County tries to shorten emergency room waits

Monday, March 29, 2004 | 11:36 a.m.

The Clark County Health District is starting a trial program this week designed to improve the flow of patients through emergency rooms.

The 90-day program, which is set to begin Thursday, targets overcrowding in hospital emergency rooms caused partly by paramedics who deliver their patients quickly, but then cannot leave for up to two hours because no hospital personnel are available to take the patients.

Adding to the problem, critics say, is the practice of "diverts," where busy area hospitals take turns closing their emergency rooms for one hour to catch up on processing patients, causing other hospitals to bear additional burdens.

Under the trial plan all Las Vegas Valley hospitals will keep their emergency rooms open and paramedics will be informed about their wait times, Rory Chetelat, emergency medical services manager for the health district, said.

A conscious patient will be asked his choice of hospital. If that hospital has an hourlong wait and a nearby hospital has a 15-minute wait, the paramedic will inform the patient so he can decide if he still wants to go to his chosen hospital or to the one with a shorter wait time.

If the patient has no preference or is unconscious, the paramedic is free to take him to the least busy hospital and reduce his wait time.

The Clark County Health District Board, in approving the plan Thursday, agreed to monitor the program on a monthly basis before taking action on making the policy permanent.

Given Southern Nevada's poor track record on resolving the issue, no one appears to be turning cartwheels over the plan.

"We've tried a variety of solutions -- none of them have worked," Chetelat said. "As a result, more ambulances and (paramedic) personnel have had to be put on the streets because of the exorbitant wait times at hospitals."

Chetelat said the hospital divert program was started years ago to direct paramedics to hospitals that were the least busy. But it failed, he said, because every hospital got busy.

Board member Dr. Joseph Hardy said the health board cannot resolve this issue alone because it involves industry-wide problems, and that wait time is "just one portion of a very large, complex issue."

Statistics show that the problem with patient wait times is getting worse.

A recent health district study found that in 2001 about 60 percent of patients brought to area hospitals by ambulance were processed in 30 minutes. Last year just about 30 percent were processed in that time.

The study also found that about 95 percent of transported patients were processed within 60 minutes in 2001. By 2003 it was between 80 percent and 85 percent. The study further found that 100 percent of transported patients were processed in two hours in 2001, compared with about 95 percent in 2003.

Each year more than 125,000 people in Southern Nevada are transported to hospitals by ambulance, county officials said. Compounding the problem is that a number of them don't need to take those rides, experts say.

"There is a misconception that if you are taken by ambulance to a hospital you will be seen quicker by a doctor than someone who was privately transported," Roy Carroll, operations manager for American Medical Response ambulance company, said after the hearing.

"But we've transported patients who wound up being told to go sit in the waiting room" because their injuries were not severe.

Health board member Dr. Jim Christensen has seen such misuse of ambulance services. One incident, he said, involved a person who had a headache for three weeks, failed to see a private doctor, then took an ambulance to an emergency room at 3 a.m. one day.

He urged the district's staff to either start or continue public education programs that address when it is appropriate for someone to call for an ambulance and when to seek emergency room services.

"We need to raise public awareness," he said.