Local hospitals diverting patients

January 13, 2001

Local hospitals diverting patients

By MARLO BARNHART / Staff Writer

Recurring shortages of available beds are forcing area hospitals to divert some patients elsewhere during so-called red and yellow alerts.

Hospital officials say no patients in need of immediate care are being turned away. However, some patients are being sent to other nearby hospitals when their primary hospital is filled.

Health care professionals said the problem is affecting hospitals nationwide. They attribute it to a dramatic increase in emergency room visits, staff and bed cutbacks prompted by concerns over rising health care costs, and difficulty in attracting new hospital employees and nurses with competitive wages.

In Maryland, a statewide task force has been formed to study the situation, said Lisa Myers, director of program development at the Maryland Institute for Emergency Medical Services System and a task force member.


Myers, a registered nurse, said the shortages are not affecting the level of care.

Washington County Hospital is among the hospitals that have established red and yellow alerts.

A red alert signals there is a shortage of staffed and monitored hospital beds. A yellow alert means there is a shortage of emergency room beds.

Dr. Tom Gilbert, chairman of emergency medicine at Washington County Hospital, said the hospital began calling red alerts last April.

Hospital on alert

During a red alert, hospital officials may transfer patients who no longer need monitoring to other beds as they become available. Recovering patients no longer in need of close care may be sent home early.

The yellow alert is a more serious condition in which the emergency room is unable to accept new patients, Gilbert said.

A system has been devised in which patients requiring emergency care during a yellow alert are routed to other area hospitals.

If an ambulance has to transport a patient more than 15 minutes away, Washington County Hospital will accept the patient until he or she is stabilized, Gilbert said. The patients could then either be placed in the soonest available bed at Washington County Hospital or transferred to another hospital with available beds.

Patients with chest pains, shortness of breath or pneumonia, trauma patients and those described as unstable will be seen by medical personnel no matter how full the hospital is, Gilbert said.

The 15-minute boundaries are at the top of South Mountain to the southeast, Leitersburg Cinemas to the north and Ott's Horticulture in Chewsville to the east.

"Hancock ambulances could go to War Memorial in Berkeley Springs or City Hospital in Martinsburg," Gilbert said. "Smithsburg could go to Waynesboro Hospital, Boonsboro to Frederick Memorial and still meet the criteria."

Washington County Hospital has gone on red alert approximately a dozen times and, since April, only six ambulances have been diverted to other hospitals, Gilbert said.

The most recent red alert was enacted at 2:30 p.m. Monday, Jan. 8, and canceled at 4:15 a.m. on Tuesday, Jan. 9, according to hospital spokeswoman Maureen Theriault.

Emerging problem

Gilbert said running out of monitored beds was unheard of before April 2000.

"But we would have situations where we were holding 11 patients in the emergency room," Gilbert said. "We decided it would be better to divert and thus provide the patient with better care."

At the Waynesboro (Pa.) Hospital, there were a few "emergency diverts" in 1999, said Dr. Bruce Foster, chief of emergency medicine. They were all during the flu season.

In 2000, the hospital had several diverts before flu season officially began.

"Our emergency room census has risen 7 percent in the past six months," Foster said.

That, along with a decrease in Medicare reimbursements, has made the problem worse.

"Hospitals can no longer afford the luxury of excess beds and staff to meet times of peak demand," Foster said.

Chambersburg (Pa.) Hospital has also had a number of emergency divert situations in recent months. Efforts to get details on those incidents from Dr. Tom Anderson, emergency medical director, were unsuccessful.

City Hospital in Martinsburg, W.Va., has not been severely affected.

"It's not a problem regularly, but we are developing a policy," said Edie McGoff, manager of City Hospital's emergency department.

Emergency demand

A significant factor in the bed shortage is the growing number of people using the hospital emergency room, said Gilbert, of Washington County Hospital.

The Washington County Hospital emergency room saw approximately 65,000 patients in 2000, up from 49,000 in 1999, Gilbert said.

Health officials say many people who don't have a family physician come to the emergency room for routine medical services.

Bonnie Forst, clinical director of the Washington County Hospital emergency room, said people should call their family doctors to request an appointment if they are sick instead of going to the emergency room.

Myers, the task force member, said the seeds of the bed shortages were planted a dozen or more years ago when hospitals began trimming staffs and closing unoccupied wings to cut back on the rising cost of health care. The cuts backfire when the demand for hospital beds increases, especially during cold and flu season, Myers said.

Mary Towe, executive for nursing services at Washington County Hospital, said another factor is there are more patients with chronic disease. With better medications and medical procedures, those patients are living longer but need more care, she said.

There is also a shortage of personnel to provide care.

Towe said attracting qualified staff isn't easy when the economy is strong and people can pick and choose where to work.

"We are competing to find our work force," Towe said.

Gilbert said there are plans to expand the emergency department this year, but there must be staff to support an expansion.

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