Emergency departments in Tennessee and Georgia are bracing for an onslaught of patients who will be newly insured under federal health reform but still will face a shortage of primary care physicians.
Many of those patients will turn to the emergency department for routine care needs, worsening existing bottlenecks, doctors fear. Efforts to bolster the primary care physician supply will take years to catch up with demand, doctors say.
PDF: ER wait times
"There's no question that emergency department (visits) will go up (with federal health care reform) ... because insurance doesn't equal access," said Dr. David Seaberg, dean of the University of Tennessee College of Medicine in Chattanooga and an emergency physician at Erlanger hospital. "We've got to be prepared for that."
Dr. Ken Hayman, emergency department director at Parkridge Medical Center, said that because of costs constraints, "the only way to meet that capacity, without spending a lot of money for extra rooms and extra personnel, is to not do business the way we've been doing it."
Hospitals in Chattanooga and North Georgia are tightening up in ERs to find and eliminate wasted minutes, as well as offering after-hours alternatives to emergency care outside their walls.
Some emergency rooms are implementing manufacturers' assembly line techniques to standardize and streamline the process and get patients in and out more quickly.
Using such strategies, Parkridge's ER has cut the average time it takes a patient to see an doctor or midlevel provider from 46.5 minutes last year to 21.5 minutes this year, officials said.
Hamilton Medical Center in Dalton, Ga., this year created a "fast track" area and designated medical providers to treat patients with less-urgent care needs who usually can be discharged quickly. That frees up space, beds and resources for patients with critical needs.
"There are some patients that really require minimal resources. They maybe just require one X-ray or one lab, so why even take up a room?" said Cathy Ferguson, director of emergency department at Hamilton Medical Center.
"If you have strep throat, we can have you in and out in 20 minutes," she said. "You can just come in, and you're seen immediately by a mid-level practitioner" such as a physicians' assistant, she said.
RISING PATIENT VOLUMES
Over the past decade, the number of patients going to emergency rooms has risen sharply while the number of ERs has declined. The increasing strain on the departments is resulting in longer wait times, officials said.
A study published in November in the Archives of Internal Medicine found that between 1997 and 2006, median wait time for all patients to see a provider increased 4.6 percent per year, from 22 minutes to 33 minutes for patients at all levels of urgency.
Part of the problem is patients who use the emergency room - where they are guaranteed care, regardless of ability to pay - for situations that aren't true emergencies, officials said.
And it's not just uninsured patients who misuse the ER, they said. Even insured patients can struggle to get an appointment with a doctor or don't want to take a day off in the current economy, so they go to the ER instead.
Building a new after-hours clinic next to the emergency department at T.C. Thompson Children's Hospital - a subsidiary of Erlanger - significantly has lessened crowding by providing an alternative for less-urgent situations, he said. The after-hours clinic had 6,000 visits last year, he said.
At Memorial Hospital's emergency room, total visit time - from arrival to discharge from the hospital - has declined by about a half hour, from 243 minutes to 213 minutes, since its "fast-track program" was implemented in April, said Jan Woods, director of emergency center and emergency medical services at the hospital.
"It helps because that keeps our beds open. We don't have somebody with a sprained ankle waiting 25 or 30 minutes to get an X-ray taking up a bed that someone with chest pains could be using," said Dr. Jeff Visser, medical director for Memorial's emergency department.
Last year, Hutcheson Medical Center in Fort Oglethorpe added dedicated rooms for less seriously ill patients and has focused on efficiency, said Cindy Hoggard, nursing director of the emergency department. Over the past few years, the average total ER length of stay has dropped from five hours to 31/2 hours at Hutcheson, she said.
FAST FACTBetween 1996 and 2006, the number of emergency departments nationwide declined from 4,019 to 3,833. During the same period, patient volume in emergency rooms rose by almost one-third.Source: Archives of Internal Medicine study, November 2009
Nationwide, more hospitals are advertising their wait times by offering updates via cell phone. Parkridge has posted a billboard over Interstate 24, advising patients they can text "ER" and their ZIP code to 23000 to receive an estimated wait time at the nearest facility owned by HCA, Parkridge's parent company.
Texting expected wait times initiative has potential pitfalls, Dr. Seaberg said. A patient with a true emergency could be deterred by a lengthy wait and potentially delay care or go to a center farther away with a quicker estimated wait time, he said.
A patient with a true emergency such as chest pains should know he or she will be seen almost immediately in an emergency room, despite estimates on wait times, he said.
"If you're having a true emergency, we'll get you back right away," Dr. Seaberg said. "There is no wait time."
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