Entries in Emergency Rooms (6)


Emergency Room Waits for Psychiatric Patients: Safe or Profitable?

iStockphoto/Thinkstock(BOSTON) -- Psychiatric patients waited an average of 11.5 hours to be admitted into the emergency room of a hospital, according to a recent study published by Annals of Emergency Medicine.
Study author Anthony Weiss of Partners Healthcare in Massachusetts says that most hospitals don’t even have mental health wards anymore.

"The reimbursement for mental health care within the country is among the lowest across the different disease states, and so it's not, in some cases, economically viable to support these types of units," Weiss said.
HealthOne, a hospital network in Denver, is taking a different approach by adding a psychiatric unit to provide more help for mental health patients, according to "Shots," an NPR health blog. They know that emergency rooms can often get backed up, especially when there are patients in the ER for particularly long periods of time.

Even though the mental health ward is the first of Colorado’s in years, it may still be a potential loss of money. The hospital expects that the loss will be gained back through a speedier flow in the emergency room where most of the hospital’s money is made, "Shots" reports.

Copyright 2012 ABC News Radio


A New Kind of ER for the Elderly

iStockphoto/Thinkstock(NEW YORK) -- Monitors beeping, loud voices and people scurrying about are just a few things people associate with a busy emergency department.  Many people may consider these factors a nuisance, but for older patients, it can be downright frightening and even affect their health.  A new trend in emergency department design is seeking to optimize the environment in which older patients are treated.

Referred to as "geriatric" or "senior" emergency departments, these facilities have been popping up across the country since the first one opened at Holy Cross Hospital in Silver Spring, Md. in 2008.  They are usually small areas, away from the hustle and bustle of the main emergency department.  Private rooms, simple layouts, natural lighting, more volunteers and soothing music are among the many features Holy Cross and other hospitals across the country are adding, all aimed at creating a calm and comforting environment.

Beyond making older patients more comfortable, the focus is really on keeping them safe.  Dr. James Del Vecchio, medical director and pioneer in the creation of Holy Cross Hospital's senior emergency center, thinks their follow-up service is one of the most important safety features of the care provided. 

Social workers are instrumental in this process. They not only set up home nursing services, but they make follow-up calls to every patient within 48 hours of being seen.

"They are checking to make sure the patient was able to get all the prescriptions or doctor appointments that they needed," Del Vecchio said.

Managing medications is another area where these senior facilities hope to intervene.  At the Holy Cross Hospital, any senior who comes in on five or more medications has their prescription list reviewed by a pharmacist before leaving. 

According to Bonnie Mahon, director of senior services, "We've had some real saves from this.  One woman kept falling until our pharmacist realized that the dose of one of her medications might be causing this."

Bed sores, one of the most common complications of hospitalization, are associated with higher costs and longer hospital stays.  Research shows that these wounds can occur in as little as four to six hours, suggesting they may be starting to form while the patient is still in the emergency department.  But the Geriatric ERs are addressing that problem as well.

Instead of the traditional thin layer of foam covered in plastic, thicker mattresses, such as the four-inch Tempur-pedic ones at Holy Cross, are being used in hopes of reducing the occurrence of these wounds.

Del Vecchio also points out that every senior who comes through the door is asked eight to 10 simple questions that help screen for problems that seniors are more prone to, ranging from memory impairment to risk for falls at home.

And to combat falls in the hospital, Holy Cross has modified the flooring and lighting.  Mahon explains that some types of lights can create shiny spots on the floor.  This interferes with depth perception and can lead to falls, especially in the elderly.

These changes in emergency care have been well received by the senior population.  DelVecchio and Mahon say their patient satisfaction scores are over 95 percent positive.

Copyright 2012 ABC News Radio


Emergency Rooms Levy Fees for Non-Emergency Visits

Stockbyte/Thinkstock(NEW YORK) -- Talk about adding insult to injury. More and more U.S. emergency rooms won't admit patients until they pony up a fee of $100 dollars or more for non-emergencies.

The fees are meant to discourage people suffering from nothing worse, say, than a sore throat or a skinned knee from taking up time and resources better reserved for the seriously ill.

Both for-profit and non-profit hospitals are levying the charge.

