Sycamore Shoals experiences national swelling in emergency waiting rooms

By Julie Fann & Megan R. Harrell
Star Staff
jfann@starhq.com; mharrell@starhq.com

   Sycamore Shoals Hospital recently expanded its Emergency Department in order to better serve the community of Elizabethton and Carter County. Although major changes have been made at the MSHA facility, administrators and concerned citizens both agree that the overcrowding of the emergency room has become a significant problem. However, they have differing views on the source of the issue.
   Johnny Mills, owner of Mills Greenhouse in Elizabethton, was appalled by the lack of treatment his son, Hannon Howard, 29, received at Sycamore Shoals Hospital for appendicitis in October 2001. Mills told Star staff that his son went to the Sycamore Shoals Emergency Department around 11 a.m. for severe pain in his right side. According to Mills, Howard went home four hours later because he could not be seen by a doctor.
   Hannon returned to the ED at 11 p.m. that night with excruciating pain. This time, Hannon stayed in the ER until he finally received an emergency appendectomy at 7 a.m. the following morning. "It was off and on, almost 20 hours from the time he first went in until they finally had a doctor say 'You need surgery,'" Mills said.
   Mills said the problems he experienced with his son led him to voice his complaints to hospital administrators. Mills met with CEO Scott Williams approximately two weeks following his son's surgery. "He was very receptive. We sat down. I told him the story, and I said, 'If the tables were reversed, would you be satisfied with this level of health care?' He said, 'Absolutely not. It's unacceptable,'" Mills said. Director of Nursing Leah Pritchard also met with Mills and Williams. She told Mills that his son had slipped through the cracks of the system.
   Hospital officials explained to Mills that, with the addition of the new Emergency Department, positive changes would occur, including an increase in hospital staff. Williams invited Mills to attend a dinner for the opening of the new Emergency Department. In November, Mills and his wife toured the new facility while it was under construction, and Williams informed him of changes that were on the way.
   Changes that have occurred at the Emergency Department at Sycamore Shoals Hospital include the addition of seven more beds (one designated for psychiatric use) and the hiring of several new staff members. Although the ED still has only one doctor on staff, during the high volume days of Friday through Monday, there is now also a physician's assistant to help patients. The hospital has also hired two paramedics, two clerks, and one additional nurse for every shift.
   Betty King's son was involved in a four-car accident last month and was advised by the Emergency Management Team to go to Sycamore Shoals ER if he experienced any discomfort. King stated that she and her son waited for approximately three hours then were told that it would be an additional two hours before they would be seen by a doctor. King saw several patients leave the ER in order to go to other hospitals. "I love my town. I grew up here and raised my family here and I do not want to have to pass by Sycamore Shoals to go to the Med Center for treatment," King said. "There is going to be a time when we need Sycamore Shoals because you never know when you are going to have an emergency and we might not survive the transport to the Johnson City Medical Center."
   King stated that she witnessed, what she classified as trauma patients, sitting for hours before they were seen, and believes that the triage process was not being carried out correctly. "Within government regulations there has got to be a way for small hospitals to be efficient," King said. "I should have a patients' advocate to turn to when I am not getting seen and I will not stop until I see it done." King added that a fast track system similar to what the JCMC has would help with some of the back log in the ER.
   Sycamore Shoals administrators recognize the fact that some patients' wait in the ER is longer than at a primary care clinic, but blame the heavy traffic in the ER for the increase in waiting time. The influx of patients seeking care at emergency departments can be attributed to several factors. Scott Williams, administrator and chief executive officer of Sycamore Shoals Hospital, believes waiting periods in the ER would be reduced if all the people seeking care were true trauma patients. He stated that half of the ER patients at Sycamore Shoals can be effectively treated by a primary care provider. "Our biggest hindrance is working to deal with patients that use the ER as a clinic," Williams said.
   The convenient availability of the ER's services has also made it susceptible to abuse. The EMTL ACT states that patients may come to the ER at any time of the day, seven days a week without an appointment, and they must be seen by a doctor. Law prohibits the ER from not treating patients who are unable to pay and the hospital absorbs a great deal of cost when patients come in for care and cannot pay.
   The TennCare system has also added to the volume of patients in the ER. TennCare patients do not have to pay a co-payment on ER visits, and some individuals covered by the state health care system use the ER to get prescriptions for over the counter drugs so they do not have to pay for the cost themselves. "We are striving hard to meet the needs of the people in the community and are taking the steps necessary to do so, but we want to make sure the public understands what the ER is for," MSHA emergency director Dr. Chris Gillespie said.
   Gillespie went on to state that when it comes to quality health care that the wait time issue will never be resolved but that they pay very serious attention to the problem. Both administrators emphasized the need for the public's education on the purpose of emergency departments, and stated that if a patient comes into the ER with a non emergency then they need to be aware that they will not be seen immediately. Administrators also believe that the culture's entitlement philosophy plays a role in the perception of the waiting room problem. "There is a mindset of I want what I want, and I want it right now and that is what has flooded the emergency rooms," Gillespie said.
   Although there is a waiting period in the ER, administrators at Sycamore Shoals are pleased with their 2.5 patients seen per hour average. All things considered, the Sycamore Shoals ER has an average turn around time of 108 minutes, which is one of the lowest in MSHA. "We will never be perfect," Williams said. "There is always going to be times when people are not satisfied but there are times when they are satisfied as well."