Sicker patients, competition for beds and a growing number of patients create long wait times at UK emergency room

The University of Kentucky‘s emergency room has the longest wait time in Kentucky and this time is also way above the national average, Mary Meehan reports for the Lexington Herald-Leader.

With beds regularly lining the halls of the ER, the average wait time for emergency care at UK — measured from the time a patient comes through the door to reaching a hospital bed — is 10 hours and 44 minutes, Meehan reports. This is 4 1/2 hours longer than the national average, according to Hospital Compare, a government website where Medicare reports data on hospitals.

Hospital officials blame the competition for beds between surgical and ER patients, the growing number of patients, and the fact that UK treats the sickest patients in the state.

Since the expansion of the ER in 2010, it annual patient count has risen to 70,000 from 30,000, chief nurse executive Colleen Swartz told Meehan.

Nearby, comparable hospitals have significantly shorter wait times. The University of Louisville Hospital, Kentucky’s other Level 1 adult trauma center, has a wait time three and a half hours shorter.

UK’s needs to add more rooms and beds, Dr. Michael Karpf, UK’s executive vice president for health affairs, told Meehan, suggesting the hospital’s empty, $763 million medical tower needs to be completed.

The UK Chandler Medical Center plans to expand its beds by shifting 35 acute-care beds from UK’s Good Samaritan Hospital by the end of the year, and the tower completion is set for 2018 to 2020.
But the hopspital-accrediting Joint Commission and Eugene Litvak, a Harvard University professor and expert in hospital efficiency, think otherwise.  They told Meehan that “better communication, scheduling and staffing is the solution.” The commission says those methods are “grossly underused.” 

Litvak told Meehan that building more beds is not the answer.  He said that “with increased communication, hospitals can achieve an even tempo of patient flow that will reduce ER wait times,” and how surgeries are scheduled is the main reason for wait-time problems.

Surgeons get priority on scheduling, and surgical patients get priority over the ER patients for rooms. Livtak said surgeries are generally covered by insurance, making them more profitable for hospitals, and ER patients often do not have insurance and are less profitable to treat. Things don’t change, because “We don’t want to upset our cash cows, the surgeons,” Livtak told Meehan.

Swartz acknowledged that surgery and ER patients can compete for beds at the hospital, but she said “All UK patients are treated equally whether they have insurance or not.”

A Herald-Leader editorial criticized Karpf for saying the ER would “muddle through” while beds are added, saying “Delays like those at UK can easily create patient-safety problems and affect the quality of care, especially as the Affordable Care Act allows more people into the health-care system.”

The editorial said “UK HealthCare should not push for spending hundreds of millions on more rooms without making every effort to examine and improve the ER system that could put patients at risk,” and take the advice of experts who say that more beds aren’t the answer, as well as allowing people with management backgrounds, not medical backgrounds, to improve the system through “streamlining and efficiency.”

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