By Angela Stewart
Star-Ledger
Copyright 2007 The Star Ledger
New Jersey — With emergency room visits on the rise, some New Jersey hospitals are straining to find enough staffed beds to treat patients, resulting in a statewide average of one ambulance an hour being diverted, a report released yesterday found.
The stress on bed capacity is so bad — especially during flu season and other peak periods — the state’s hospitals would have a difficult time responding to a major health disaster without displacing many existing patients, according to the report by the Rutgers Center for State Health Policy.
“During peak periods, the state’s hospitals appear to be extremely constrained,” the report concluded.
In 2005, the number of emergency room visits in New Jersey rose to 3.36 million — up 4.5 percent over the previous year and more than 25 percent since 1998, according to the report.
The problem of capacity is especially acute in hospital units such as critical care, where the nationwide nursing shortage has hit hard.
“It’s not always as simple as saying hospitals have fewer staffed beds,” said state Health Commissioner Fred Jacobs. “Emergency department diversions occur when units like critical care are full.”
Since 1995, 17 financially strapped acute care hospitals have closed in New Jersey and a commission appointed last year by Gov. Jon Corzine to review how the state’s health care resources are distributed could result in the closing of other weak performers.
Because many procedures that once required hospital stays are being done in an outpatient setting, the average daily census in hospitals has dropped, said Ron Czajkowski, a spokesman for the New Jersey Hospital Association. As a result, hospitals have consolidated some units in an attempt to increase occupancy and reduce costs. While increasing efficiency, it has also resulted in fewer beds available for sick patients.
In 2005, for example, there were 47 days when more than 95 percent of all staffed hospital beds in the state were occupied, up from 29 days in 2004 and 11 days in 2003, according to the report.
That meant about once every hour an ambulance carrying a sick patient had to be diverted to another hospital, said Derek DeLia, the senior policy analyst and Rutgers assistant professor who authored the report, titled, “Hospital Capacity, Patient Flow and Emergency Department Use in New Jersey.”
He said diversion tends to increase during times of peak demand, such as the first three months of the year, when flu season is at its height. Hospitals also see an increase in volume on Mondays, resulting in many being nearly 90 percent full Tuesdays through Friday, before rapidly emptying on the weekend.
He said doing a better job managing factors that affect capacity — such as ensuring patients who are ready to leave the hospital are cleared by doctors for discharge in a timely fashion — can help the system run smoother.
“Hospitals that are better at streamlining these kinds of issues can take on more volume,” DeLia said.
But under current conditions, the state’s hospitals have “almost no surge capacity available” to respond to major medical emergencies, such as a terrorist attack or a pandemic, he added. From 2003 to 2005, there were fewer than 500 empty staffed beds available per million residents on any given day, the report found.
And with growing use of the emergency room, things are not likely to improve. Hospital Association officials say emergency rooms are treating a growing number of uninsured, as well as patients who don’t have access to a family physician.
“We’re also hearing that even insured patients who don’t choose to wait a few days for a physician’s appointment are using the emergency department more,” said Czajkowski, the association spokesman.
Even people with chronic health conditions such as asthma and congestive heart failure are increasingly making more visits to the emergency room, the report notes.
Some inner-city hospitals have responded by developing chronic disease management systems within their emergency departments, according to the report.
Laurence DesRochers, president of the New Jersey Chapter of the American College of Emergency Physicians, said the report presented no surprises, noting hospitals are continually working on capacity issues.
“Many hospitals are now even using outside consultants to help from a business perspective,” said DesRochers, who is an attending emergency physician at Community Medical Center in Toms River.