By Cortney Fielding
Pasadena Star-News (California)
Copyright 2006 MediaNews Group, Inc. and Los Angeles Newspaper Group, Inc.
All Rights Reserved
PASADENA, Calif. — Pasadena paramedics warn that overcrowded emergency rooms are forcing them to divert patients at an ever-increasing rate, ultimately impeding the quality of critical care they can provide.
Hospital closures have hindered the Fire Department’s ability to answer 9-1-1 calls, they claim, resulting in longer ambulance response times as paramedics drive farther outside the city to reach open emergency rooms.
To help combat the strain of hospital diversions and increasing patient loads, the Pasadena Fire Department will add a new ambulance and six new paramedics to its staff of 65 in 2007. The department also will purchase an additional rescue ambulance.
Experts say the local diversions are part of a larger national trend — one that presents a real danger to patients.
“For time-sensitive situations, this is going to be a big deal,” said Dr. Benjamin Sun, an emergency room physician and associate professor of clinical research at UCLA who authored a study on the subject.
“We are just seeing crowding getting worse and worse, and while diversion was intended to be a temporary solution, unfortunately it’s become a common everyday practice,” he said.
In 2005, one out of three ambulances in Pasadena was diverted from its intended hospital. And more than 400 of the estimated 12,300 emergency calls coming into the Fire Department had to be fielded by outside agencies because paramedics were unavailable.
While the figures represent only a small percentage of total calls, the number is alarming when compared with 139 diverted calls in 2004, said Kevin Costa, Pasadena Emergency Medical Services battalion chief.
“It’s a dramatic increase,” he said.
The statistics offer a glimpse into a taxed health care system that hasn’t stabilized since a round of hospital closures earlier in the decade.
In 2002, Tenet Healthcare Corp. announced it was closing St. Luke Medical Center in East Pasadena because of dwindling profits. Two years later, the company shuttered Santa Teresita Hospital in Duarte, blaming the closure on a state mandate to increase the nurse-to-patient ratio. Tenet said the added costs were too burdensome for the financially troubled facility.
The closures spread emergency resources thin throughout the San Gabriel Valley. In Pasadena, Huntington Hospital — the city’s one remaining hospital — saw emergency room visits increase by 50 a day in the immediate aftermath.
And that number continues to grow, said Huntington spokeswoman Connie Mathews. Now, the hospital built and staffed to hold 3,000 patients a year treats almost twice that, she said.
“It’s definitely worse now,” she said.
When emergency rooms become saturated with patients, they are allowed to stop taking patients in a process known as diversion.
Last year, Huntington Hospital’s emergency room was closed for more than 4,000 hours. At the same time, the hospital diverted almost 2,000 ambulances to other hospitals.
And while diversions allow emergency rooms to catch up, it causes a chain reaction for emergency workers, who are forced to drive farther outside the city in order to unload patients.
Pasadena ambulances find themselves increasingly headed to hospitals in Arcadia, Verdugo Hills and Glendale to help with the overflow.
That means there’s lag time while the rigs return to the city, Costa said.
“We are having to drive further and further out, and that affects us greatly,” Costa said.
The typical emergency call now lasts 52 to 55 minutes — from the time paramedics leave the station to the time they drop off patients and return.
When Pasadena paramedics can’t reach a patient in time, they say they must call in an ambulance crew — often from another city or private company. These outside crews average 8 minutes, 17 seconds to reach a patient - 17 seconds beyond the nationwide call time standard. Pasadena paramedics admit they are already pushing the standard, averaging 8 minutes exactly.
While experts say that in rare situations, diversion time can result in drastically reduced care or even death in a patient, the average effects are hard to gauge. Few institutions have the capability to track how patients are impacted by increased waits. Sun said data collected in Canada, one of the few countries that conducts ambulance diversion research, may shed light on the issue soon.
“We know diversions are happening at increasing rates,” he said. “The next question we have to answer is `What does that mean?”’
All officials contacted for this story agreed that hospital closures aren’t the only factor responsible for the current situation.
Cathy Chidester, assistant director for Los Angeles County’s Emergency Medical Services agency, said there are simply more patients using emergency services now than even four years ago.
An aging population, a rise in the number of uninsured patients using emergency rooms for primary care, as well as nursing ratios that limit the number of patients that a hospital can treat all clog the system, she said.
“The point is, emergency rooms are closing and patients needing emergency rooms are growing.”
The San Gabriel Valley isn’t the only area feeling the crunch. According to the American Hospital Association, between 1992 and 2000, the country lost 2,000 emergency rooms. Meanwhile, the number of patients visiting emergency rooms rose by more than 18million, to about 108 million per year.
According to Los Angeles County Emergency Medical Services statistics, there are currently 75 hospitals countywide to treat about 10 million people, down from 84 in 2000. And those hospitals are going on diversion an average of 8 percent more this year versus last.
But while the burden on emergency services increases each year, Costa said the situation is not hopeless.
In April, the state passed a law requiring hospitals on diversion to open their doors for at least 15 minutes of every hour they’re closed.
At Huntington, a planned emergency room expansion, which is still some years off, should relieve some of the pressure, officials said.