Live chat with Dr. Steve Kotch, Washington County Hospital's Director of Emergency Services and Mary Towe, director of nursing

January 23, 2007

Dr. Steve Kotch, Washington County Hospital's Director of Emergency Services and Mary Towe, director of nursing, will discuss the recent Red and Yellow alerts at the hospital and what they mean for patient care. Our chat will start at 1:00 pm and end at 2:00 pm today.

Questions or comments can be submitted by clicking here before and during the chat. Or send an email to:


This is the first I've heard of these alerts. Can you briefly explain the differences between the two levels of alerts?

Dr. Kotch: Red alert is a lack of monitored beds in the facility. That would include ICUs, telemetry beds, and the emergency department. Red alert reflects more of ability to care for the critically-ill patient. Yellow alert is a state in which the emergency department is overwhelmed with either volume of patients, or one-time high volume accidents. This would reflect on the ability of emergency room department staff to care for new incoming patients. Trauma bypass would mean that we do not have the capability at that time to care for a critically-ill trauma patient. An example would be lack of operating rooms due to cases or the unavailability of a trauma surgeon.


Monitor: It has been reported that there will be fewer beds at the new Robinwood hospital than the downtown location currently has. Given the growth the area is experiencing, won't that make the problem worse?

Mary: Licensed beds are designated through the planning agency of the state of Maryland. The state planning agency fully controls the number of beds and the number of hospitals that they will approve. While we'll have four fewer licensed beds than in the current hospital, utilization will actually improve because each room will be for one patient. Currently, in the present hospital, over 2/3 of the beds are in semi-private rooms, and at any time, 10 to 15% of those beds are unavailable because of isolation, opposite sex, or incompatible diagnosis. We have planned in the new facility an additional bed tower that we will shell in to accommodate future growth. The plans for the hospital at Robinwood include ample expansion opportunities, both in bed complement, emergency department, and operating rooms to address the growing community population and future advances in technology.

Monitor: Lou Ann Myers, clinical manager for the emergency room, said earlier this month that the problem is not staffing, but space. Will renovations to the current emergency room improve that situation?

Dr. Kotch: Our current emergency department census is approximately 70,000 patients per year. We are currently operating in a facility designed to see approximately 47,000. So there's a clear need for more space. As a temporary measure--until the construction of the new hospital-- we are currently about to finish a new 7-bed express care area. The current express care will be renovated to 6 new emergency department beds. In addition to the expansion there will be various renovations to the physical plant of the emergency depatment, as well as enhanced and improved bedside monitoring capabilities. While this can be viewed as expensive expansion, we anticipate 225,000 emergency department visits during the 36 months it would take to construct the new hospital. Physician and nursing staff is adequate currently to meet this expansion.

Moderator: We have heard that irregardless of their condition, patients who arrive by ambulance are treated more quickly than those who are taken to the emergency room by family or friends. Have you seen any evidence that patients are using ambulances to bypass long waits in the emergency room?

Dr. Kotch: Contrary to what might be perceived, ambulance patients undergo the same triage process as patients who present through the front door. If the emergency department is full and the patient is able to be triaged to the waiting room, this may occur. One has to understand in general that ambulance patients tend to have a higher severity of illness, however, some patients presenting through the front door may be more ill than an ambulance patient. The bottom line is that we feel that our triage system works and is applied universally to all of our patients.

Moderator: How should a patient decide whether to come to the emergency room or to an urgent-care center?

Mary: One helpful place to start is by calling the hospital triage line, which is 1-800-274-0499. A specially-trained nurse can assit the caller in determining the appropriate level of treatment. In an emergency, however, it's always best to call 911.

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