MSHA officials brief state legislatures on trauma centers

By Megan Harrell


     Mountain States Health Alliance (MSHA) officials met with area state legislators Monday to discuss the status of MSHA emergency departments and trauma centers. Lawmakers were briefed on a number of areas of concern within emergency medicine, including overcrowding and patient wait times.
     The purpose of the meeting was to inform politicians so they will be better equipped to deal with the public concerning issues arising in emergency medicine. By providing reasons for the cause of problems, and by explaining what is being done to solve them, MSHA executives hope to increase public awareness and understanding.
     MSHA President, Dennis Vonderfecht, encouraged legislators to come to him or his staff if they are approached with concerns. "If any of our legislators get complaints about our organization, all of us within the organization would be glad to look into those complaints and get back with them," Vonderfecht said. "We have many more positive things than negative, but it seems like the negative is what pops up."
     MSHA completed an analysis of the emergency departments within its system after the American Hospital Association (AHA) completed a similar national study earlier this year. The AHA found emergency rooms at their maximum capacity all around the nation. The study showed 62 percent of hospital emergency rooms in the nation are at, or over, their capacity.
     The research completed by MSHA showed its hospitals following the national trend. Nearly 14,000 more patients were seen at MSHA hospitals in 2002 than were seen in 2000.
     "We have had a tremendous amount of growth in just the last two years," Vonderfecht said.
     Executives at MSHA believe TennCare is partially to blame for the steady increase in the number of people seeking care at emergency departments. Vonderfecht stated that the shift has been toward TennCare as the primary payer, and that a lot of doctors have dropped out of the program. Therefore, the emergency room has become, for many individuals their only access to a physician.
     Vonderfecht said that MSHA is looking into establishing a TennCare clinic to cut down on the number of patients seeking primary care at emergency rooms. He stated that the organization might call on ETSU students to help run the clinic.
     The increase in volume of patients seen at MSHA emergency departments has placed pressure on staffs to provide quality care in a timely manner. The pressure is most evident at MSHA's largest emergency department, the Johnson City Medical Center (JCMC).
     JCMC is one of only six level one, urban trauma centers in Tennessee. Its patient volume is nearly two times higher than others within the MSHA system.
     Although JCMC has the busiest emergency department in the system, it falls between the national average for at-capacity and over-capacity hospitals. The average length of stay in the JCMC emergency department is approximately 3.7 hours. The length of stay is measured from the time patients enter the hospital to the time they receive a bed.
     In an attempt to decrease the amount of time patients spend in emergency department treatment areas, JCMC opened a Clinical Decision Unit this April. Patients waiting for results from the lab or radiology, as well as those who are waiting for a bed, are taken to the unit. By moving patients to the Clinical Decision Unit, vacancies are created in the emergency room, officials said.
     JCMC is also currently working on a registration program designed to cut emergency room length of stay in half. Brent Lemonds, Director of Emergency Services for JCMC, stated that the system would allow patients to be registered in their rooms at mobile terminals.
     "They will be getting into a bed quicker and to a doctor quicker," said Lemonds. "We are measuring the door to doctor time, trying to get the doctor to see the patient before we really even get them registered."
     With emergency department patient volumes higher than ever, area legislators seemed satisfied with MSHA's efforts to handle the influx. "We are the ones that get the calls when people are upset, and we have not been getting the calls," Sen. Rusty Crowe (R-Johnson City) said. "There has been a big downturn in the amount of calls and emails."