Visits to ERs rise 31 percent since 1990, report shows

Crowding also increases ambulance diversion time

April 19, 2002|By Gus G. Sentementes | Gus G. Sentementes,SUN STAFF

Hospital emergency department visits rose 31 percent from 1990 to last year in Maryland, and problems with patient crowding have led to "substantial increases" in the number of hours that hospitals are on ambulance diversion, according to a report presented yesterday to the Maryland Health Care Commission.

The report found that much of the escalation in emergency department visits in the state occurred over the past six years, reflecting a broader trend at hospitals across the country.

Emergency room visits totaled 1.94 million last year compared with 1.48 million in 1990.

A key finding of the report included a fourfold increase, from 1996 to last year, in the hours that metropolitan Baltimore area hospitals were on "yellow alert," or when a hospital diverts ambulance patients not in need of critical care to another center.

Hours on "red alert" status - declared when hospitals no longer have staffed beds for critical care and cardiac patients - more than doubled during the period. Under either type of alert, ambulance patients can be diverted to neighboring hospitals depending on the care they need.

"It's become an issue because a lot of times hospitals use the yellow alert to try to get some time to catch up on patients they have on backlog, and that may well affect the walk-in patients," said Dr. Robert E. Roby, chief of emergency services at Maryland General Hospital in Baltimore.

Several hospitals in the state have renovated and expanded their emergency departments. From 1997 to last year, eight hospitals spent a combined $44.4 million. From this year to 2004, at least 17 hospitals are expected to spend a combined $81.9 million on emergency department renovations and expansions, according to the report.

Pamela W. Barclay, deputy director of health resources for the commission,, said in her presentation of the report that Maryland emergency rooms are crowded because of increased demand, changes in patient management and hospital capacity.

Less restrictive managed care policies also are enabling consumers to turn from their busy primary care physicians to emergency rooms for treatment, Barclay said. A lack of critical care beds, seasonal variations and a shortage of nurses and on-call specialists also contribute to crowding and longer patient stays, the report found.

Emergency departments can be gateways to more business for hospitals. In 2000, 55.2 percent of all admissions for inpatient care came through the emergency department, the report says. But the debate now is whether to continue expansion of emergency department services.

"Is there a better alternative for care?" asked Barbara McLean, the commission's executive director, after the meeting. " ... We have not yet made a determination whether this kind of growth should be promoted or whether we should be looking at other resources."

The report is part of a continuing review of patient crowding in hospital emergency departments and will eventually influence the commission's planning and decisions with hospitals across the state.

The study found that emergency department services accounted for 52 percent of total patients served by Maryland acute care hospitals in 2000. But delays in transferring patients in emergency rooms to inpatient units was a significant factor in congestion, the report found.

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