused," Slaughter said. "If you're very good at something and focus on it, you get better at that."