Ambulances diverted out of county Howard General ER frequently cannot accept emergencies

'Patients ... not being hurt'

Alerts last an average of 2.1 hours

October 15, 1995|By Ed Heard | Ed Heard,SUN STAFF

You have sudden pain and call 911 for an ambulance. But instead of a five-minute trip to Howard County General, the driver takes you to a hospital 20 minutes away in another county.

For an average of 27 times a month from April through August, Howard County General was on Code Yellow -- too full for emergencies in which patients weren't in immediate danger of dying.

During the alerts, each of which lasted an average of 2.1 hours, ambulances were sent to Laurel Regional Hospital or St. Agnes Hospital in West Baltimore.

The Code Yellow policy, which most hospitals in the state follow, frustrates patients and doctors. It applies only to ambulances transporting patients, not to walk-in visits.

But during the hospitals' busiest times -- when filled stretchers line their halls and patients wait hours to see doctors -- officials say that sometimes the longer ambulance trip can result in faster care.

"Patients are not being hurt by the hospitals being on by-pass," ++ said John Donohue, Emergency Medical Services (MIEMMS) administrator for Baltimore City and Baltimore, Harford, Howard, Carroll and Anne Arundel counties. "It might be a little more inconvenient, but they get better attention."

Dr. David Paul, director of the emergency department at the county's only inpatient facility, said the system "is designed to produce the greatest good for the greatest number of people."

But Carl Behrens, whose elderly father relies on Howard County General for emergency care, questioned the rationale for hospitals sending patients elsewhere.

"When you reroute you're not doing your job anymore," Mr. Behrens said. "Hospital emergency departments are there to serve emergency health care needs of the community."

Mr. Behrens recently drove from his Burtonsville home to Columbia and then Laurel when told that his father had been taken by ambulance from Columbia to the Laurel hospital, which seldom turns away ambulances because its emergency room is full.

But 89-year-old Carlton Behrens had refused to be diverted to the Laurel hospital and then was returned home. He was OK, but his son was alarmed.

"I thought, did something happen?" said the younger Mr. Behrens. "With a longer transport when you're elderly, a lot of things could go on. I had never heard of this yellow alert business before."

But yellow alerts are common.

In August, when the hospitals statewide averaged 10 alerts, Howard County General went on yellow alert 32 times at an average of 2 hours and 15 minutes per alert.

For that month, that meant there were 69 hours -- nearly three whole days -- when ambulances transporting patients to Howard General could have been turned away.

The August totals were above average for the Howard hospital but within the limits set by the Maryland Institute of MIEMMS, which monitors the yellow alert system at 23 hospitals in the Baltimore metropolitan area.

Hospital administrators decide when their emergency rooms are too crowded to accept more patients by ambulance.

If two adjacent hospitals are on yellow alert, ambulance patients are rerouted to the next nearest hospital. In any case, the policy does not permit an ambulance driver to pass more than one hospital.

Under a new rule in April, hospitals can go on yellow alert no more than six hours a day and no more than two hours at a time. When they hit these limits, they have to get an exception from state monitors to continue with the yellow alert status.

Before the new limits, it wasn't unusual for hospital emergency rooms -- including Howard's -- to be closed to ambulance traffic the equivalent of one week a month because of yellow alerts.

In January, for example, yellow alerts at Howard County General hospital averaged 7.5 hours each time. Alerts at busier hospitals in Baltimore, Sinai Hospital and Northwest Medical Center, averaged 12 hours each time, MIEMMS records show.

State officials are studying the effects of the new alert system. An Emergency Medical Services task force will make recommendations to improve the yellow alert policy by early next year, said Mr. Donohue.

And for better or worse, Howard hospital officials said the yellow alert system is a necessity.

"We want to keep everybody here, but we can't put people at risk" while they wait in a crowded emergency room, said Susan Goodwin, Howard County General's senior vice president. "It's upsetting because we feel we can provide the best care."

Howard County General President Victor Broccolino said his staff is working to make the emergency room more efficient.

The hospital's "fast track" program provides four extra beds to get patients in less serious condition out of the emergency room quicker. More employees also are being placed on call to help when the emergency room begins to get crowded.

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