Web site shares information on patient loads, beds available
By Kate Moran
Times-Picayune (New Orleans)
Copyright 2007 The Times-Picayune Publishing Company
When workers evacuated a Metairie office building last month complaining of burning eyes and choking, word went out to local hospitals that patients might need treatment for exposure to an odorless but noxious chemical.
The signal flashed across a Web page that hospitals have been using since October to improve coordination among their crowded emergency rooms. The hospitals immediately posted online how many beds they had available, and nursing homes relayed that they could absorb patients if the hospitals were overwhelmed.
While the chemical scare did not ultimately swamp the hospitals, the incident illustrates how Internet technology has helped promote a spirit of collaboration among local emergency rooms, all of which have suffered from gridlock since Hurricane Katrina.
The state Department of Health and Hospitals joined the site — called EMSystem — to aid communication during a hurricane, flu outbreak or other public health crisis. While it is available to hospitals around the state, health care providers in the New Orleans area are the only ones using it on a daily basis to juggle patients among besieged emergency rooms.
“Most regions in the state will only use the technology when we have a disaster. The hospitals do not all have a comfort level about sharing this kind of information because it may give another facility a competitive edge, and that needs to be addressed,” said Dr. Jimmy Guidry, the state health officer. “New Orleans does not have a problem sharing because everyone there is struggling to meet demand.”
Wait times in local emergency rooms have ballooned since Katrina because several hospitals, including Memorial Medical Center in New Orleans, closed after the storm. Those that remain open are overrun with uninsured patients who used to receive care at Charity and University hospitals, and are now looking to emergency rooms for basic medical needs.
To help relieve the backlog, hospitals are using the EMSystem to direct patients to the emergency room where they can get the most effective treatment in the shortest amount of time. The site displays what kind of beds each hospital has open — medical-surgical, intensive care, psychiatric — and uses color-coding to show the average unloading time for ambulances at each of the local facilities.
The site also has a section for comments, where hospitals can broadcast changes in availability of services that would not be discernible from looking at the general bed census. Bryan Dean, clinical manager of the emergency department at Tulane University Hospital and Clinic, said he posted a note when the CAT scanner, a type of X-ray machine that shows cross-sections of body tissues and organs, was down for an hour for maintenance.
“If you were a patient who had a head injury from a vehicle accident, this is not where you would go during that hour,” Dean said.
Routing patients
Cynthia Matherne, a regional coordinator with the Metropolitan Hospital Council, said the Web site would not be used to guide ambulances carrying patients with life-threatening conditions, such as a gunshot wound or a failing heart. Paramedics always take those patients to the nearest hospital, where they are triaged to the front of the line.
The site instead comes into play when dispatchers have to decide where to take patients with less grievous conditions who might be forced to wait several hours for treatment at a crowded facility. On busy days, stretchers can sometimes pile up several deep in the hallways.
“We are five minutes from University Hospital, and if we are swamped but University has no wait, it is in the patient’s best interest to bypass our facility and go where there is an open bed,” said Dean of Tulane.
While wait times are unpredictable, they tend to be longest during the holidays and major events like Carnival or the Sugar Bowl. Matherne used EMSystem during the Sugar Bowl to help route ambulances away from Tulane, where beds would be needed if an incident erupted at the Superdome. She also posted updates on the Web site about what was happening at the stadium.
While Matherne and others say the site, along with 800-megahertz radios the state bought after the storm, has revolutionized communication among the hospitals, some emergency-room doctors say the technology has shortcomings that impede the ability to connect patients with the facility that can offer them the most expeditious care.
Making it work
Dr. Joseph Guarisco, chairman of emergency medicine at Ochsner Medical Center, says the Web site would be more effective if it were automatically updated every time a hospital admitted or discharged a patient. As it stands now, a hospital staff member has to log in and change the bed status -- a job that sometimes gets done every two to four hours.
“Emergency departments change minute to minute. They are always in flux,” Guarisco said. “Because a person has to stop what they’re doing to update the system, it is never accurate as to what is happening at a particular moment.”
Still, he said, “this is a useful tool, and it’s great people are using it. It’s an improvement, no doubt about it.”
Matherne said she is less bothered that the site has to be updated by hand. Emergency rooms are so packed these days that beds tend to fill up the minute a patient is discharged. As much as a real-time update, she said, doctors and dispatchers need a general survey of how many patients are piling up in the lobby so they can divert patients if one hospital is getting overrun.
“The issue is how many people you have waiting to get into those beds. That is where your problem comes up,” Matherne said. “You are going to get some very sick people, some very uncomfortable people, who have to sit in ambulances or waiting rooms for periods of time. For the individual, that is very stressful.”
The bigger picture
Guidry, the state health officer, said the Web site also could give the state health department a global perspective about the capacity of local hospitals in the event of a flu outbreak or other health emergency. If the site shows hospitals are close to full, he said, the state might move patients to hospitals outside the New Orleans area.
Conversely, if a hurricane were barreling toward New Orleans, the site could help state health officials determine which hospitals in other parts of the state could receive patients from the city and its suburbs.
“It helps to see what resources are available and what might be needed during a patient surge or other out-of-the-ordinary business,” Guidry said. “It is more about broader needs.”