When 11-year-old Daniel Ratcliffe fell from a swing at his Central Austin home, his mom rushed him to Dell Children's Medical Center emergency room.
After waiting nearly five hours on a Monday night last month while children wailed and some parents yelled to get attention in packed waiting rooms, Daniel and his mom, Debbie, left in frustration about midnight without ever seeing a doctor. A private doctor put Daniel's fractured wrists in casts two days later.
Hospital officials concede that they opened an ER with too few beds and staff members to meet demand. They now are moving to add both.
"We're much busier than we anticipated," said Bob Bonar, hospital president and CEO.
Like other area hospitals, the newest one in Austin is experiencing wait times in the ER. But having waits that trigger a plan to add beds is not something a new hospital expects.
"I would still bet you lunch we're the fastest (emergency department) in the city, except for the small, boutique places, like Heart Hospital and Westlake," said Dr. Pat Crocker, chief of Dell Children's emergency department.
Bonar and other hospital officials had predicted that it would take much longer than two months for people to get used to coming to the new hospital, the only one for children in a 46-county region. Children's Hospital of Austin, which closed June 30, had been on the Brackenridge Hospital campus, at 15th and Red River streets, for years. Some pediatric specialists and nurses stayed behind to treat children, but with a trickle of children coming, those staff moved to the new hospital, near Interstate 35 and 51st Street.
Construction projects to add up to 24 beds have been proposed, with half of the beds expected to be available next summer. The rest have to be approved by higher-ups , Bonar said.
Three more doctors are being hired, and so are more nurses, Crocker said.
Starting in a week or so, a doctor will be added to the triage area for 16 hours a day, so patients won't have to wait long for treatment to start, Crocker said. Right now, one nurse works that area 16 hours a day.
"Currently, our standard (for exam room waits) is under three hours," Crocker said.
The long-term goal is to reduce wait times to an hour or less, Bonar said.
The new hospital opened with 34 ER beds, which on paper is 14 more than old one. However, the old ER opened up additional beds in the day surgery center in the evening, and six of the 34 beds aren't for everyday use, so the gain at the new hospital wasn't that much, Crocker said. The new hospital is owned and operated by the Seton Family of Hospitals; previously it was part of Brackenridge, which is publicly owned.
Patient loads initially seemed manageable, officials said, although July and August provided clues that predictions were off. Hospital officials had predicted that in its first year, Dell Children's would see about 80 percent of the 52,000 patients the old hospital saw in its last year. But ER visits were up 2 percent in July and 1 percent in August from the previous year.
In September, typically the slowest month for ERs, patient visits soared 18 percent over the year before, data show.
If that pace continues and officials believe it will the Dell Children's ER could see 60,000 to 65,000 patients its first year, Crocker said. Those levels were not expected until 2012, he said.
The hospital was built with "shelled space" to add ER beds, and although Bonar is relieved to have it, he did not expect to use it so soon.
Bonar received drawings Tuesday to fill in the shelled space with 11 or 12 beds and expects them to cost a total of roughly $700,000 to $900,000. He is proposing adding 12 more beds; if the Seton board agrees, they'd be for children who need to be treated for less than 24 hours but not admitted, Bonar said.
Debbie Ratcliffe said it was clear the ER was understaffed.
"It was easily 40 minutes to get a bracelet," said Ratcliffe, who is a spokeswoman at the Texas Education Agency.
Monday nights are notorious because people who get sick on a weekend and can't get in to see a doctor during the day end up in the ER. Also, uninsured and underinsured people often use ERs for primary care, especially in Texas, which has more uninsured people than any other state.
Ratcliffe saw a child come in who had dropped a load of bricks on his feet, which were bruised and bloodied. He cried for two hours in the waiting room, she said. An 8-month-old who had arrived by ambulance with a 105-degree fever before she and Daniel got there also waited five hours and was taken to the exam area only after the family complained loudly, she said.
"A number of people walked out and just gave up," she said.
"All of the staff I saw were constantly busy," Ratcliffe added. "It's not like they were slacking off. They were overwhelmed."
Crocker said he "hates to hear these stories, but I know they're probably true."
He thinks the schedule changes, new hires and, ultimately, the additional beds, will make a difference. His goal is to make the ER one of the nation's best in a few years, and he encourages parents to bring their children there, even bypassing other hospitals, unless the child is not breathing or does not require immediate aid.
The American College of Emergency Physicians has a different view on ER use. It says people should feel comfortable taking their children to "any emergency room that is appropriately staffed."
"If the child has a chronic medical condition that is rare or complex or cared for by specialists at the children's hospital, then it can be the best choice," said Dr. Rick Blum, a past president of the college. He is certified in pediatric emergency medicine and works in the ER at West Virginia University Hospital.
Crocker said he is pleased so many parents are flocking to the new hospital.
"Despite the challenges, we're all very enthusiastic about the community's response to the new medical center, and we're going to do everything we can to respond rapidly," he firstname.lastname@example.org