Busy season for hospitals has arrived

Emergency rooms across metro area call `yellow alerts'

Patients exceed resources

Weather, economics share responsibility for national trend

January 11, 2001|By Jonathan Bor | Jonathan Bor,SUN STAFF

With the flu season just getting under way, hospital emergency rooms throughout metropolitan Baltimore have been declaring "yellow alerts" this week -- meaning they are too busy to take additional patients.

Though the number fluctuates from hour to hour, seven of the region's 21 hospitals were asking ambulances to take patients elsewhere by late afternoon yesterday.

A day earlier, 17 said they were treating all the patients they could handle.

"It's very busy," said Dr. Brian Browne, director of emergency medicine at the University of Maryland Medical Center. "In fact, it's busier than ever."

Echoing others in the field, Browne said the crush of patients is not the product of a sudden upsurge in influenza or any other disease.

Rather, Browne said, this is the continuation of a trend -- part economic, part seasonal illness -- being felt by emergency rooms across the country.

Patients are relying more on emergency rooms for their primary care, a condition made worse when winter brings the usual increase in respiratory infections, asthma attacks and broken bones from slips and falls.

Also, emergency departments are having trouble moving patients to hospital floors -- creating bottlenecks in waiting rooms.

In some cases, this is because cost-conscious hospitals have reduced the number of beds in inpatient units; many are also having trouble hiring enough nurses.

"The emergency rooms are and emergency medical systems are becoming increasingly crowded," said Dr. Robert Bass, executive director of the Maryland Institute for Emergency Medical Services Systems. "This is happening all over the country."

The flu season has been relatively mild and late in getting started. The state has recorded 17 cases of laboratory-confirmed influenza, compared with 94 at the corresponding time last year, according to Dr. David Blythe, an epidemiologist with the state Department of Health and Mental Hygiene.

Although just a snapshot, a look around the University of Maryland Medical Center's emergency department shows what hospitals are facing.

In the "acute" portion of the emergency room, where patients with a range of illnesses are taken, doctors were treating three patients with chest pain, one with lightheadedness, a few with shortness of breath and several who were running fevers.

Hooked to monitors and intravenous tubes, these were among the patients filling curtained-off beds on either side of a main corridor.

Meanwhile, a patient in the midst of an asthma attack was sitting in an "asthma chair" -- such patients are uncomfortable lying down -- while three having psychiatric episodes were seated in another area not in plain view.

"We're busy, but not unusually stressed," said Dr. David Rorison, an emergency room physician. "It's not a crisis."

Last year, the hospital treated 40,000 patients -- a 10 percent increase over the previous year, Browne said.

He said patients were waiting about two hours to see a doctor yesterday. It could take another two hours to get treated and discharged.

Though the West Baltimore hospital was on "yellow alert" yesterday, this is not an unusual occurrence. It declares itself too busy to accept new patients at various points throughout the year, but more often in the winter.

When a hospital declares a "yellow alert," the state's emergency medical system asks ambulances to take all but the sickest patients to the next closest hospital not on alert.

Under state law, all hospitals must accept patients who walk in on their own. Also, ambulances are expected to take critically ill patients -- such as those in the midst of a heart attack -- to the closest emergency room, regardless of patient load.

In Towson, the Greater Baltimore Medical Center placed extra nurses on duty to cope with its busy emergency room.

Dr. John Wogan, chief of emergency medicine, said the hospital has seen a wide range of illnesses, including flu, asthma, pneumonia and flare-ups of emphysema.

"Because it's slipperier out there, you also see more orthopedic cases," he said.

Overcrowding has afflicted not only the largest hospitals, such as Johns Hopkins in East Baltimore, but also small ones in Cumberland in Western Maryland and Berlin on the Eastern Shore, according to Bass.

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