By Jill Coley
The Post and Courier
| Related Article: Overcrowded emergency rooms strain EMS care |
COLUMBIA, SC — Increasingly, emergency departments across South Carolina are in gridlock.
More uninsured people are arriving sicker. Mental health patients in crisis are unable to be evaluated or moved. And patients and families are snapping into violence, yelling and hitting staff.
“The ER is the only arena of care in the U.S. health system where you can’t turn anyone away because they can’t pay,” said Arthur Kellermann, associate dean for health policy at Emory
University in Atlanta. And that safety net is fraying under the strain.
Kellermann shared the findings Tuesday of an Institute of Medicine report on emergency care, to which he contributed, to representatives from hospitals across the state. The South Carolina Hospital Association is hosting the two-day event.
Emergency departments are getting clogged inside and out. Internally, hospitals have little motivation to prioritize potentially uninsured emergency patients over elective patients, who can pay.
A life-threatening brain injury may be routed to another hospital, Kellermann said, but you never hear of a back fusion patient being diverted.
External pressures include a growing number of uninsured patients who are turning up in emergency rooms, where federal law requires they be treated.
Mindi Huckabee, director of emergency services at Trident Medical Center and president-elect of the S.C. Emergency Nurses Association, said, “Overcrowding is not getting any better as the economy is not getting any better.”
More people are visiting with colds or to get excuses for work or school, she said. Trident Health System hospitals now post emergency room waiting times online to help people plan their visits.
“It’s not that they’re not sick,” she said. “It’s not an appropriate use of resources.”
But many have nowhere else to go. In February, nearly 90 percent of emergency physicians in the American College of Emergency Physicians reported treating patients who had been turned away for care elsewhere.
While undocumented immigrants who are uninsured are a major issue in border states, the greatest growth in uninsured is among Americans, Kellermann said.
Rick Foster, senior vice president for quality and patient safety at the hospital association, said mental health patients are placing the largest demand on emergency care in the state.
In a hospital in Manning last week, six of the 10 emergency department’s rooms were holding psychiatric patients, Foster said.
A shortage of mental health beds has led to the backlog. For decades, psychiatric hospitals have been phased out, with the idea that smaller community facilities and outpatient counseling would replace them.
But years of budget cuts have left many mental health patients with nowhere to go, forcing emergency rooms to hold them until space opens up somewhere.
And topping off all the tension are bursts of violence. Eighty-six percent of emergency department nurses reported recent violence at work, according to the Journal of Emergency Nursing.
Huckabee said, “We have had violence in the emergency department not related to mental health emergencies.”
Solving these problems would require ending the diversion of ambulance patients, pressuring hospitals to admit emergency patients, Kellermann said.
Foster pointed to the S.C. Mission Lifeline, a network of 17 hospitals that offer primary cardiac intervention, as a model of efficiency.
Participating hospitals have agreed not to divert patients EMS has identified as having a heart attack. This one-call system moves them efficiently to the care they need, he said.