MSHA officials give reasons for emergency department overload

By Julie Fann
star staff
jfann@starhq.com

   MSHA officials held a press conference on Friday to quell growing local concern over emergency department overload in area hospitals. Hospital officials presented local data related to a recent national study on the topic conducted by the American Hospital Association.
   MSHA President Dennis Vonderfecht said that he believes the public needs to better understand the process that occurs when patients come into the emergency room. "There is a lot of misunderstanding concerning emergency departments and the process of how patients are seen," he said. Vonderfecht and other hospital officials who attended a Thursday night meeting of the grassroots organization Concerned Citizens for Healthcare said citizens fail to understand the complicated process surrounding patient care in emergency rooms.
   Brent Lemons, Emergency Services Director for MSHA hospitals, explained the step-by-step process that occurs when a patient enters the emergency room. First, patients go to a triage station where an RN decides the severity of the patient's problems by taking vitals and asking questions. If the patient is stable, they go through the registration process and are then taken to a room where a doctor assesses the patient's condition.
   "What people don't understand is that, while they may be a walk-in, many patients are ambulance patients who are in more serious condition, and we must attend to their needs first, which is why they may be experiencing a wait time," Lemons said.
   According to the AHA study, 62 percent of the hospitals surveyed report their emergency departments are "at" or "over" operating capacity. One third of all hospitals experienced "ED diversion," times when their EDs could no longer accept patients arriving by ambulance. The report states the three main reasons for the problem are a lack of available staff, critical care beds, a high RN vacancy rate, and a significant increase in the number of patients coming to emergency departments. The problem exists across the nation but is more prominent in the northeast and on the west coast.
   MSHA officials outlined where their hospitals stand in relation to the national data. From January to March 2002, the JCMC emergency department treated 11,660 patients. Only 17 of those patients were diverted. The average length of stay in an ED treatment area, for November 2001, was 3.7 hours at JCMC and 2.3 hours at Sycamore Shoals Hospital.
   The average time waiting for transfer from the ED to an acute critical care bed was 3.8 hours for JCMC; whereas the AHA survey reports a "good balance" time as 2.2 hours. According to hospital officials, 44.2 percent of patients seen at the JCMC emergency department in 2002 are either TennCare recipients or uninsured. Officials said that many times, patients come to the ER because there is a two-month wait to see their primary doctor and they have no choice but to go to the emergency room.
   Dennis Vonderfecht said that much of the problem rests also in the public having "unrealistic expectations." He said that Americans have a "fastfood mentality" and that they expect "immediate health care." "Which is fine if there is an unlimited number of resources, but that's not the case....Reimbursement rates are going down while costs are going up," he said.
   To correct the problem, MSHA officials said they are doing all they can by reallocating beds between JCMC and Northside Hospital, adding more critical care beds, and increasing patient awareness of alternatives. Officials said they plan to expand the emergency department at Indian Path Hospital and also mentioned the recent expansion of the emergency department at Sycamore Shoals.
   "There is also a growing population of people needing immediate care," Vonderfecht stated, referring to the aging baby boom generation, "and that adds to the problem," he said.