Ambulance Diversion Common in Michigan


Holly Klaft | | Tuesday, March 25, 2008

FLINT, Mich. -- Full hospital beds. Packed emergency rooms. Long waiting times.

They've become frequent problems at Genesee County (Mich.) hospitals, which are turning patients away to let staff catch up with the sometimes-exploding number of people in need of emergency care.

"It's a combination of capacity issues at all three hospitals," said John Stewart, director of emergency department operations at Hurley Medical Center. "It's a cyclic phenomenon."

The county's three hospitals have been closed to incoming ambulances for more than 384 hours combined since Feb. 1, according to Genesee County Medical Control Authority statistics.

Hurley Medical Center and McLaren Regional Medical Center both shut their doors to ambulances early last week due to a packed ER.

And for about 2 1/2 hours last week, all three hospitals were reported closed to incoming ambulances - at which point patients were transported to the nearest hospital available, despite overflowing ERs.

Though area doctors say they try to keep wait times to a minimum, patients can end up sitting in the ER for hours when the sick and injured start filling up beds and waiting rooms.

About five months ago, Antonio Watts said he spent nearly six hours in Hurley's ER waiting to be seen for a dislocated shoulder.

"There were people waiting in the hallway in beds because it was so full," said Watts, 27, of Flint. "It was bad. I was in pain."

Not every ambulance is turned away during an overcrowding crisis. Those carrying children, patients with potentially life-threatening conditions and walk-ins were still accepted during the recent shutdown. However, ambulance patients who didn't need to be seen immediately were sent elsewhere.

"This is just an exacerbation of an ongoing problem," Dr. Ray Rudoni, director of emergency services at McLaren Regional Medical Center, said Tuesday afternoon while the hospital was diverting ambulance patients. "The entire hospital is full of new patients already."

The emergency room's 36 beds and makeshift holding areas had been overflowing for hours, Rudoni said.

But there's no single reason for the influx of patients, he said.

"I know we're coming to the end of flu season, but I can't say we're seeing mostly one thing," Rudoni said.

Doctors and medical authorities say a number of factors can contribute to emergency room overcrowding, including cold and flu season and full beds throughout the hospital that can keep patients lodged in the ER until one opens up.

Officials also speculate that the growing number of uninsured, who may see the ER as the only option for primary care, may have an impact. About 46 million people nationwide are without health insurance.

"When they come in, they're pretty sick and it takes longer to manage," Stewart said. "Typically people who don't have insurance have less prehospital and preventative care."

The hospitals are trying to combat the problem by expanding their emergency departments, creating auxiliary ER holding areas and calling in more staff when patients pour in.

The county's Medical Control Authority has tried to make the diversion process more efficient by establishing an automated system that warns ambulance providers of a full ER.

Before the system was established this year, hospitals had to call each Emergency Medical Service provider to inform them of a diversion.

"The communication about diversions is quite rapid," Joe Karlichek, vice president of operations for STAT EMS, said of the new system. "It was a little helter-skelter before."

There's no set formula for when a hospital does decide to divert ambulances; it's just a judgment call that staff must make based on ER wait times and capacity, said Dr. Michael Jaggi, emergency department chairman at Hurley.

The decision to shut out some ambulances is a last resort when all other means to control surges of patients have been exhausted, he said.

The same holds true at Genesys Regional Medical Center, where hospital staff use a scoring system that's based on capacity, the number of patients in the ER and their medical conditions to determine when to divert.

"Our goal is not to go on diversion at all," said Kim Johnson, director of emergency services at Genesys. "Once we go on diversion, everyone's trying to work and do whatever we can to come off that."

County hospitals are continuing to evaluate ways to accommodate more patients and cut down on diversions, said Stewart of Hurley.

Still, there doesn't seem to be an immediate solution.

"It never seems like it's very far away," he said of the ER closings.

Approximate amount of time Genesee County hospitals were closed to incoming ambulances from Feb. 1-Thursday:

Hurley Medical Center: 67.5 hours

Genesys Regional Medical Center: 189 hours

McLaren Regional Medical Center: 128 hours

Amount of time hospitals diverted ambulances in 2007:

Hurley Medical Center: 318.5 hours

Genesys Regional Medical Center: 225 hours

McLaren Regional Medical Center: 677.5 hours

Source: Genesee County Medical Control Authority

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