Stretched to capacity, hospitals expand EDs - Triangle Business Journal:
DURHAM – To understand the state of the emergency care, consider this: all five major Triangle hospitals are spending millions to expand their emergency departments.
Hospitals say they are adding everything from emergency room beds to freestanding emergency departments. Along the way, hospitals have to deal with round-the-clock staffing, an unpredictable patient volume and numerous uninsured patients.
Those factors are a constant drain on the hospitals’ bottom lines.
“Generally, emergency departments are not considered to make money,” says Dawn Carter, president of Health Planning Source, a Durham-based health-care consulting firm. “Some emergency rooms may break even or make some money, depending on the area they serve, but it is very difficult.”
More people are being seen annually in area emergency rooms. From 2004 to 2008, ED patient visits at Rex Hospital increased 11 percent, from 49,649 in 2004 to 55,274 in 2008. The Triangle’s population growth accounts for some of this increase, says Mary Lou Powell, senior vice president of patient care services at Rex.
Part of the increase also can be attributed to the people who seek care in emergency departments because they have no other options, says Janice Frohman, director of emergency services at WakeMed’s Raleigh campus, which saw 118,413 ED patient visits last year.
“Many people use the emergency room like their primary care physician,” she says. “We are seeing many patients who are uninsured that simply have no place else to go for health care.”
Across the Triangle, emergency departments are expanding to meet the increased need. Many have carved out separate emergency care areas by patient groups, such as adults, children and psychiatric emergencies.
Duke University Hospital’s emergency department upgraded in 2007, expanding from 54 to 82 beds. With 71 beds now, UNC Hospitals’ emergency department will add 21 beds by the end of 2009.
WakeMed is expanding throughout Wake County with freestanding emergency departments, a new concept in emergency health care. Currently, WakeMed is awaiting approval of free standing emergency departments in Garner and Brier Creek.
Rex Hospital, which has a 41-bed emergency department, is expanding its after-hours treatment with urgent care centers around the county. Currently, Rex has urgent care centers in Cary and Wakefield.
Two other Rex urgent care centers have been approved. They will open in May 2009 in Holly Springs and Knightdale. Another urgent care is planned near the Lake Boone Trail hospital to open in July 2011.
“The urgent care model with its extended hours is a great option for patients,” says Bernadette Spong, vice president of finance and chief financial officer of Rex Hospital. “It is less expensive for patients, and they are typically seen much quicker than in the emergency room.”
Hospitals are expanding their emergency care for a variety of reasons.
Jeff Horton, acting director of the N.C. Division of Health Service Regulation within DHHS, says freestanding emergency departments bring care closer to residents.
“The trend now is to bring the emergency health care services to the growth areas where the residents live,” he says. Carter says free-standing emergency departments in fast-growing areas serve as a doorway into the larger hospital system. Patients seen at these EDs often are admitted or referred to the hospital for more treatment. Also, hospitals when faced with packed EDs can shift patients to free standing sites, Carter says.
The opening of a freestanding emergency department in the suburbs can help pave the way for the next hospital location. In fast-growing Johnston County, Johnston Health, based in Smithfield, is building a $30 million medical center that will include an emergency department in Clayton. It is scheduled to open in July 2009.
Hospital officials have plans to expand the center into a full-service hospital in Clayton, says Suzette Rodriguez, community relations specialist with Johnston Health. Plans are to move 27 acute care beds from Smithfield’s Johnston Medical Center to Clayton.
According to census data released in August, about 16.4 percent of North Carolina residents, or 1.5 million people, do not have health insurance. This is above the national rate, which was 15.3 percent last year and is the 13th highest in the nation.
“More and more people without access to a primary care physician come to the ED for non-emergency care,” says Jeff Doucette, associate operating officer for emergency services at Duke University Hospital. “This helps create a large backlog of patients.”
The Emergency Medical Treatment and Active Labor Act, passed in 1986, requires hospitals to provide care to anyone needing emergency treatment regardless of citizenship, legal status or ability to pay.
Emergency rooms are the most expensive places to seek care, experts say. The average cost of a visit in Wake County is $1,100, according to published data.
To overcome lengthy lines, Triangle hospitals employ nurses to screen patients and ensure the seriously ill are treated first. Doucette says the average time in the ED at an academic hospital like Duke or UNC Hospitals is five hours. Both hospitals, along with WakeMed in Raleigh, are Level 1 trauma centers and treat the most seriously injured. The average time at other hospitals varies from two to three hours.