Hospital emergency departments across the U.S. have faced myriad unique challenges for years. From the smallest rural community hospital emergency rooms to the fastest-paced, big city trauma centers, areas of concern range from extended waits and people coming in for basic (non-emergency) treatment to maintaining adequate levels of physician and nurse coverage.
Here in south Florida, emergency department challenges run the gamut. “Overcrowding is a huge problem,” says Nabil el Sanadi, M.D., chairman and director of the emergency department at Broward General Medical Center. “We’re a Level I Trauma Center and the largest emergency department in Broward County, but about half our patients use the ED for primary care. That’s happening at other hospitals, as well.” The reason, he believes, is because “emergency is in the eye of the beholder. A lot of 911 calls are transported by ambulance, and they make the call as to where to bring the patients.” He adds that the problem is magnified between the Thanksgiving and Easter seasons. “That’s when the snowbirds come down here,” he says. “It’s an older population with more illnesses.”
The overcrowding problem often begets additional challenges, according to el Sanadi. “There’s also a manpower shortage at hospital emergency departments in general,” he says, adding that, “we’re blessed at Broward General with excellent recruitment and retention packages for nurses.” He also points to regulatory issues and constraints. “Because of regulations such as EMTALA and COBRA,” he says, “emergency departments are the only specialty area that, by law, has to see every patient that shows up.”
Operational and regulatory issues aside, one relatively new challenge faced by emergency departments is the ongoing need to be aware of and prepared for situations that are potentially terrorism-related. “Since 9/11, we’ve been the safety net for communities,” says el Sanadi. “Should there ever be a problem involving weapons of mass destruction, serin gas, dirty bombs, anthrax or the like, people will come here. Add to that epidemics and natural diseases and ongoing problems with AIDS and syphillis, and you can see how we could be stretched to our limits. Although, even in a time of physician shortages, we have three specialists on our ED staff so, we’re in excellent shape.
At Cape Coral Hospital, a community hospital that’s part of the Lee Memorial Health System, Emergency Department Director Polly Spate immediately mentions the fact that the ED is very busy.
Lee Memorial Health System has an emergency department at each of its five hospitals, and each has its own characteristics. For example, Lee Memorial Hospital operates a trauma center, while Health Park Medical Center specializes in cardiac and pediatric emergencies. And Cape Coral Hospital has the distinction of being the only hospital in Cape Coral, so things can quickly become very hectic. “When that happens,” she says, “the department often becomes overcrowded, with patient overflow spilling out into the corridors.
It can be dramatic. Spate notes that patient levels at Cape Coral have been increasing by three to six percent annually, as more people remain in Florida after the winter season. “But still, the overcrowding problem is seasonal.” she adds. “When springtime rolls around, the patient volume returns to normal.”
When things are at their busiest, Spate says, people will get frustrated and leave without being seen. To help alleviate the situation, the hospital is undertaking a variety of initiatives. A recently begun renovation project will increase the number of beds from 24 to 42 by the year 2010. “Also,” Spate says, “we’re staying current with core measurements, like providing EKGs within 10 minutes. Like all other hospitals, we have our challenges and we deal with them.”
Dawn Nesbitt, who was hired two years ago as director of emergency services at Plantation General Hospital, part of HCA, says she has been seeing a consistent national shortage of nurses. “Not really at our hospital, but overall it’s an ongoing national issue,” she says. She attributes to problem to a few factors. “Nursing schools are experiencing high enrollment but a decrease in the number of professors, so the waiting list is getting longer” she says. “And, the turnover rate at hospitals is very high in south Florida as nurses are retiring, so there are fewer replacements available for them.” To address that problem, Plantation General has been working with its own staffing agency.
Like el Sanadi, Nesbitt mentions the ongoing challenge of having to provide care for non-emergency patients in the ED. “Many people don’t have primary care physicians, so they use the emergency department as a doctor’s office.” To help address the problem, the hospital has instituted a screening program that helps staff determine the level of each patient’s emergency.
“Through a specialized program, we screen patients to assess whether an emergency exists,” she says. “Each patient receives a medical screening exam to determine if there is a medical emergency present. If not, the patient is informed about alternative treatment options, and the decision to receive care at the hospital is decided by that individual seeking care. This helps us provide faster treatment to those individuals who are experiencing a medical emergency.