Ed Fishbough, spokesman for the nation's biggest for-profit chain, HCA Healthcare in Nashville, Tenn., says the company first started imposing such fees in 2004, at one of its Houston-area hospitals.

The practice has since spread to 76 other hospitals in the 163-hospital chain. The purpose, he says, is to "help reduce crowding in the ER and to educate people about appropriate use of ER resources."

Critics of ER fees include the American College of Emergency Physicians, which says that two to seven percent of patients determined to have non-emergency conditions are admitted to a hospital within 24 hours.

Patient advocacy groups, likewise, blast the policy, saying it discourages the sick from seeking help. "It seems the point of the policy is to put a financial barrier between the patient and care," Anthony Wright, executive director of advocacy group Health Access California, told Kaiser.

Either way, here's how it works at HCA:

You show up at the ER wanting treatment. A clinician checks you out, and decides whether your case qualifies as a true emergency. If it doesn't, but if you want to stay in the ER and get treated there anyway, you are asked to pay a fee, which at HCA runs between $100 and $150.

Pregnant women, children younger than 6 and people older than 64 are exempt.

HCA says it had six million emergency room visits at its hospitals last year. Of those, 314,000 (about five percent) were from people who, after screening, were determined not to have an emergency condition. They were offered the choice of paying the fee and remaining in the ER for treatment, or leaving and seeking treatment at what HCA calls a "more appropriate setting," such as a clinic or doctor's office. About 233,000 patients chose to stay and pay. About 80,000 didn't, and took a hike. It's unknown where they ended up.

Such ER fees are common now at other big, for-profit chains (including Health Management Associates of Florida, and Community Health Systems of Tennessee) and nonprofit hospitals, as well.

Tomi Galin, vice president for corporate communications at Community Health Systems, says patients who choose to leave "are provided with information about other community health resources for their non-emergency medical conditions." Imposing a fee, she argues, helps reduce costs for the patient and the hospital alike because "the ER is the highest cost environment to receive non-emergency care."

The U.S. Centers for Disease Control and Prevention says patients with non-urgent problems account for about eight percent of ER visits. Other studies have put the figure considerably higher. One by Health Affairs policy journal in 2010 concluded it was closer to 27 percent.

The non-profit Midland Memorial Hospital in Texas implemented a $150 ER fee in 2009, as part of an exercise in cost-control, according to a Kaiser Health News story. Kaiser says the hospital had lost $14 million in 2008, in part because of millions of dollars in ER bills left unpaid.

Since imposing its fee, the hospital has seen a drop in debt, according to its chief financial officer, whom Kaiser quotes. He estimates that about 75 percent of patients with nonemergency conditions leave the hospital rather than pay the fee. "More people now know," he says, "that our ER is not a walk-in clinic or a primary-care office."

Copyright 2012 ABC News Radio


Hospitals in Hurricane Irene's Path Enact Safety Plans

Stockbyte/Thinkstock(NEW YORK) -- As Hurricane Irene heads north, hospitals in its path are getting ready for the worst. ABC News contacted medical facilities up and down the coast in the path of Irene to get their take on this weekend's safety plan.

"All acute inpatient facilities need to have disaster preparedness committees, and we routinely practice for these kinds of scenarios," said Dr. Michael Lucchesi, chief of emergency medicine at the SUNY Downstate Medical Center in Brooklyn, N.Y., which should begin to feel Irene's effects late Saturday night and Sunday. "Some hospitals are better at disaster preparedness than others, but all have a plan."

"We've closed shutters, put boards over windows [and] we'll be sandbagging the doors later today," said Jarie Ebert, spokeswoman for North Carolina's Outer Banks Hospital, which is less than half a mile from the coast and a mere 14 feet above sea level. Hurricane Irene will make its first U.S. stop near the shores of North Carolina Saturday morning, according to the National Weather Service.

"Anyone considering elective or nonemergency surgery has been already done or rescheduled," said Ebert, noting that 40 to 50 hospital staff members, known as Team A, will arrive Friday night and stay through the duration of the storm.

Emma Inman, a spokeswoman for Sentara Norfolk General Hospital in Virginia, also in Irene's Saturday morning path, noted that the hospital has been testing backup generators and stocking supplies, medications, food, water and fuel to last several days.

