Leading Question

By Hannah Wallace October 31, 2008

Patients visiting emergency rooms these days are sicker, less insured and arriving in greater numbers than ever before.

Total ER visits nationally are up 32 percent from 1996 to 2006, according to a report released this year by the National Center for Health Statistics. Local hospitals are also feeling the crunch, caused in large part by uninsured patients opting for ER visits rather than appointments with a primary care physician.

 “A lot of these patients are uninsured,” says Michael Harrington, chief operating officer of Sarasota Memorial Hospital. “They’re not accessing routine care and then emergency care becomes their only option.”

Manatee Memorial Hospital, for example, has seen about a 6.3 percent bump in ER traffic in the past year alone. And even hospitals that aren’t seeing more patients in the ER are feeling the pains of a shifting customer base. Doctors Hospital in Sarasota actually had a slight reduction in ER visits from 2007 to 2008, but saw an increase in admissions.

“What it means is that they’re sicker when they get here,” says Doctors Hospital CEO Robert Meade. “Based on the high cost of healthcare insurance, a lot of businesses are no longer able to afford coverage for their employees. As a result, many people are waiting longer and longer to see a doctor.”

In what Meade calls “an alarming trend,” Doctors Hospital has increased its portion of net revenue to cover charity and indigent care from nine percent in 2007 to 21 percent in 2008. And while Doctors Hospital hasn’t had to reallocate personnel and other resources to handle a spike in ER visits, Meade admits that the impact on services will be felt soon enough if it continues to provide more and more care for patients unable to pay.

Changes in the ER are forcing hospitals to add staff, open new facilities, borrow available staff from other departments and make other changes, such as shortening inpatient stays and encouraging morning discharges to free up beds for when the ER starts to get busy later in the afternoon, says Linda Antes, director of Critical Care Services at Manatee Memorial.

She says Manatee Memorial added 4.2 positions this year to help triage ER patients and another two positions during the peak seasonal months to help manage admissions and treatment.

“Our process improvement has helped us manage patients more effectively,” Antes says. “Getting people upstairs is key; it’s a hospitalwide initiative to improve our ER efficiency.”

Sarasota Memorial has perhaps taken the greatest steps in recent years to manage its ER traffic. In January 2006, SMH opened an urgent care walk-in center on

University Parkway
and a year later opened a similar facility on
Stickney Point Road
. Not surprisingly, ER business at SMH’s main facility has remained steady at about 80,000 visits per year. But walk-in center volumes leaped 36.3 percent from 2007 to 2008, with many of those patients seeking treatment for less-serious conditions such as sprains, fractures and flu viruses. And the number of self-pay patients at those walk-in centers jumped from 15 percent last year to 53 percent this year, underscoring the growing struggle facing individuals and families in need of urgent care.

SMH also is in the middle of construction of a freestanding emergency care center in North Port, aimed at catching up with the growth in South County while also managing the flow at the hospital. The North Port center is expected to open in the summer of 2009.

You can expect to see continued efforts to improve emergency care efficiency, as hospital administrators everywhere expect more of the same in near future.

“Nationally, ER wait times are increasing and ERs are clogged with patients,” Antes says. “We’ve been doing some things to try to improve service. You have to. Eighteen percent of our patients are admitted, and that’s probably not going to change any time soon.”

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