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Hospital taking steps to clear up overcrowded ER

BY LESLIE ROTT
Daily Staff Reporter
Published October 19, 2004

Engineering sophomore Derek Deveaux sat in an artificially lit
room cramped close together with 20 other people. Complaining of
chest pains and shortness of breath, he ended up at the University
Hospital’s emergency room, after waiting for a day in the
hopes that his symptoms would subside.

Deveaux said he arrived at the hospital at 6 p.m. and waited
five hours in a crowded room just to see a doctor. When he told one
of the nurses that the pain in his chest had gotten worse, she told
him that there was nothing she could do for him — he would
just have to wait his turn. When he finally was seen, he said the
doctor looked at him for 10 minutes, and sent him home with
medication.

Deveaux’s experience of waiting several hours for care is
not uncommon, and is a symptom of a nationwide dilemma among
hospitals: overcrowded emergency rooms.

William Barsan, a physician and the chair of emergency medicine
at the University Hospital, said packed emergency rooms have become
typical in hospitals across the country. In 1996, there were 6,200
emergency rooms in the country and more than 90 million annual
visits, Barsan said. By 2002, there was a decrease in the number of
emergency rooms to 4,037, while annual visits increased to more
than 114 million.

The Centers for Disease Control and Prevention confirmed these
statements in a recent news release, citing “a continuing
increase in the number of Americans seeking medical care in
hospital emergency departments, even as other data show the actual
number of emergency departments on the decline.”

The issue can be especially pertinent to college-age students,
who have the second highest rate of visiting emergency departments
behind the elderly, according to the CDC.

“Persons aged 75 and older continue to have the highest
rate of emergency department visits (61.1 per 100 persons), while
the next highest rate was for persons aged 15-24,” a March
report from the center states.

In order to determine who needs to be treated first, hospitals
must “sort out who is most likely to need medical attention
right away,” Barsan said, adding that he would nonetheless
not want to have to decide who should be treated first.

Such decisions prove to be problematic, not only for those
trying to receive care, but also for the hospitals that have to
deal with severe overcrowding. Despite the increase in the number
of patients, hospital budgets are shrinking, Barsan said. This
means that even though the number of patients is increasing,
funding allocated to hospitals may not grow at a rate that will
allow hospitals to accommodate all the new patients.

There are many reasons for the increase in hospital emergency
room visits. Sicker patients, shorter hospital stays leading to
greater rates of home care, an aging population that consumes many
health care services, and the fact that hospitals are able to keep
chronically ill patients alive longer all have a huge impact on the
overcrowding that hospitals are seeing today, Barsan said.

Some of the patients crowding emergency rooms are often waiting
to receive care that could be administered elsewhere in the
hospital, if there were only enough beds for them to use.

But simply adding additional beds is not necessarily a solution
to this problem because the state puts a cap on the amount of beds
that a hospital is licensed to have.

The University Hospital is licensed to operate 865 beds, but
does not have enough space to operate that many because some
patients are sicker and require more privacy. The University is
currently using 786 beds, said Kathryn Gavin, spokeswoman for the
hospital.

Despite this, the hospital is actively working to find solutions
to the problem of overcrowding. The hospital is adding automated
services within the emergency room to make patients’ visits
shorter. For example, the hospital has recently added X-ray
machines that send results instantaneously to a computer screen
viewed by physicians and support staff. Hospital staff have also
begun computerizing all patient information and sending results via
transportation tubes from one floor of the hospital to another.

These tubes allow for patients to be kept in one place, while
test results are reviewed within minutes and sent quickly back to
the emergency room. Normally, patients must be transported outside
the emergency room to receive tests, adding time to their hospital
visits.

The hospital has also opened an occupational health care center
alongside the emergency room to filter out patients who need care,
but are not in such critical condition that they need to wait in
the emergency room, Gavin said.

But all these improvements appear to be somewhat of a
“Catch 22,” Barsan said. “Each time we get a
little better, the number of patients goes up,” he said.

It does not appear that the situation is going to improve much,
especially with a national shortage of flu vaccines this year,
Gavin said. Every year, hundreds of people flock to the emergency
room with bad cases of the flu, she said. This year will be
especially difficult considering that emergency rooms are already
overcrowded and flu season has not hit yet. “It is going to
be an interesting winter,” she added.

The University Hospital and other highly rated hospitals are
faced with another dilemma — this one long-term and possibly
more serious than the impending flu epidemic of this winter.
“What happens when there is an emergency if all the beds are
full?” Gavin asked, referring to a natural disaster, plane
crash or terrorist attack.

With all of the improvements that the hospital is trying to
make, there is still a long way to go. Despite this, Gavin said the
hospital is on par with similar hospitals in the country in dealing
with overcrowding, and is doing better than most inner-city
hospitals.

But this is little consolation to patients who must wait hours
in order to receive medical attention, like Deveaux, who described
his visit to the emergency department as “pretty
ridiculous.”