Copyright 2006 Albuquerque Journal
By WINTHROP QUIGLEY
Albuquerque Journal (New Mexico)
Albuquerque hospital administrators are concerned their already overworked emergency rooms could be overwhelmed when Lovelace Health System closes its Gibson ER next year.
The city’s emergency rooms are already stressed, and hospital leaders expect the problems to get worse no matter what Lovelace does.
“We’re paddling as fast as we can to stay even” with annual growth in emergency room use of 5 to 8 percent, said Presbyterian Healthcare Services chief operating officer Mark Reifsteck.
Lovelace says that its system actually will have more emergency room beds than it has now, even after the hospital on Gibson SE closes, and that efficiencies and improved infrastructure will allow its ERs to handle patients more efficiently. But there is more to the city’s emergency system than just the emergency rooms, said Jeff Dye, New Mexico Hospitals and Health Systems Association executive director.
“Sheer numbers are not the only answer,” he said. Where hospitals are located and to which emergency rooms ambulances are dispatched also make a difference. “Protocols and wait times of ambulances and those things have to be on the table at the same time,” Dye said.
To get the issues on the table, the association is hosting an emergency services planning session June 5 with Lovelace, Presbyterian Healthcare Services, the University of New Mexico Hospital, ambulance services and local government officials.
“Our goal is to help them to be successful in their transition,” Reifsteck said.
That’s because if Lovelace does not handle its share of the load successfully, the city’s other systems will be swamped.
Until he understands Lovelace’s plans, Reifsteck said, “I don’t know if I need to hire three doctors or four. I don’t know if I need 10 nurses or 15. I don’t know if I need to add three rooms or four rooms to take on new volume.”
The hospital association estimates demand for emergency room services should increase 8 percent city-wide this year. Demand grew about 6 percent last year.
The University of New Mexico Hospital emergency room is capable of handling about 55 patients a day. In March, UNM nurses complained to the hospital’s board of directors that 12 to 20 patients a day are held in the emergency room, often on cots in hallways, waiting for a hospital bed to open up.
The university system is building a new emergency department at its Lomas NE hospital that will be four times the square footage of its current department. UNM Health Sciences executive vice president Paul B. Roth said the department already will be strained when it opens in 2007, even without the Gibson closure.
Hospital beds
If managing emergency services were only a matter of predicting how many people would be shot, be hit by a car, fall out of a tree or have a heart attack, managers would have no problem planning new capacity. It is not that simple.
Hospitals have to admit many of the patients who show up in the emergency room. That means the hospitals have to have enough beds, and it means they have to have enough people to staff those beds. Otherwise, the patients just sit in the emergency room waiting for somewhere to go, said UNM emergency medicine department chairman David P. Sklar.
As it is, some University Hospital patients have waited days in the ER area for a hospital bed to become open.
Compounding the problem, Reifsteck said, is population growth and especially the growth in New Mexico’s uninsured population.
“The emergency room is primary care for people who don’t have a connection with a physician” because they don’t have insurance to pay for physician services, Reifsteck said.
UNM expects even more demand as Indian Health Service budget cuts force urban Indians to seek care at the university, Roth said.
Lovelace CEO Ron Stern said Lovelace’s solutions will go beyond merely the number of emergency room beds in the system.
Planning for change
Gibson has handled 34,000 visits a year, and Lovelace’s Downtown hospital handles 17,000 today. The Downtown emergency room, currently under renovation, will be able to handle up to 68,000 visits when Gibson closes, Stern said. Lovelace can handle 23,000 visits a year in its West Mesa hospital and 17,000 at Women’s Hospital in the Northeast Heights. Women’s Hospital will also improve its urgent care capacity so cases that arrive in the ER but aren’t emergencies can be quickly moved to an appropriate care setting, Stern said.
Lovelace is also improving emergency room efficiency so the same beds can handle more people. Stern said doorto-door emergency room service (the time from arrival at the ER until the patient is either released or admitted to the hospital) declined from 4.24 hours in January 2005 to 2.4 hours in November. The system’s goal is to get the number down to two hours.
One part of emergency service that has actually improved is ambulance diversion. When emergency rooms are too busy to accommodate new patients, they close, and ambulances are diverted to other ERs that are open.
Last year, emergency service providers agreed that emergency rooms would divert a maximum of one hour out of every eight, and had to remain open at least eight hours after it had diverted ambulances, Sklar said.
“What’s happened is most of the emergency departments have gone on divert much less,” Sklar said. “That doesn’t mean that the departments themselves aren’t crowded, because they are. But as far as the ambulances having to bounce around looking for a place to drop patients, that’s much less of a problem.”