Busiest days for Altru ER are Sundays and Mondays, but staff always ready for the unpredictable

"There will be some fluctuation on the weekends," she said. "I think a patients try to make it through the weekend as they can, maybe not feeling that bad."

The clinics aren't open on Sunday, and if a patient becomes more ill or needs a checkup after a traumatic event, they come to the ER for an assessment.

The Sunday-Monday scenario aligns with national numbers, Wald said. More than 141.1 million patients visited hospitals across the U.S. in 2014, the latest numbers available through the Centers for Disease Control and Prevention. Studies show those numbers are on the rise.

Preliminary numbers show Atru had 33,574 emergency visits last year, an increase of about 400 from last year, Altru spokeswoman Michelle Adolphsen said in an email to the Herald. The time period that sees the most patient arrivals typically is between 2 and 9 p.m., Wald said.

But that isn't always the case, she said. No night or shift is the same from the previous one, any patient can come in with any number of conditions—from car crash victims to stroke patients.

The ER is staffed and ready to handle any situation, Wald said.

"There is no predictability in the emergency department," she said. "It's really hard to say our Friday night is this. We're ready to take those patients whenever they come.

By the numbers

The busiest days for the ambulance service are Fridays, Altru Ambulance supervisor Jen Berger said, though it's not much busier than an average day.

Fridays on average see about 26 calls compared to the average day rate of 24 calls, with the shift from 7 a.m. to 7 p.m. being the busiest. She attributed that extra call volume to transfers to other facilities in and out of Grand Forks—that makes up about 10 percent of its work, Berger said.

About 65 percent of its patients are taken to the ER for further examination, she added.

"From start to finish, a call can take anywhere from a half-hour to 45 minutes to and hour sometimes, depending on how much conversation we have on scene," she said, adding they typically can arrive at the scene within nine minutes.

The hospital runs multiple drills for different scenarios in which it would have to accept a large number of patients at once, Wald said. For example, the hospital needed to treat about a dozen children who were involved in the Jan. 5, 2015, crash near Larimore, N.D., when a train collided with a school bus.

"We do drills upon drills about this," Wald said. "We have specific protocols on who we communicate with and what happens in those incidents."

Wald described moving patients who wouldn't fit in the ER to what she called a "surge unit." The ER also can ask for help from other hospital departments if it is shorthanded, she said.

"As our volumes go up, we have resources throughout the hospital that we can utilize," Wald said.

The national trend of a higher demand for emergency services has been felt in Grand Forks, Berger said. A supervisor who has worked with Altru for 17 years, she said the ambulance service averaged about 10 calls for service a day when she started working there. That has increased each year.

The ambulance service had 8,701 in 2017. That was down from the 8,900 calls in 2016, but Berger attributed that decrease to a change in policy. The ambulance service last year stopped responding to every fire call unless requested, which made up about 600 calls for service.

"As people continue to get sicker, the need for emergency services is greater," she said.

The ER sees sicker patients compared with previous years, Wald said, but the time spent in the ER has dropped dramatically. The length of stay in Altru's ER has been reduced by an average of 35 minutes in the last seven months, she said.

The number of beds also has increased in an effort to shorten wait times, Wald added. The ER added five beds since November, bringing its current total to 29.

The goal is to get the patients the treatment they need as fast a possible, Wald said.

"We really focus on getting the patient to the doctor very quickly," she said. "They're here to see the doctor, so we really work to streamline our process to get them in through the front door, checked in and into a bed so they can see our doctor."