PORT ANGELES — Dr. Evan Small, the medical director of Olympic Medical Center’s emergency department, said rebuilding trust was his first assignment after he was hired last summer.
Addressing concerns that have drawn criticism from patients and the community has been central to that effort.
Small told the Port Angeles Business Association on Tuesday at Joshua’s Restaurant that core challenges facing the emergency department include long wait times driven by high patient volume, limited inpatient bed availability, shortages of primary care and specialty providers and the need to transfer patients for services not available locally.
He said those pressures compound each other, increasing crowding and contributing to frustration among patients and staff.
“The emergency department doesn’t operate in a box,” Small said. “So many services flow through us, and small delays elsewhere can dramatically affect wait times.”
Small spent 13 years at the Mayo Clinic, where he held leadership roles in the Mayo Clinic Health System, including regional chair of emergency medicine and vice chair of hospital practice for a Wisconsin-based system overseeing seven hospitals.
While Small manages the emergency department at Olympic Medical Center, he is employed by Sound Physicians, a Tacoma-based company that provides physician staffing and clinical services to hospitals. Sound Physicians is owned by UnitedHealth Group’s Optum division and the private equity firm Summit Partners.
He pushed back on the idea that the emergency department is staffed by outsiders, saying most physicians live on the Olympic Peninsula or in nearby communities. He compared that with a heavier reliance on short-term contract physicians, known as locums, in the past.
Small addressed repeated citations issued by the state Department of Health over the course of 2025, saying they did not involve problems with patient care. He said the findings underscored the need for clearer accountability, standardized practices and closer oversight.
Improving patient movement through the emergency department has meant reducing bottlenecks that have kept patients waiting at each step of care — from arrival to discharge or admission.
He said the emergency department has focused on assigning physicians to patients earlier, ordering tests sooner, clarifying responsibility for each patient sooner and establishing coordination with inpatient units sooner so admitted patients can move out of the emergency department more quickly.
Small said key measures such as how long patients wait to see a provider and how long they remain in the emergency department have started to improve. The median time from arrival to being seen by a provider has been reduced by about 10 minutes, he said, and the department’s median length of stay has dropped by roughly 50 minutes.
Asked whether the staffing level in the emergency department is sufficient, Small said it is adequately staffed, but nursing availability and inpatient bed capacity remain significant factors that affect overall wait times.
Transfers remain a challenge, he said, because Olympic Medical Center does not offer some specialty services available at larger hospitals, such as cardiac catheterization for certain heart attacks. He said reducing avoidable transfers is a priority, particularly for patients who could remain in Port Angeles.
Small said shortages of primary care and specialty providers contribute to emergency department crowding, as patients seek care there when they can find alternatives.
He said one of the most effective ways to improve emergency department care is for patients and the community to provide specific feedback, adding that waiting is a universal frustration in emergency medicine when the sickest patients are prioritized.
“We hear you, and we want to get better,” Small said.
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Reporter Paula Hunt can be reached by email at paula.hunt@peninsuladailynews.com.