"A number of our facilities are contemplating lockdowns," said Inman. "They won't make that decision until tomorrow, though."

One Sentara nursing home located on coastal Currituck, Va., has already been evacuated. Patients have been dispersed to facilities in Hamptons Roads, which is farther inland from the hurricane's path.

Located in one of the most vulnerable areas of New York City, Brooklyn's Coney Island Hospital was evacuated Friday morning. Patients were transferred to SUNY Downstate Medical Center, which sits more inland.

"We're going to have 25 to 30 percent of additional reserves on hand because of the transfer," said Downstate's Lucchesi. "When you get a surge of patients, you have to make sure you have enough medication, and [that] ventilators are all functioning."

As the fire departments and emergency medical services go into "transport mode" for the next 24 hours, 911 calls in the New York area may not receive as quick of a response as they normally would, Lucchesi said.

For patients on dialysis, SUNY Downstate will extend Friday evening hours "so patients can get dialyzed who would normally come in Saturday," said Lucchesi.

Hospitals cannot be too prepared for disasters, said Lucchesi. After much criticism of the emergency response when Hurricane Katrina hit the gulf region in 2005, most medical facilities and government agencies are not taking any chances with safety this time.

"We have to worry about the panic that goes across the population, but a little bit of preparation beforehand, like getting enough water, flashlights, gas in the car, can go a long way," said Lucchesi.

Copyright 2011 ABC News Radio


Hospitals Giving Faster Help to Heart Attack Victims

Medioimages/Photodisc/Thinkstock(WASHINGTON) -- Hospitals all over the country are getting faster at giving life-saving angioplasties to patients who have heart attacks, according to a report published Monday in the American Heart Association's journal, Circulation.

The five-year study of more than 300,000 patients found that the average time it took for doctors to perform an angioplasty -- a procedure used to open a blocked or narrowed artery in the heart -- after they were admitted decreased from 96 minutes in 2005 to 64 minutes in 2010.

During a heart attack, blocked blood vessels prevent the heart from getting the blood it needs to function. Angioplasty opens the blood vessels -- often using a balloon passed through the narrowed locations which is then inflated -- and, if performed quickly, can keep the patient's heart from getting damaged by a lack of blood.

Previous practice guidelines have recommended that patients should get emergency angioplasty in less than 90 minutes after a heart attack. In 2006 and 2007, the American College of Cardiology and the American Heart Association launched campaigns to get cardiologists and hospitals to lower their door-to-balloon times to give the best care to heart attack patients.

Mike Valentine, a cardiologist at Centra hospital in Lynchburg, Va., said patients with heart attacks there get angioplasty in an average of 43 minutes. Several years ago, the door-to-balloon time was about 80 minutes.

"Our times are excellent, but we try to never be satisfied," Valentine said. "We're constantly trying to improve those times and get that care to our patients faster."

Copyright 2011 ABC News Radio


Where Are the Nation's Best Hospitals?

Siri Stafford/Photodisc/Thinkstock(WASHINGTON) -- Need help researching hospitals in your area? You might find some help from U.S. News and World Report, which released its 22nd annual ranking of the nation's best hospitals on Tuesday.

Johns Hopkins Hospital in Baltimore and Massachusetts General Hospital took the top "Honor Roll" hospitals, which were ranked near the top in six or more specialty areas.

Here are the top 10:

  1. Johns Hopkins Hospital, Baltimore
  2. Massachusetts General Hospital, Boston
  3. Mayo Clinic, Rochester, Minn.
  4. Cleveland Clinic
  5. Ronald Reagan UCLA Medical Center, Los Angeles
  6. New York-Presbyterian University Hospital of Columbia and Cornell, N.Y.
  7. UCSF Medical Center, San Francisco
  8. Brigham and Women's Hospital, Boston
  9. Duke University Medical Center, Durham, N.C.
  10. Hospital of the University of Pennsylvania, Philadelphia

Johns Hopkins Hospital stayed in the top spot from last year's rankings and Massachusetts General Hospital beat out Mayo Clinic to take the silver this year.

The rankings were based on death rates, patient safety, and other objective data. Physicians' opinions of the best hospitals for the toughest medical cases were also factored into the results.

Copyright 2011 ABC News Radio

ABC News Radio