Medical director evaluating Olympic Medical Center’s emergency department changes

Published 1:30 am Friday, March 27, 2026

PORT ANGELES — When Evan Small arrived as Olympic Medical Center’s emergency department medical director last summer, he brought with him a background in large health systems and a focus on improving how emergency departments move patients through care.

Small spent 13 years at Mayo Clinic and served as regional director of emergency departments in southwest Wisconsin and vice chair of hospital practice for seven hospitals, where he helped oversee operations and build a $350 million, 96-bed facility.

He is employed by Sound Physicians, the company that staffs OMC’s emergency department. He also works a couple of shifts a month for TeamHealth at emergency departments in Bremerton and Port Orchard.

Small spoke Wednesday on Coffee with Colleen, hosted by Colleen McAleer, executive director of the Clallam Economic Development Council.

“I see the care in our emergency department broken up into three ways,” Small said. “Seeing patients as fast as possible, providing accurate and efficient care, and then getting them where they need to go as quickly as possible.”

Small said one of his first priorities at OMC was changing how patients were treated from arrival to departure.

Previously, patients were first evaluated in triage and often waited before being they were assigned a provider. Now, they are assigned one upon arrival, allowing care to begin sooner and streamlining their treatment.

The change has improved accountability and efficiency, he said.

“We’re now saving over 60 hours of care every day,” Small said, referring to reduced time patients spend in the department.

Even with those improvements, the emergency department continues to face challenges.

Patients must still be transferred out of OMC because it lacks certain specialty services. Patients can wait hours — or longer — for transport depending on ambulance availability and weather conditions that can limit air transport.

Small said he sees expanding community paramedicine programs in which paramedics work in expanded roles outside emergency response by providing in-home, follow-up and preventive care as a potential solution to some of OMC’s challenges.

In a program he worked on in the Midwest, he said, regular home visits for patients with congestive heart failure reduced hospital readmissions by more than 60 percent.

Olympic Medical Home Health, which provides in-home care, is a great program, he said, but there are strict eligibility requirements and it can take weeks to access.

A shortage of nursing staff remains a challenge because they play a key role in critical tasks, such as discharging patients.

“The nurses in the emergency department is probably one of the strongest things we’ve got; they’re fantastic,” he said, adding, “We just don’t have enough.”

Small said the emergency department is the central entry point for patients to OMC, and it’s essential that it performs at the highest level.

“There are days where everything runs smoothly,” Small said. “Other days, it feels like there’s glue in the gears.”

Even then, he said, the goal remains the same.

“I don’t go to work to make people wait,” Small said. “I want to help people.”

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Reporter Paula Hunt can be reached by email at paula.hunt@peninsuladailynews.com.