Delaware residents in need of emergency care often spend more time in the waiting room than patients in other states, according to a national study released last month.
Delaware has the second longest average emergency room wait times in the country, coming in just ahead of Washington, D.C., according to the report from the independent, non-profit investigative newsroom, ProPublica.
The national average for the time a patient spends waiting in an emergency room before being seen by a doctor, nurse practitioner or physician’s assistant is 28 minutes, according to the ProPublica study. The organization based its findings on a report from the Center for Medicare and Medicaid Services, with data collected from April 1, 2012 through March 31, 2013.
According to the study, the average wait time in Delaware is 45 minutes, with Christiana Care having the longest average wait time in the state at 1 hour and 20 minutes. Six Delaware hospitals were analyzed in the study, including Bayhealth-Kent General Hospital located in Dover. Kent General has the third longest wait time in the state, with an average wait time of 52 minutes, according to data.
The other hospitals reviewed were St. Francis Hospital in Wilmington, Christiana Care Health Services in Newark, Bayhealth-Milford Memorial Hospital in Milford, Nanticoke Memorial Hospital in Seaford and Beebe Medical Center in Lewes.
Tom Sweeney, vice chair of emergency medicine for Christiana Care, points to Christiana’s trauma unit as the main factor when it comes to ER wait times. Christiana Hospital is currently the only Level 1 trauma center in the state.
“The fact that we are a Level 1 trauma unit plays into the general acuity of this ER,” Sweeney said. “We really have a high admission rate. We are a referral center and we see a lot of patients who are quite ill or severely injured. The most critically injured patients from Kent and Sussex will be put on helicopter and flown directly here to Christiana.”
In order to reduce wait times, Christiana Care opened an emergency department in Middletown and is adding space at the Wilmington Hospital emergency department. The health care system is also adding more inpatient beds at Christiana Hospital.
According to the study, Christiana Care patients also wait the longest between entering the emergency room and being sent home, with an average time of 202 minutes. The national average is 138 minutes, with Delaware’s average at 156 minutes.
Christiana has begun implementing a new model to help medical teams move patients through more efficiently.
“We have a physician assistant, a nurse and a tech work together to see patients in the most efficient way possible,” Sweeney said. “We also have another process that focuses on staff being synchronized and working together, so patients don’t have to answer questions a whole bunch of times to different people. We get doctors and nurses in together to do evaluations and make plans of care clear.”
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Where Kent County stands
Out of the six Delaware hospitals analyzed, Bayhealth-Kent General Hospital’s patients waited the longest to be transferred from the ER to a hospital bed, the study showed.
Kent General’s average wait time in this category is 263 minutes. The data for that figure is based on a sample of cases and patients. The national average is 97 minutes; Delaware’s average wait time is 193 minutes.
Craig Hockstein, chair of emergency departments for Kent General, says the longer waits are caused, in part, by regulations on the state level.
“It is a multi-factorial problem,” he said. “It has to do with patient capacity. Often times, in any emergency department, beds are tied up with patients who have been admitted but don’t have rooms. That ties up beds and makes it hard to get patients back promptly. Part of the problem is that the number of inpatient beds is controlled by the state. [The state is] very restrictive in the number of beds that can be open.”
The problem is the same at Bayhealth’s Milford Memorial Hospital, said Bonnie Perratto, senior vice president for patient care services and chief nursing executive for Bayhealth.
“Patient volumes have increased for both Kent General and Milford Memorial,” Perratto said. “It’s like trying to put more cars on the road with the same amount of pavement.”
The number of beds in hospitals is overseen by the Health Care Commission within the Delaware Department of Health and Social Services. The Delaware Health Resources Board determines if hospitals can expand. Members of the board are appointed by the governor, said Perratto.
Hospitals have to attain a certificate of public review from the board in order to expand facilities, said Jason Sinclair, senior planning analyst for Bayhealth. A number of criteria are used by the board to determine if a hospital needs additional space or beds.
“The main thing a hospital has to demonstrate is need,” Sinclair said. “They have to show that there is a community need for the proposed project.”
The Health Care Commission regulates the number of beds in hospitals for a number of reasons, said Helen Arthur, director of planning and policy for the Delaware Health Care Commission.
“The focus is on balancing concerns of cost, access and quality,” Arthur said. “The state regulates the number of inpatient medical and surgical beds in hospitals to assure that there is continuing assessment of certain health care developments, which could negatively affect the quality of health care.”
Page 3 of 4 - To address the backup caused by occupied beds last year, Kent General Hospital began utilizing its old emergency department, which was no longer needed for emergency space when the new ER opened in 2012. The former space is utilized for patients who have been admitted but are waiting to be taken to a room, said Perratto. The space is typically used during flu season and other busy periods. The old emergency department holds 16 beds, in addition to the 40 beds that are housed in the new emergency room, Hochstein said.
How do the hospitals downstate fare?
Nanticoke Memorial Hospital in Seaford has the shortest wait time between when a patient enters the emergency room and when they are seen by a doctor, but the hospital is also facing challenges, said Penny Short, Nanticoke’s chief operating officer.
“All of us face patients who don’t necessarily need emergency care but come to the ER,” Short said. “Some don’t have access to primary care so they seek it in the ER. So when you actually have emergencies, the ER bogs down and wait times increase.”
In order to address the primary care shortage, Nanticoke has opened two urgent care facilities and has hired additional nurse practitioners in its primary care offices. One of the ways that both Lewes’ Beebe Medical Center and Dover’s Bayhealth-Kent General Hospital keep patients moving is to run an internal waiting room.
“We bring people into a treatment room and they’re evaluated by a physician and a nurse together,” said Loretta Ostroski, director of patient care services at Beebe Medical Center.
“They have initial testing done, such as lab work and X-rays, and then they go into an internal waiting area to wait for their results and we can use a treatment room for another patient.”
At Beebe, the flow of patients in and out of the emergency room is something that the staff keeps tabs on daily, Ostroski said.
“We constantly look at, on a daily basis, how quickly we are able to get patients out of the ER and the hang-ups you might have, such as getting patients up to inpatient beds,” Ostroski said. “Another problem is getting patients discharged because you have to get patients who are in inpatient beds out with the outpatient resources they need, so that patients that are new to inpatient beds can get in.”
Another factor that slows down the flow of emergency room traffic, Ostroski said, is when beds are tied up by behavioral health patients who need to be transferred to other treatment facilities.
Page 4 of 4 - Monitoring patient flow is something that every hospital has to tackle one day at a time, according to Ostroski.
“The challenges are different every day based on what’s happening,” she said. “That’s why hospitals, every day, have to monitor bed flow.”