Getting tight-ER: Economy packing Triad emergency rooms - NC

Emergency room directors across the Triad say the tight economy is causing their waiting rooms to swell even more than they predicted earlier this year.

Hospitals, already strained by dwindling insurance reimbursements and rising costs, are trying to develop new ways to deal with those patients — about a quarter of which will never be able to pay — by fast-tracking cases that aren’t true emergencies.

The ERs at nearly every area hospital have seen steady increases in the number of patients in recent years, with a rise of about 3 percent annually.

This year, the growth rate has more than doubled or tripled at some hospitals as patients lose their employer-sponsored health insurance or delay treatment until manageable conditions require a more intense, immediate and expensive course of action.

Forsyth Medical Center, for example, set an all-time record for emergency patients in May, with 9,424 people streaming through the ER that month. That was almost 9 percent higher than the 8,666 patients the hospital had budgeted for in its annual projections and 10 percent higher than the 8,534 patients who visited during May 2008.

The Winston-Salem metro area alone has lost about 7,600 jobs during the past year, according to the N.C. Employment Security Commission. Jason Carter, vice president of operations at Forsyth Medical Center, said the higher volumes in the ER are almost entirely due to the economy.

“As we have looked at people losing their jobs and becoming either uninsured or underinsured, this has become a very busy place,” Carter said. “We anticipated higher volumes, but all our projections are getting blown out of the water this year.”

As a result, Forsyth Medical Center is trying out a new system of five zones based on patient acuity.

A registered nurse sees patients immediately when they walk through the door to gauge the severity of each case. Three days a week, from 3 p.m. to 11 p.m., a so-called green zone staffed with nurses and a physician assistant will see patients with more minor needs. A yellow zone sees patients who are slightly more serious, while orange serves as a swing unit and red sees the most pressing cases. A blue zone treats patients with behavioral health needs.

Early results show the process is helping relieve wait times. Patients in the green zone previously were waiting 63 minutes before seeing a doctor, but the wait time has dropped to 26 minutes during trials. Total length of stay has gone from two hours and 16 minutes to an hour and 13 minutes.

And Carter says the department is able to see as many patients a day in three rooms as providers were treating in 14 rooms before, which creates more capacity to treat more serious conditions.

In the yellow zone, for those who might need a bit more intensive treatment than the green zone, total length of stay has dropped from roughly four hours to two and a half hours.

While Carter says Forsyth Medical Center is proud of its increased efficiencies, he said the improvements are also aimed at better overall care.

“We’re not looking to put up a billboard that says we guarantee we’ll see you in 90 minutes or under,” he said. “We want people to seek us out because the we can make the experience less miserable and we catch those clinically important things.”

The only alternative
The growth is no different in Guilford County; data show the Greensboro-High Point metro area has lost more than 23,000 jobs during the past year, three times as many as Forsyth.

High Point Regional Medical Center has seen 16,755 patients in its ER, an almost 7 percent increase from the 15,706 emergency patients who came during the same period last year.

“It’s the only alternative (for medical care) that a lot of people have right now,” said Meg Cashion, manager of the emergency department at High Point Regional. “I think that’s probably the biggest factor.”

Cashion said her hospital is also working on new processes to improve patient flow. She declined to elaborate on the process — which is being run on Mondays and will expand to two days a week in August — but she said the goal is to get patients to a doctor sooner and move lower-acuity patients through quickly.

“I can just say we have cut a substantial amount of time” off the average length of stay during trials, Cashion said.

At Wake Forest University Baptist, emergency volumes were 24,487 during the past three months, up about 9 percent from 22,499 during the same period last year.

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