CHICAGO (AP) — As University of Chicago Medical Center struggles to unclog its emergency department, one statistic keeps pushing back. Because of overcrowding — a growing, nationwide problem — the hospital turns away ambulances more often than any other ER in Illinois.
The city's premier South Side hospital turns away
ambulances for 13 minutes, on average, each hour. No other hospital comes
close, according to Illinois Department of Public Health numbers obtained by
The Associated Press.
In addition, some ER patients wait more than 24
hours for a hospital bed to open upstairs in the hospital.
Earlier this year, the hospital agreed to pay a
maximum $50,000 fine to settle allegations it had violated federal law when
78-year-old Maurice Ross died in the ER waiting room, after nearly four hours
without care. Hospital officials insist the incident was a staff member's
mistake and not part of a systemic problem.
A UCMC task force is quietly addressing ER crowding
with some success, two years after the facility weathered a public relations
nightmare involving an initiative to find community doctors for patients who
use the ER for basic care. But other hospitals' closures and a shortage of
primary care in the impoverished area mean nearly 70,000 patients a year still
arrive at the ER seeking help.
The nonprofit academic medical center has struggled
with emergency room crowding for years. Many at the hospital see the
stubborn situation as a symptom of a health care system that leaves many poor
people without care and appoints emergency rooms as the one place that
can't turn anyone away — a problem that may only get worse at other hospitals
in years to come.
"It's really a manifestation of what's going
on with health care in our country more broadly," said Dr. David Howes,
the hospital's emergency medicine section chief, in an interview. "We are
not alone and we are doing our very best to address this."
Crowding is a widespread national issue. Patients
across the country are experiencing the longest wait times in ERs since reports
were first made available in 2002, according to Press Ganey Associates Inc., a
health care consulting company. Many experts predict the problem will get worse
after the new national health overhaul expands insurance to 32 million more
Americans.
In any hospital, patients compete for inpatient
beds, whether they know it or not. More lucrative patients — those with
scheduled surgeries, for example — often are moved first. To survive
financially, hospital executives must be certain the mix of patients includes
people with private insurance, which pays better.
Some patients actually cost hospitals money — those
without insurance and those covered by Medicaid, the state-federal health
program for the poor and disabled. University of Chicago's ER patients
generally fall into those money-losing categories, Howes said.
Having private insurance didn't eliminate the wait
for patient Paula Ellis, a suburban resident who's more affluent than many in
the ER. The 55-year-old computer programmer waited more than 24 hours for a room
to open up for her one day last month at UCMC. She came to the hospital's ER
because she lost vision in her right eye.
"This was unexpected," Ellis said sitting
cross-legged in an ER bed. "I was told I'd be admitted, but then they
never found the bed. So that became frustrating because you can't sleep in here
because it's loud and it's light and you're not feeling good."
That day, Ellis was one of five patients who waited
more than 24 hours. They took up space in the ER, and the domino effect kept
about 20 others waiting in the lobby. Seven percent of ER patients wait more
than a day after being admitted, hospital figures show.
UCMC's high rate caught the attention of state
officials, who visited the hospital in November 2009 and found legitimate
reasons for turning away ambulances. "They literally just had more
patients than they had ER beds," said Jack Fleeharty, chief of emergency
medical systems for the Illinois Department of Public Health.
The hospital's improvements show in two statistics
that gauge ER crowding:
—The rate of patients who left the ER without being
seen has improved. That rate dropped from 21 percent in November 2008-March
2009 to 10.6 percent in October 2010, according to figures released to AP by
the hospital.
—The time a patient sits in the waiting room before
getting care fell from an average of 79 minutes in November 2008-March 2009 to
55 minutes in July-September 2010.
Howes said the hospital's task force prevented a
planned reduction of beds in the general medicine department — beds that typically
are filled by patients admitted from the ER. And a 12-bed specialized unit
opened a year ago to take ER patients with cancer, Howes said.
In addition, University of Chicago doctors now
staff 40 beds at Mercy Hospital, about five miles away, another relief valve
where ER patients can be admitted if they agree to transfer. And the University
of Chicago ER nursing staff increased in early 2010 by nearly 25 percent, Howes
said.
Since 1986, six South Side hospitals have closed,
leaving patients with fewer choices.
With 530 beds, University of Chicago Medical Center
"cannot by itself solve the problems of an area that has lost nearly 2,000
hospital beds," said Dr. Bruce Minsky, the hospital's chief quality
officer. He said a lasting solution will require "community-wide
effort."
The family of the elderly man who died while
waiting for emergency care at UCMC spoke out for the first time to The
Associated Press in hopes of drawing attention to crowded conditions.
Maurice Ross died at age 78 last year after waiting
nearly four hours for care in the emergency waiting room, according to federal
documents and family members.
"I kept going to the registered nurse. She
told me to sit back down for 15 minutes and she'd talk to me," recalled
Ross' daughter, Vanessa Ross, who accompanied her father to the hospital on
Feb. 3, 2009.
The death was made public without the patient's
name and without much detail in March 2009 when the hospital issued a
statement. An internal investigation found staff members didn't follow protocol,
the statement said, and would be disciplined. The hospital submitted a plan for
improvement to government regulators. The plan stressed better monitoring of
patients in the waiting room and a committee to oversee emergency care quality.
Ross died of dehydration while sitting for hours in
a wheelchair under the TV in the waiting room.
"If they would've given him a feeding tube,
he'd still be alive," Vanessa Ross told AP.
Copyright
2010 The Associated Press.
(AP
Photo/M. Spencer Green)
