Hospital Overloads Becoming a Worry

Friday, January 12th 2001, 12:00 am

By: News On 6

PHILADELPHIA (AP) â€” Hospital cutbacks and closings coupled with nurse shortages are forcing more and more overcrowded emergency rooms around the country to send ambulances elsewhere.

The hospitals do not have enough ER staff or beds to handle the crush.

Health care officials say no one in critical condition is being turned away, and other patients are simply being directed to other hospitals nearby. But they worry what could happen if the crunch gets any worse.

``We're dealing with lives. It's not like we're selling widgets,'' said Brian Connor, president of the Massachusetts Ambulance Association.

When a hospital goes on diversion, as it is known, it puts out the word to emergency services, so that ambulance drivers and their passengers do not have to wander from hospital to hospital.

Walk-in patients are still being treated, but many of them are waiting hours to be seen, and then waiting in the ER some more until a bed opens up somewhere in the hospital.

``The kind of complaint we hear is, `Yes, I got the care, but they had to put me in the hallway on a gurney for two hours,''' Pennsylvania Department of Health spokesman Richard McGarvey said.

Nearly all hospitals have to divert patients from time to time, particularly in the winter, which is the season for colds and flu, as well as chest pain and heart attacks from shoveling snow. But the problem appears to be happening more often, earlier in the season, and over broader areas than usual.

In Delaware County, outside Philadelphia, all seven county hospitals were full Monday night and went on diversion. In the Harrisburg area, all five hospitals had to divert patients for most of three days last week.

``We're not even in the flu season yet. I think, come the end of this month, we're going to be in a crunch again,'' said Cynthia Ehlers, president of the Harrisburg area's Emergency Health Services Federation.

Experts attribute the problem in part to long-term changes in the health-care industry.

In the past 10 years, more than 1,000 hospitals and 1,100 emergency rooms in the United States have closed, and others have had to cut back because of diminished payments from Medicare and managed-care plans.

Add to that a severe nationwide shortage of nurses, and an aging population that is starting to require more hospital care.

In November, Cleveland hospitals set a third straight monthly record when eight hospitals went on diversion 57 times. With hospitals filling even before flu season, Cleveland and Cincinnati authorities last month proposed opening ``treat and release'' clinics in recreation centers or schools for flu patients.

In Boston, the area's 27 emergency rooms shut down for a total of 631 hours in November â€” nearly twice the 386 hours that ambulances were diverted in October.

In Buffalo, N.Y., hospitals have reported keeping patients in emergency rooms, sometimes for more than 24 hours, until beds in intensive care or other floors open up.

Similar situations are being reported in cities such as Seattle, Tucson, Ariz., Los Angeles and New York.

``It places horrendous tension and stress on emergency medical technicians and paramedics that now have to shop around and find a hospital,'' Connor said. ``And the tension we feel on the street is probably nothing compared to what doctors and nurses feel.''

Calling the recent overloads a wake-up call, Pennsylvania health authorities scheduled a series of working groups to look at the problem and come up with solutions. Others say a broader solution is needed.

``It's like the highway system, which was pretty much ignored and fell into disrepair until federal and state governments decided they needed to rebuild the infrastructure,'' said Dr. Michael Carius, emergency room physician at Norwalk Hospital in Connecticut and president-elect of the American College of Emergency Physicians.

``We've put health care on the back burner for so long, it's going to take a massive commitment to say, `We have to have more beds, better-equipped hospitals â€” a system that meets the needs of the population.'''

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On the Net:

American College of Emergency Physicians: http://www.acep.org

Pennsylvania Department of Health: http://www.health.state.pa.us