June 9th, 2011

DC Area access to the ER

My sister mentioned that there had been some scandal in the Baltimore area regarding access to beds in the emergency room(s) -- people having to do the ambulance version of flying circles waiting for a runway to clear so they can land. She had confirmed the story with someone who rode in ambulances for a living, IIRC, but had not thought to find out what was done to fix the problem once it had risen to the level of a local scandal.

My regular readers know that I can't leave something like _that_ alone.

http://articles.baltimoresun.com/2011-05-26/health/bs-ho-emergency-health-20110523_1_emergency-room-triage-nurse-urgent-care-clinics

These would appear to be the relevant paragraphs:

[quote begins here] Stuart Kohn, a North Laurel resident and HCCA member who has led a personal crusade to reduce emergency room crowding at Howard County General Hospital in Columbia, told the group of about 40 people at the meeting that the situation has improved dramatically over the past 18 months.

"Yellow" alerts, which advise county firefighters to take patients to less-crowded facilities, have declined steeply, he said.

Kohn told the group, which included hospital President Victor Broccolino and hospital emergency room supervisor Dr. Walter Atha, that in 2008, the hospital emergency room was on yellow for 63 days.

That increased to 101 days in 2009, but dropped to 16 days in 2010; and so far this year, "there was less than half a day" on yellow," he reported from statistics kept by the state of Maryland. The hospital treated 75,600 patients in the emergency room last year, and Atha said each one has initial contact with a triage nurse within 15 minutes, though treatment can take hours. [quote ends here]

Basically, they had a problem in 2008 (1+ day a week they were telling ambulance drivers not to drop people at Howard County General) that got worse in 2009 (2+ days a week), improved it in 2010 (1ish day a month) and have since basically fixed it. How? There's really only one way in the short run: add beds. Over the medium- to long-term, you need some procedural changes, too.

"Broccolino said later the hospital's addition of 43 new beds plus new procedures for moving patients helped to speed people waiting for hospital admission out of the emergency room, leaving more room for new arrivals."

They also are trying to reduce primary care in the ER: make sure people know where the urgent care options are and what their hours are, make sure they understand the price difference between the two, and make sure anyone without resources doesn't land in the ER as a result by giving them money to go to urgent care.

Very simple, straightforward, public policy.

Because the urgent care options in the area are private, not public, clinics, and because they are lightly regulated by comparison to the ER, there is some concern about quality of care. The clinics are certainly trying to conveniently serve their population: "The newest private clinic is one called Kinder Mender, a walk-in clinic for children, preparing to open in July next to the new Toys "R" Us store on Dobbin Road in East Columbia."