By Lisa Gray
The Houston Chronicle
Copyright 2007 The Houston Chronicle Publishing Company
All Rights Reserved
HOUSTON, Texas — The ambulance crews hate it. They respond to a 911 call, hustle their patient to a hospital, carry the stretcher into the emergency room, and then ... they wait.
It’s common, says David Persse, Houston’s director of Emergency Medical Services. The city’s emergency rooms, like emergency rooms all over the country, are overflowing. And not even paramedics can skip to the front of the line.
Every day, somewhere in Houston, EMTs wait for emergency rooms to accept their patients. The minutes tick past - 30, maybe 40 - with the patient lying on the ambulance stretcher, usually in a hallway. If the wait lasts an hour, the crew calls a fire department supervisor, who talks sternly to the hospital. Fairly often, says Persse, two hours drag by.
For the patient on the stretcher, the emergency-room wait might be painful, but it’s not a matter of life and death. By design, ERs respond quickly to critical situations. It’s the less-than-critical patients - the ones who need attention, but aren’t in immediate danger - who wait. And wait.
As the minutes crawl, the paramedics grow surly. In their world, seconds count. They want to be out responding to emergencies, not waiting in hallways.
Growing demand
Persse used to be frustrated with hospitals, too.
“Let me check at random,” he says on a normal weekday afternoon, and types in his computer password. Of Houston’s 25 emergency rooms, he counts three flagged “drive-by” - requesting no emergency patients - and another four flagged “caution.” Paramedics could expect a wait at more than one hospital in four.
But that, Persse says, counts as a vast improvement. In 2002, the average Houston hospital was on drive-by more than 35 percent of the time. It wasn’t uncommon, he says, for every hospital in town to be on drive-by. Once, an ambulance crew waited four hours for a patient to be admitted.
“If you’d talked to me between 2001 and 2003, I’d have been angry at the hospital administrators,” Persse says. “But they’ve really tried.” Houston hospitals have become more efficient, he says, rooting out the bottlenecks in their systems, hiring more cleaning staff needed to prepare rooms quickly, say, or an extra radiologist to handle a Tuesday rush.
But the problems that remain run deeper than anything an individual hospital can address.
“I’d point my finger at people who think health care can be run like a widget factory,” says Richard Bradley, chief of emergency medicine at LBJ General Hospital. Decades ago, he says, hospitals operated far more beds and kept more staff on duty to handle surges in demand. Now in the managed-care era of razor-thin operating margins, surge capacity no longer counts as “ready beds in waiting” but “waste.” Some hospitals axed their unprofitable emergency rooms entirely.
Demands on the remaining ERs surged. The city’s population grew, as did the number of people not covered by insurance. According to the Census Bureau, 30 percent of Harris County residents are uninsured - a rate almost twice the national average. Untreated, diabetes, high blood pressure and other manageable illnesses explode into life-threatening emergencies.
Most hospitals now immediately send patients with minor problems to clinics. But those too ill for a clinic, but not at the verge of death, languish ever longer in the ER. In the normal course of business - not natural disasters, not plane crashes, just everyday bad days - Bradley has heard of 12- and 16-hour waits.
“Society has accepted that we’ll have long waits in the ER,” Persse says blackly. “We know to pack a change of clothes and a lunch.”
911. From the ER
But we expect something different of an ambulance.
Almost every day, Persse says, someone calls 911 from inside a hospital ER. In the waiting room, a would-be patient loses patience, or fears for his life. The dispatcher sends an ambulance.
Usually, Persse says, the EMTs convince the caller to remain at the hospital where he is. Arriving at a different hospital would probably slow things down, they explain. Ambulance or no ambulance, the patient would lose his place in line.