Posted on 11/03/15
| News Source: WBAL TV
Could it be that emergency room wait times are getting longer?
Emergencies aren't scheduled and time is critical. John Hickey, an EMS provider in Baltimore County, explains what happens when the closest hospital may have an extended wait in the emergency room.
"There's nothing you can do about it, you're stuck," he said. "You are stuck at the hospital until they triage the patient, put them where they want to put them."
When that backup happens, a hospital might go on Yellow Alert, which is when the emergency room requests it receive absolutely no one in need of urgent medical care, because it is experiencing patient overload. And if you're sitting in a waiting room, it could be a long time before you see a doctor.
The 11 News I-Team analyzed six months of data provided by the Maryland Institute for Emergency Medical Services Systems to determine how often local hospitals go on Yellow Alert. Most hospitals in the greater Baltimore area experience it. The top three are Johns Hopkins Bayview Medical Center, Sinai Hospital and MedStar Franklin Square Medical Center.
Bayview went on Yellow Alert 167 times, the average alert lasting 9.8 hours. Sinai went on Yellow Alert 126 times, the average alert lasting 5.4 hours. Franklin Square went on Yellow Alert 120 times, the average alert lasting 11.7 hours.
Rick Sloane, of Odenton, suffered from a bulging disc and a pinched nerve last spring.
"I woke up in the middle of the night, and I was in excruciating back pain, and I had pain shooting down my leg, and my foot started getting numb," Sloane said.
He drove to Baltimore Washington Medical Center for treatment, where, he said, he stood watching and waiting more than four hours, in too much pain to sit.
"People would come in like they have been through this before, you know? Check in, give their names, so forth, grab a blanket. They had a stack of blankets and they would go lay down and go to sleep like it was part of the routine," Sloane said.
On the night of Sloane's visit, the hospital went on Yellow Alert at 9:21 p.m. and remained on alert until 5:49 a.m. By that time, he knew his doctor's office opened soon, so he left.
"I went there for urgent care. This really wasn't urgent care," Sloane said.
Baltimore Washington Medical Center said its average wait time to be triaged is 11 minutes, well below a national benchmark of 20 minutes. Patients are prioritized based on acuity and informed if there is an extended wait.
"The alert status you referenced is really an overall marker of system stress with the hospital and EMS, basically," said Dr. Kevin Seaman, director of MIEMSS. "I see this as an important problem, one that will continue to require our attention."
Seaman sent a letter last January to the Maryland Hospital Association concerned about the frequency and length of alerts. He asked hospitals to reevaluate their procedures.
"Can we look at every decision point in every part of the process and make that the most efficient possible?" Seaman said.
The Maryland Hospital Association cites two reasons for ER gridlock: the Affordable Care Act, which provided people with health coverage for the first time in 2013, and the state's growing demand for mental health and substance-abuse services.
Bayview blames a shortage of beds because of months of construction and renovations to its ER.
Sinai is addressing the problem by helping frequent ER visitors, those with nonurgent or chronic health problems, manage their own care. Sinai is also opening an urgent care center to treat non-life-threatening health issues.
Franklin Square, which displays its ER wait times on a chalkboard, said it has added providers during peak hours and is developing new procedures to manage and treat patients sooner.
But experts warn unless hospitals get a handle on the gridlock, alerts and long waits in the ER will go from a problem to a crisis.
St. Joseph Medical Center in Towson had the fourth-highest number of Yellow Alerts during the six-month time period the I-Team examined. There were 93 alerts lasting an average of 9.7 hours. The hospital said it continues to explore solutions aimed at minimizing diversions, including a partnership with ChoiceOne Urgent Care, which will provide high quality care in a non-ED setting.
Statement from Johns Hopkins BayviewMedical Center
"Johns Hopkins Bayview Medical Center began construction on a new Emergency Department in 2012. During this time, we have been operating in fewer treatment spaces. While we opened our new building in March 2015, further renovations and construction projects continue. We look forward to completing the project and being able to better utilize all of our new space in 2016. At that time, we will have increased our capacity by 14 beds."
Statement from Sinai Hospital
"Yellow alerts result from a high number of patients. Sinai Hospital is working on several initiatives to address this, including our Access Health program and the construction of an ExpressCare Urgent Care Centers facility next to the emergency department."
Statement from MedStar Franklin SquareHospital
"MedStar Franklin Square Medical Center takes our Emergency Department wait times very seriously. Our Emergency Department, the largest in the State of Maryland, treats over 100,000 patients each year. Reducing wait times is a constant priority and area of focus for our leaders. As such, we have added providers during peak hours and we are developing new procedures to manage patients more efficiently so that they are treated sooner. MedStar is also expanding our network of primary care providers and we recently opened a MedStar PromptCare which is intended to offer urgent care thereby reducing demand on our Emergency Department. Most recently, we have seen reductions in our median wait time from door to provider, and hope to continue this trend into the winter months when ED visits spike."
Statement from University of Maryland St. Joseph Medical Center
"Providing prompt and clinically appropriate high-quality care for patients in the emergency department is a priority for University of Maryland St. Joseph Medical Center. Temporary ambulance diversions (“Yellow Alerts”) are not uncommon across the Baltimore region and throughout the State. SJMC is one of several hospitals providing dedicated behavioral health services in its emergency department, which often operates at or above capacity due to a growing shortage of psychiatric beds statewide. Like many other emergency departments, we also take care of many patients with chronic illnesses who lack a primary care physician. We continue to explore solutions aimed at minimizing diversions. For example, SJMC recently launched a partnership with ChoiceOne Urgent Care, which provides high quality care in a non-ED setting; we have reworked our process to help improve patient flow, and we have added a coordinator to help make appointments for frequent ED patients who don’t have a primary care practitioner, thereby reducing future ED visits."