Expansions not likely to alleviate ER overcrowding

Jace Radke

Friday, Sept. 15, 2000 | 12:04 p.m.

Despite two hospital expansions set to open in the next few weeks, and another scheduled for completion later this year, the Las Vegas medical community may only be treading water when it comes to dealing with overcrowded emergency rooms.

Dr. Paul Fischer, director of the emergency room at Columbia/HCA Healthcare Corp.'s Sunrise Hospital, will soon be running a 35,000-square- foot emergency room after a $14 million expansion is completed in October. Despite the latest technology, and more beds for patients, Fischer says the expansion may only allow the hospital to keep pace with the area's growing population.

"We're just chasing our tail," Fischer said. "What do you do in a community that is growing by 4,000 people a month? No one saw this coming. It's the same thing you see at the DMV and in the schools."

As soon as next week, MountainView Hospital could open its $34 million, 72-room expansion that includes new operating rooms with open-heart surgery capabilities.

In December University Medical Center is scheduled to open an emergency room expansion that will include 51 emergency room beds in a 26,000-square-foot facility. UMC's $18.5 million expansion will add a 26,000-square-foot intensive care unit and critical care unit.

Helen Vos, vice president of clinical services at MountainView, says the expansions could help drop the frequency of incoming patients being rotated to different hospitals when overcrowding is at its worst. The rotation, known as divert status, occurs when a hospital does not have enough beds to handle a certain type of patient, whether it's someone headed to the ER, pediatrics or another medical unit.

"It's hard to tell if the additions will help with overcrowding," Vos said. "I think we'll have to go through a winter divert before we know whether this will make a dent in the problem.

"Our problem here is that we have so many people waiting for a bed that they take up emergency room beds. We're thinking that the added beds upstairs will take care of that and open up our emergency room."

Dr. Dale Carrison, director of UMC's emergency room, says the problem of other patients taking up emergency beds is what causes the overcrowding at all of the Las Vegas Valley's hospitals.

"There are enough emergency room beds in Las Vegas right now to handle the population.

The problem is that the emergency rooms get filled up with people that need to be in monitored beds," Carrison said. "We see people in the ER every day, and we can handle that. It gets overwhelming when we can't get people to hospital beds, and they end up stuck in the ER waiting for a spot."

Overcrowding and the forcing of emergency rooms into divert status is borne out of greater numbers of sick people and a national nursing shortage, Carrison said.

"We have an aging population and sicker patients that need monitored beds," Carrison said. "There are beds in Las Vegas, but there just aren't enough nurses to monitor them all because of the nursing shortage across the United States.

"My hat is off to my nurses because they are getting stuck with the load. They are emergency nurses having to do in-patient care, and that's not what they signed up for."

Fischer is looking forward to the expansion of his emergency room, but like his colleagues doesn't believe it will help alleviate the crowded conditions.

"Two years ago we had a group of hospitals open up on the west side of town, and we thought that would probably alleviate some of our problems," Fischer said. "It honest-to-goodness did not make a dent for us.

"Our expansion will create a bigger space for us and allow for better patient flow and tracking. It should provide quicker service for someone who comes to the emergency room, is treated, and then goes home. But we'll still have the same problem of gridlock when people come to emergency and then need to be admitted."

Emergency rooms are hit the hardest during the fall and winter flu season, but this year hospital staffs haven't had much relief with divert status becoming a constant even in the generally slower spring and summer months.

If a bad flu bug hits Las Vegas this year the emergency rooms could reach a breaking point, Carrison said.

"That's what everybody is worried about," Carrison said. "Last year we got the flu shots for the flu that ended up here, but this year there is a shortage of flu vaccine. We could be looking at a bad flu epidemic."

American Medical Response Director of Operations Brian Rogers is also uncertain over how much of an influence the expansions will have when flu season hits.

"We're not talking about making a dent, it's more like a nick," Rogers said. "It quieted down for a couple of weeks in August, but now it's busy again and we're back on divert going into flu season."

More than 80 local health care executives are meeting today to discuss the divert crisis in an all-day summit organized by AMR.