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Emergency Not Enough Room
A report on the state of the country's emergency medical system was recently released by the
The nation's emergency rooms are overcrowded. While the number of emergency rooms fell by 425 (or 198,000 beds) between 1993 and 2003, the overall demand for emergency care grew by 26 percent. To complicate matters, health care systems are not very good at communicating and cooperating with one another. This leads to two common failures of a community's emergency medical system: diversion and boarding.
Diversion is the practice of temporarily closing an emergency department because it cannot take any more patients. Boarding refers to keeping non-emergency patients in the ED because of a lack of available inpatient beds.
Both of these practices are widespread and growing in frequency, the report shows. Poor collaboration between health systems also makes for a public health network not well equipped to handle a large-scale emergency such as a natural disaster or terrorist attack.
In addition to all of those factors, there is a nationwide shortage of emergency and trauma specialists, especially those trained in pediatric emergency medicine.
The state of emergency rooms across the country looks pretty bleak. Fortunately for residents of
"We're not as bad in
Helen Berghoef, director of emergency and ambulatory services for Metro Health and a member of the executive committee for Kent County Emergency Management Services, said that
"I know we're not seeing the level of overcrowding and diversion that many other communities are experiencing," she said.
Over the past several years,
"It was a commitment by the hospitals' upper management to recognize the emergency departments as sort of a safety net, and that we couldn't just have us handle all of the incoming traffic and have the inpatient units say 'Oh, we're not ready for that patient. We don't have a bed for them.'"
Metro, Saint Mary's and Spectrum Health have all undertaken similar efforts to improve the efficiency of their emergency care.
Spectrum Health's emergency department was ranked 19th busiest in the country by a 2005 Modern Healthcare study. Spokesman Bruce Rossman said that, despite a dramatic increase in ED traffic, Spectrum has instituted procedures that have cut down on wait times, length of stay and diversion.
"We rarely ever close one of our EDs to (all) traffic, but may occasionally close to lesser kinds of cases coming by ambulance," he said.
Under most circumstances, Spectrum can balance its emergency patient flow between the Blodgett and Butterworth campuses. Rossman said that it is not unheard of for patients to be forced to wait in the ED for an inpatient bed to open up, but that those wait times are much shorter than the two-day average mentioned in the
"In less than a year, we've dropped our average wait time at Butterworth to 28 minutes and about 60 (percent) to 64 percent of our patients go from door to doc in less than 30 minutes," said Rossman. "Not bad for an ED that will likely see 130,000 patients this year."
Despite the comparative health of
"I think we're still going to see enough professionalism among the departments that they're still going to have the cooperation," said Saint Mary's Buller. "But, the patient load that Metro used to take was a load that, quite frankly, is not going to be able to make it all the way out there (to southern
Buller said that
Metro's Berghoef doesn't think that will be so. She doesn't believe that the move will result in a decrease in Metro's patient load — poor or otherwise.
"Absolutely not. I don't think any ER anywhere in the
Both Metro and Saint Mary's are implementing new "lean" processes that they will incorporate into the treatment given in their new facilities.
"We're working on new processes so we don't just take our old, broken-down processes and just put them in a new facility. That isn't going to work," said Buller.
Those efforts underscore one of the reasons for the area's success. Even though
"We have everybody working together, from
"Regional planning and finding a way for the departments to work together? That's fine, but put some of the money into the departments themselves," said Buller. He said there is a limit to the ability of emergency departments to "lean out" their processes.
"Good for us that we're stretching, but bad for the system when it's 'Oops, we can't stretch any more. That's it.'"