June 14, 2010 in City

Hospitals look for options as more use ER as instant appointment

By The Spokesman-Review
Colin Mulvany photo

Dawn Scott holds her 4-month-old daughter Kailee as Providence Sacred Heart Medical Center Pediatric Emergency Center nurse Cassandra Dubbels does an evaluation Wednesday. Scott brought her baby to the emergency room because the child was having breathing problems caused by a respiratory infection.
(Full-size photo)

By the numbers

230,000: Annual visits to Spokane’s main emergency rooms.

1 in 3: Emergency room visits that are to treat an injury.

30,000: Spokane County residents would gain insurance under new federal mandates.

Emergency rooms in Spokane are busier than ever as annual visits to the four main hospitals have topped 230,000.

What’s driving the numbers? Though the swell of uninsured and poor people in waiting rooms is certainly a cause, it’s not so simple.

A growing shortage of primary doctors, sicker people, diabetics, the mentally ill left to fend for themselves, and more elderly all play a role. And so does this: an impatient group of patients. Many people have been conditioned to expect immediate results and are unwilling to wait to see a doctor for mild maladies. They go to the hospital instead.

A report last month from the Centers for Disease Control and Prevention found similar trends across the country. Health insurance coverage or a lack thereof was not associated with emergency room patients being triaged as nonurgent.

Emergency rooms will treat about 120 million people this year.

Dawn and Eric Scott recently took their 4-month-old daughter Kailee to the emergency room at Sacred Heart. She had already spent five days in the hospital to fight a stubborn respiratory virus that commonly sickens infants.

When baby Kailee seemed to labor with her breathing, the parents brought her back.

“This has been hard to get over,” Dawn Scott said.

Kailee is enrolled in Washington state’s Children’s Health Insurance Program, subsidized coverage that has helped parents afford health care for their children.

Providence Sacred Heart Medical Center and Providence Holy Family Hospital are in the early stages of a program to curb the rising use of emergency care.

Just 1 in 3 of those 120 million visits this year will be to treat an injury.

The hospitals would attempt to link emergency room patients who need primary care or other services with family medicine clinics in the hope of avoiding expensive nonemergency hospital visits.

Asking physicians to leave appointment times open for the possibility of such a referral is a sacrifice, acknowledged Elaine Couture, chief executive of Sacred Heart and Holy Family.

As an example, Couture spoke of helping people manage diabetes instead of waiting for them to reach an acute phase where emergency care and hospitalization become necessary.

“Everyone realizes the need to move away from the ER being the default provider,” she said.

It’s not just medical clinics that need to participate. Social service agencies and organizations have been asked to help.

Cathy Simchuk, vice president of trauma care for Sacred Heart and Holy Family, said such a broad collaboration needs to emphasize a set of communitywide health offerings that range from ensuring children have enough to eat for lunch during the summer months to helping the homeless sleep warm during the depths of winter.

Federal health care reform is expected to help at least some of the problems facing emergency rooms.

The major changes are still three to four years away, including the aim of insuring 94 percent of Americans. If realized, such insurance reforms would translate to 30,000 more people in Spokane County gaining insurance, said Dr. Andrew Agwunobi, chief executive of Providence Health Care.

The number of uninsured in the county has reached 12.8 percent. It does not include those covered by Medicaid and Medicare.

About half of the uninsured are ages 18 to 34. A provision that allows 19- to 26-year-olds to remain on their parents’ coverage plans kicks in this year.

Some say the possibility of many more people attaining insurance coinciding with a deepening shortage of primary care doctors could be problematic. Emergency room care has changed in Spokane during the past two years. Sacred Heart is now the busiest and boasts its status as the only major trauma center in the county.

Deaconess Medical Center surrendered its similar status last year in the wake of Sacred Heart buoying its offerings and hours.

Yet Deaconess, along with Valley Hospital and Medical Center, continues to see about the same number of emergency room patients for treatment, said spokeswoman Christine Varela.

The hospital has looked at improving its emergency department as part of a larger strategy to upgrade buildings and equipment.

Sacred Heart is drawing up construction plans that should add rooms to its ER.

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