By Bill Murphy
The Houston Chronicle
Copyright 2006 The Houston Chronicle Publishing Company
All Rights Reserved
Harris County’s public hospitals are about to tighten access to their emergency rooms, which for decades have served as the doctor’s office for some patients with noncritical medical needs.
On Tuesday, what has been an open-door policy at Ben Taub and LBJ hospitals will become stricter.
To reduce emergency room overcrowding, the hospitals for the county’s needy will begin screening adult patients and requiring those who don’t need urgent care to seek treatment in community health clinics.
“We’ve been enabling primary care treatment in emergency rooms, but not liking it,” said Bryan McLeod, spokesman for the Harris County Hospital District. “So what do we do to change things? This is one of those options.”
Patients who go to the county’s emergency rooms with nonurgent symptoms sometimes wait 12 hours or more for treatment.
Waits also are long and scheduling difficult at clinics. But there will be an incentive for seeking treatment in the appropriate setting: money.
After evaluating patients who come to the emergency room, nurse practitioners or physician’s assistants will inform those with nonurgent symptoms that they can seek treatment at a specific community health clinic.
Patients who insist on staying will have to pay a $150 deposit before being treated in the emergency room or an $80 deposit to be seen in urgent care centers at LBJ and Ben Taub.
These are comparable to private minor emergency centers that treat non-life-threatening trauma and illness.
The district is beefing up the urgent care staff at LBJ and expanding the urgent care center’s hours to help treat patients diverted from the emergency room. Construction will begin soon on a $650,000 urgent care center near Ben Taub’s emergency room.
Except for the new deposit requirement, the cost for treatment at district facilities will be on a sliding scale, based on patients’ financial situation, as it is now. Children 17 and younger won’t be subject to the diversion program, though the district will encourage parents to take children with nonurgent symptoms to clinics.
In recent years, emergency rooms at local public and private hospitals regularly have gone on “drive-by status,” requiring ambulances to divert seriously ill or injured patents to other facilities.
Drive-by status has become frequent, in part, because so many patients with nonurgent symptoms seek care at emergency rooms, concluded Save Our ERs in a report two years ago. Save Our ERs was a coalition of regional leaders in medicine, business and government that advocated changing local health care policy to help alleviate emergency room overcrowding.
Last year, Ben Taub’s emergency room was on drive-by status 42 percent of the time and LBJ’s, 55 percent.
More than half of the 166,000 people who went to LBJ and Ben Taub emergency rooms last year could have received appropriate treatment elsewhere, said James Hearn, assistant administrator at LBJ, who is leading the effort to divert nonurgent patients from emergency rooms.
“Accessing the emergency room for the sniffles is not appropriate. We will be teaching people to navigate our system and use our clinics,” Hearn said.
He said patients come to emergency rooms for sore throats and minor stomachaches, and some bring children for immunization shots.
The district predicts the diversion policy will cut emergency room visits by 20 percent, Hearn said.
According to a district handout for patients, the diversion program is called RightCare because the district is trying to get patients “to the right place, at the right time, for the right level of care - at the right price.”
It costs the county much more to treat patients in emergency rooms than at clinics.
RightCare assistants will work with patients to locate the most convenient community health clinics.
It often takes eight weeks to get an appointment at community clinics. But clinics will try to treat patients who need to be seen for minor illnesses within a week to two, said district spokesman John Martinez.
Some patients could be seen sooner if they went to a clinic and sought walk-in appointments, he said.
RightCare will try to get patients established in “a medical home” — a clinic or other setting where they can receive ongoing primary care treatment, Martinez said.
EMERGENCY ONLY
Harris County’s public hospitals hope to reduce overcrowding by diverting adult patients with nonurgent symptoms from emergency rooms to clinics in a program called RightCare. Effective Tuesday, here’s what patients can expect:
Assessment: During triage, a nurse practitioner or physician’s assistant will evaluate the patient’s complaint, considering symptoms, blood pressure and pulse .
Diversion: If the condition is not urgent, patients 18 and older will be directed to a clinic operated by the district or a community health clinic.
Deposit: Patients who opt to stay must pay a $150 deposit to be treated in the emergency room, or an $80 deposit to be treated in adjacent urgent care centers, designed to treat non-life-threatening trauma and illness.
Source: Harris County Hospital District