ER crisis:Boston
boston.com
When emergency rooms temporarily close, ambulances must be diverted
By Associated Press, 10/31/2000 07:46
BOSTON (AP) The notion that when you have a medical emergency you will be
taken by ambulance to the nearest hospital is being challenged by a growing trend
of hospitals shutting down their emergency rooms for hours at a time.
The hospitals say they are facing a lack of resources and more new patients,
forcing them to close their ER doors for hours at a time. Meanwhile, ambulance
drivers are being diverted to other hospitals, which usually adds to the time it
takes to deliver a patient.
In Boston, an average of two ERs close every day. Massachusetts General
Hospital has been shutting its ER an average of 45 hours a week in recent months,
according to a study by Boston Emergency Medical Services.
The study said waits in the ER of an hour or more are becoming standard, and
patients often leave before getting treatment.
According to The Boston Globe Tuesday, one-third of the country's hospitals are
losing money, and a third are on the brink, because of Medicare cuts, labor
shortages, the soaring costs of drugs, delayed payments from cash-strapped health
maintenance organizations, the uninsured population and the need to renovate or
build new facilities.
Massachusetts, with a higher-than-average cost for medical procedures, is the
only state where none of the major payers Medicare, Medicaid or private insurers
reimburses hospitals for the actual costs of patient care. Two-thirds of the Bay
State's hospitals are losing money, the Globe said.
Although the patient load in emergency rooms has risen about 10 percent in the
last few years, the Globe said, there is less incentive to invest in ERs than in more
financially lucrative things such as elective surgery.
According to the study, hospitals in Boston and 61 surrounding communities last
summer closed for a total of 1,064 hours, a third more than the summer before.
There were only three days from May to August when no hospital was on
diversion.
''It puts our crews on a daily basis in a very tough predicament,'' said Richard
Serino, Boston's Emergency Medical Services chief.
On Cape Cod, in Western Massachusetts and other parts of the state, ER
overcrowding is less of an option because there are not as many hospitals nearby
to pick up the slack.
To help meet the problem, state officials already have advised hospitals on ways
to alleviate the need to close, and are developing an Internet-based system of
alerting EMS on closures.
Also, Boston hospitals have agreed to cut in half the number of hours they can stay
closed at one time, and the state is urging them to develop uniform standards.
Dr. Howard Koh, the Massachusetts Commissioner of Public health, said he and
Gov. Paul Cellucci have set up a task force to study the problem.
''It's a rising public health priority,'' Koh said. ''This is just one reflection of a
health-care system in turmoil.
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Same thing next dooe in Ontario Canada:
Ontario Emergency Rooms Are a Powder Keg: Ontario Specialists
newswire.ca
TORONTO, Dec. 14 /CNW/ - "Specialists have a medical duty to patients
to
blow the whistle on the Ontario government's refusal to acknowledge what
everyone knows is a patient care disaster of unprecedented proportions in
Ontario emergency rooms. The public must be told that this government is
threatening their health in virtually every community in the province by
making insufficient investments to support emergency medical care," reported
the Specialists Coalition of Ontario (SCO), an organization representing over
9,000 medical specialists.
Ontario's medical specialists previously warned the province that the
health care system was incapable of handling the strain caused by hospital
restructuring, years of financial cutbacks, decreased investment in hospital
facilities, reductions in diagnostic equipment funding, and layoffs of
thousands of Ontario health care employees. Hospital restructuring, emergency
room closures and the aftermath of the Ontario government's continual cutbacks
are directly responsible for the emergency room powder keg. Hospitals, doctors
and health care workers are being placed in a position which undermines their
ability to provide timely medical care.
The Minister of Health's three-zone ER announcement is trying to paper
over a problem that will not go away. Fundamentally, the issues causing the
problem are unchanged. This is little more than a public relations exercise.
The government's announcement also underlines their continued unwillingness to
involve physicians in developing real solutions to real problems. It has been
clear to specialists for a long time that the solution to the problem of
Ontario hospital ER's does not exist at Queen's Park.
Medical specialists are the front line in receiving referrals coming
through hospital emergency rooms. The profile of today's emergency room
patient is alarming. ER patients are among the sickest and many should have
already been admitted to hospital beds. We have an insufficient number of
specialist physicians to care for our expanding and aging population on an
out- patient basis. As a result, increasing numbers of patients are arriving
at emergency rooms in life threatening situations. Poor planning and under
funding end up costing the health care system more and unnecessarily placing
patients in intolerable situations.
The recent statement that redirecting ambulances is an example of our
health care system's efficiency is an outrage. It conflicts with the fact that
ambulances are carrying an increased number of critically ill patients to
unknown hospital destinations. Anyone who works in hospitals knows that the
emergency rooms are stretched to their maximum capacity. They do not have the
capacity to cope with the increasing volume and acuity of patients arriving at
their doorstep. These patients require acute medical intervention in
institutions which are already overflowing.
At the same time, specialists are working longer hours because of their
dedication to their patients yet cannot keep pace with patients' needs for
their specialty care. The capacity of specialists to cope with the growing
number of acute medical emergencies is rapidly approaching a breaking point.
The shortage of new specialists, due to major reductions in medical
residency programs, the aging physician population and emigration of highly
trained specialists has made it much more difficult to replace and augment the
existing specialists in both urban and rural settings across the province.
This, combined with aging and sicker patients, increasing populations and the
reduced ability to replace outdated technology, is straining the capacity of
the existing specialists to provide care where and when it is needed. Once
again, short-sighted government decisions about physician human resources and
inadequate health care funding have reduced the level of patient care and
resulted in an increasingly intolerable strain on the system and those working
in it.
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