August 10, 2008
ER Waits, Patient Counts Rise at Hospitals
By T.J. GREANEY
Columbia is matching a nationwide trend of patients increasingly turning to hospital emergency rooms for care.
In Columbia, changes in waiting times and patient volumes are not nearly as high as elsewhere.
Boone Hospital Center measures wait time from the moment a patient checks in to the time he or she is taken to a patient room. Wait time there in the past three years rose to 33 minutes from 28 minutes. Patient volumes also rose during that time to 32,656 in 2007 from 30,786 in 2005.
At University Hospital, the area's only Level 1 trauma unit, officials said they do not keep track of wait times, though they say patient volume rose to 33,591 in 2007 from 30,847 in 2005.
Columbia Regional Hospital, operated by University of Missouri Health Care, treated 8,950 patients last year in its emergency room. Historical data and wait times were unavailable for the hospital, said spokeswoman Mary Jenkins.
University Hospital tracks of the time it takes for a patient arriving by ambulance to be seen by staff. That time has remained steady at about one minute since 2005.
Boone Hospital takes all its patients directly to a treatment room instead of a waiting room, which means they would not have recorded wait times by the hospital's definition. Mary Schnell, director of emergency services at Boone Hospital, said she's proud the hospital has kept wait times relatively low.
"We try to work smarter, not harder," she said. "That's an old saying, but our No. 1 focus is our patients and trying to get them through the system and trying to get them to see a physician and get a disposition as quickly as possible."
Schnell, however, acknowledged some challenges. "The biggest challenge right now is the nursing shortage," she said. "Trying to get experienced nurses to come into the department and to have experience - we certainly don't mind training our own staff, but it does take longer."
Schnell also said rising patient volumes are tougher because they come in unexpected bursts. "I never know when six people are going to come in and say, `I need to see a physician,' " she said.
At University Hospital, administrators are hoping to buck a national decline in hospital emergency rooms in recent years as patient volume has risen. The hospital just launched a plan to expand its ER, adding eight or nine new examination rooms. The expansion should be complete in about a year.
"At a time when other people are maybe downsizing or closing, we're going to be expanding," she said. "We're handling the patients we have now very efficiently, and this is just going to allow us to be more efficient."
Researchers have blamed the nationwide trend toward longer wait times on factors such as an aging population, a rise in the number of uninsured and an inability to get an appointment with a primary care physician.
Both local hospitals said they handled people with emergencies that were minimal by most standards.
The definition of emergency varies, said Schnell, and emergency rooms use an algorithm called the "Emergency Severity Index" to rate patients on a 1 to 5 scale. Patients rated 1 have a life- threatening condition and are admitted immediately; patients rated 5 are those who wait the longest. That does not mean, said Schnell, patients with a 5 rating should not be in the ER.
"I wouldn't say anybody ever shouldn't be here because they all have the right to health care," said Schnell. "The mom who the school nurse has called and says, `Your child has an infectious process, and they can't return to school until they get it taken care of' whether it's scabies or head lice or whatever that's an emergency to that mom."
Reach T.J. Greaney at (573) 815-1719 or [email protected]
Originally published by T.J. GREANEY of the Tribune's staff.
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