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Online chat with Mary Towe and Dr. Steve Kotch

January 28, 2007

Editor's note: On Tuesday, Jan. 23, The Herald-Mail held an online chat with Washington County Hospital's Mary Towe, vice president, chief nursing officer, and Dr. Steve Kotch, director of emergency medicine, who discussed the recent red and yellow alerts at the hospital and what they mean for patient care.

Our next chat will be Wednesday, Feb. 14, at 1:30 p.m. with John Barr, who is president of the Washington County Commissioners.

Those wishing to submit questions in advance may e-mail them to onlinechat@herald-mail.com.




The following is an edited version of Tuesday's chat.

Dixie: This is the first I've heard of these alerts. Can you briefly explain the differences between the three levels of alerts - red, yellow and trauma bypass?

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.

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Yellow alert is a state in which the emergency department is overwhelmed with either a high volume of patients, or a one-time, high-volume accident. 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 a high number of cases or the unavailability of a trauma surgeon.




Moderator: 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?

Towe: 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 it 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, more than two-thirds of the beds are in semi-private rooms. At any time, 10 to 15 percent of those beds are unavailable because of the need to isolate one patient, because we don't put men in rooms with women patients and because patients have incompatible diagnoses.

In the new facility, we have planned an additional bed tower that we will rough 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.




Moderator: 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?

Kotch: Our current emergency department is seeing 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 seven-bed express care area.

The current express care will be renovated into six new emergency department beds.

In addition to the expansion, there will be various renovations to the physical plant of the emergency department, 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 currently adequate 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?

Kotch: Contrary to what might be perceived, ambulance patients undergo the same triage process as patients who arrive at our front door.

If the emergency department is full and the patient is able to be triaged to the waiting room, this might occur.

One has to understand that, in general, ambulance patients tend to have more serious illnesses.

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?

Towe: One helpful place to start would be calling the hospital triage line, at 1-800-274-0499.

A specially-trained nurse can assist the caller in determining the appropriate level of treatment. In an emergency, however, it's always best to call 911.

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