Hospitals Expand Emergency Rooms as Patient Volumes Rise

New Jersey Business, Apr 01, 2002 by Birritteri, Athony

Patient visits to hospital emergency rooms (ERs) are on the rise nationwide. The causes are the increase of uninsured patients which ERs cannot turn away, and managed care patients who cannot wait a handful of days to see their group network physicians, or who don't want to travel long distances outside of their communities to see a network doctor.

Coupled with a nursing shortage and a lack of hospital beds on main floors, which both create a logjam of ER patients, either lying on hallway stretchers or sitting in waiting rooms, it seems emergency departments (EDs) need a cure for their own illnesses.

New Jersey hospitals are applying remedies to combat the situation by expanding emergency room facilities, implementing technologies that better track the flow of patients and open beds, and expanding nurse recruitment efforts.

Patient visits at University Hospital, Newark, the core teaching facility of the University of Medicine & Dentistry of New Jersey - New Jersey Medical School, have increased from 35,000 during its first full year of operation (1979 - 1980), to 75,000 patients per year today The increase in volume, according to Dr. Suzanne Atkin, associate director of the emergency department at University Hospital, is due to the closing down of area hospitals such as United Hospital, a growing number of uninsured patients and "the fall out of managed care."

Atkin blames part of the increase in patient volume on managed care. "When managed care came into being, the 'experts' predicted that visits to emergency departments would decrease. Many people would see private physicians which would relieve the ER," she says. "But doctors didn't have office hours that coincided when people got sick."

The hospital, which is a Level I Trauma Center that features the NorthSTAR helicopter emergency and critical care transport system, is in the midst of a $14.7million renovation of its current emergency room, expanding the facility from 27 beds to 45 beds. To be completed by this November, the project includes a six-bed psychiatric emergency unit (already operational), the joining of what was once two separate adult ER areas with an additional eight beds, a four-bed fast track area for patients who have minor injuries, an asthma room, a larger emergency pediatrics unit, larger triage evaluation area plus waiting room and new ambulance entrance.

At a time when more patients are visiting University Hospital's ER, the facility is also grappling with a nursing shortage which, in turn, limits the number of inpatient beds a hospital can make available. This then creates a logjam of patients in the ER waiting to be admitted.

"We continuously go out on recruiting missions at nursing schools, advertise in publications and try to get referrals from other nurses," says Chris McCallion, director of patient care services for the ED at University Hospital.

McCallion is attempting to fill eight vacancies for nurse positions in the ER. What makes this difficult is that since the hospital is a LEVEL I Trauma Center, it cannot hire nurses right out of school. Two years of experience at an acute medical/surgical arena is needed.

The hospital is attempting to work around this by introducing a pilot program this spring in which it will take three graduate nurses and give them an extensive orientation.

McCallion is currently balancing the workload by a combination of regular staff nurses, per them nurses and agency nurses. The latter two groups usually work in the fast track area and holding area in which a patient is observed after treatment.

Chilton Memorial Hospital, Pompton Plains, is dealing with its nursing shortage with heavy recruitment efforts. Of great interest is its "Helping Hands" program which the 256-bed acute care hospital has implemented. Here, nurses and other personnel from different medical areas of the hospital are cross-trained to assist in the ER during times of high patient volumes.

Chilton has also been seeing ER patient volumes increasing, which now total between 35,000 and 40,000 visits per year. "We are serving 14 different townships in Northern New Jersey which are bulging at the seems," says Brian White, spokesperson for the hospital. Patient volumes are expected to increase by 8 percent to 10 percent annually Some of this increase is the result of a senior housing development being built in the region.

To combat growth, the hospital, last year, completed $3.5 million worth of ER renovations which entailed a patient bed increase from 18 to 28, mostly private rooms.

Updates were made to make the patient visit as comfortable and efficient as possible. This includes automated bedside monitoring equipment, which enables doctors and nurses to keep closer track of patients' vital signs such as blood pressure, pulse and oxygen saturation every one to two minutes.

The ED also installed state-of-the-art digital radiology imaging equipment which allows instantaneous viewing of digital X-rays by doctors and radiologists. This results in three to four times faster patient throughput and remote viewing capabilities since X-rays can be e-mailed. "Not only does this expedite the entire Xray process, it also reduces the amount of time patients spend in the emergency room and waiting area," says Dr. Gennaro Marino, director of the ER department at Chilton.