I asked the nurse assigned to me, “How many doctors are on duty tonight?” She replied , “Two.” That confirmed my suspicion that The Medical Center’s Emergency and Trauma Center was understaffed that night, Sunday, April 3, 2011. That suspicion had been formed when another nurse, the one assigned to triage, told me that wait times would probably be up to seven hours for some of the many people sitting in the ETC waiting room, and the average wait would be about five hours. Because I had a head wound and was on a blood thinner which could have increased the chances of internal bleeding, I didn’t have to wait that long. I got to see a doctor in about two hours from the time I signed in.
So, my impression was the ETC was like emergency rooms all over the country, overburdened and understaffed, but was it? In my opinion, that night, Sunday, April 3, 2011, it was. However, it was not a normal night. I learned just how abnormal it was when I posed a few questions to Marion Scott, who is Director of Communications for the Columbus Regional Medical System. I decided to let her speak for herself unedited. This is what she wrote to me.
On the night you were treated, staffing in the ETC was at the “best practice” standard as set by the national Emergency Nurses Association. Staffing ratio is one nurse to four patients.
There were two emergency physicians in the ETC that evening; again, an appropriate staffing level under routine conditions. Residents from our teaching program do not routinely work in ETC. They do report to the ETC for duty when we call “trauma,” a designation indicating extraordinary and severe patient volume that increases staffing across clinical and non-clinical support areas. We typically have one to three trauma cases in a 24-hour period. In the 24-hour period during which you were treated, we had 20 trauma cases – seven to ten times the normal trauma volume.
You also asked about the number of patients treated in the Emergency and Trauma Center who cannot pay for care. For our last full fiscal year, which ended June 30, 2010, 86 percent of the total patient encounters through the ETC were uninsured and 33 percent resulted in uncompensated care. The Medical Center’s total uncompensated care for last fiscal year was just over $32 million.
As you and I have discussed, the greater issue related to emergency care is the number of people who use an emergency room for minor illnesses and injuries and for primary care. Approximately 40 percent of the patients treated in The Medical Center’s ETC could have been treated in a more appropriate setting, such as their physician’s office or an urgent care center. The result of inappropriate use of an emergency room is overcrowded emergency rooms with long waits, inefficient use of hospital resources and higher costs for patients and insurers.
Also, many people treated in an emergency room for minor illnesses and injuries do not have a physician, or “medical home.” It is so important to have a physician with whom you can establish an ongoing relationship and who will understand your health and medical needs and provide continuity of care.
There are no easy answers or quick fixes to these serious problems. We can address the issues through education, communication, and services to assist the uninsured in finding programs that might help them and to assist people without a physician in finding a medical home.