As University of Chicago Medical Center struggles to unclog its emergency department, one statistic keeps pushing back. Because of overcrowding — a growing, nationwide problem — the hospital turns away ambulances more often than any other ER i
CHICAGO (AP) — As University of Chicago Medical Center struggles to unclog its emergency department, one statistic keeps pushing back. Because of overcrowding — a growing, nationwide problem — the hospital turns away ambulances more often than any other ER in Illinois.
The city’s premier South Side hospital turns away ambulances for 13 minutes, on average, each hour. No other hospital comes close, according to Illinois Department of Public Health numbers obtained by The Associated Press.
In addition, some ER patients wait more than 24 hours for a hospital bed to open upstairs in the hospital.
Earlier this year, the hospital agreed to pay a maximum $50,000 fine to settle allegations it had violated federal law when 78-year-old Maurice Ross died in the ER waiting room, after nearly four hours without care. Hospital officials insist the incident was a staff member’s mistake and not part of a systemic problem.
A UCMC task force is quietly addressing ER crowding with some success, two years after the facility weathered a public relations nightmare involving an initiative to find community doctors for patients who use the ER for basic care. But other hospitals’ closures and a shortage of primary care in the impoverished area mean nearly 70,000 patients a year still arrive at the ER seeking help.
The nonprofit academic medical center has struggled with emergency room crowding for years. Many at the hospital see the stubborn situation as a symptom of a health care system that leaves many poor people without care and appoints emergency rooms as the one place that can’t turn anyone away — a problem that may only get worse at other hospitals in years to come.
"It’s really a manifestation of what’s going on with health care in our country more broadly," said Dr. David Howes, the hospital’s emergency medicine section chief, in an interview. "We are not alone and we are doing our very best to address this."
Crowding is a widespread national issue. Patients across the country are experiencing the longest wait times in ERs since reports were first made available in 2002, according to Press Ganey Associates Inc., a health care consulting company. Many experts predict the problem will get worse after the new national health overhaul expands insurance to 32 million more Americans.
In any hospital, patients compete for inpatient beds, whether they know it or not. More lucrative patients — those with scheduled surgeries, for example — often are moved first. To survive financially, hospital executives must be certain the mix of patients includes people with private insurance, which pays better.
Some patients actually cost hospitals money — those without insurance and those covered by Medicaid, the state-federal health program for the poor and disabled. University of Chicago’s ER patients generally fall into those money-losing categories, Howes said.
Having private insurance didn’t eliminate the wait for patient Paula Ellis, a suburban resident who’s more affluent than many in the ER. The 55-year-old computer programmer waited more than 24 hours for a room to open up for her one day last month at UCMC. She came to the hospital’s ER because she lost vision in her right eye.
"This was unexpected," Ellis said sitting cross-legged in an ER bed. "I was told I’d be admitted, but then they never found the bed. So that became frustrating because you can’t sleep in here because it’s loud and it’s light and you’re not feeling good."
That day, Ellis was one of five patients who waited more than 24 hours. They took up space in the ER, and the domino effect kept about 20 others waiting in the lobby. Seven percent of ER patients wait more than a day after being admitted, hospital figures show.
When ERs fill up with patients, hospitals are allowed to send ambulances to other hospitals, a status called bypass. Illinois Department of Public Health numbers show UCMC spent 1,764 hours on bypass from Jan. 1 to Nov. 30 of this year, 22 percent of the time. Advocate Christ Medical Center in Oak Lawn was next at 706 hours, about 9 percent of the time. Across the state, hospitals in Galesburg, Rockford and Decatur spent less than 1 percent of the time on bypass, the state numbers show.
UCMC’s high rate caught the attention of state officials, who visited the hospital in November 2009 and found legitimate reasons for turning away ambulances. "They literally just had more patients than they had ER beds," said Jack Fleeharty, chief of emergency medical systems for the Illinois Department of Public Health.
The hospital’s improvements show in two statistics that gauge ER crowding:
—The rate of patients who left the ER without being seen has improved. That rate dropped from 21 percent in November 2008-March 2009 to 10.6 percent in October 2010, according to figures released to AP by the hospital.
—The time a patient sits in the waiting room before getting care fell from an average of 79 minutes in November 2008-March 2009 to 55 minutes in July-September 2010.
Howes said the hospital’s task force prevented a planned reduction of beds in the general medicine department — beds that typically are filled by patients admitted from the ER. And a 12-bed specialized unit opened a year ago to take ER patients with cancer, Howes said.
In addition, University of Chicago doctors now staff 40 beds at Mercy Hospital, about five miles away, another relief valve where ER patients can be admitted if they agree to transfer. And the University of Chicago ER nursing staff increased in early 2010 by nearly 25 percent, Howes said.
Since 1986, six South Side hospitals have closed, leaving patients with fewer choices.
With 530 beds, University of Chicago Medical Center "cannot by itself solve the problems of an area that has lost nearly 2,000 hospital beds," said Dr. Bruce Minsky, the hospital’s chief quality officer. He said a lasting solution will require "community-wide effort."
The family of the elderly man who died while waiting for emergency care at UCMC spoke out for the first time to The Associated Press in hopes of drawing attention to crowded conditions.
Maurice Ross died at age 78 last year after waiting nearly four hours for care in the emergency waiting room, according to federal documents and family members.
"I kept going to the registered nurse. She told me to sit back down for 15 minutes and she’d talk to me," recalled Ross’ daughter, Vanessa Ross, who accompanied her father to the hospital on Feb. 3, 2009.
The death was made public without the patient’s name and without much detail in March 2009 when the hospital issued a statement. An internal investigation found staff members didn’t follow protocol, the statement said, and would be disciplined. The hospital submitted a plan for improvement to government regulators
. The plan stressed better monitoring of patients in the waiting room and a committee to oversee emergency care quality.
Ross died of dehydration while sitting for hours in a wheelchair under the TV in the waiting room.
"If they would’ve given him a feeding tube, he’d still be alive," Vanessa Ross told AP.
Copyright 2010 The Associated Press.
(AP Photo/M. Spencer Green)
About Post Author
