Ambulances stalled at emergency rooms - East Valley Tribune: Get Out

Ambulances stalled at emergency rooms

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Posted: Thursday, July 14, 2005 10:23 am | Updated: 7:21 am, Fri Oct 7, 2011.

An ambulance got Toni Poppy to Banner Baywood Medical Center in a few minutes, but it took 17 hours for her to be treated and released Wednesday from the emergency department.

Arriving by ambulance does not guarantee quick treatment in the emergency department — a lesson patients are more likely to learn now as waiting rooms packed with sick people sometimes force ambulances to wait with less critical patients, medical authorities said.

The backup, which at times has left nearly a dozen ambulances waiting several hours at one hospital, has led to a pilot program at six East Valley hospitals that aims to more evenly distribute ambulance patients among emergency departments.

If successful, the program could help ease overcrowding in some emergency rooms and get ambulances back in service quicker, said Mesa deputy fire chief Mary Cameli.

"We’re trying to fix something that wasn’t working anymore," she said. "We had no choice but to change what we’re doing."

Hospitals in Arizona use a diversion system when their emergency departments reach saturation, sending ambulances with noncritical patients to other hospitals. But in the rapidly growing East Valley, where demand for emergency services far exceeds capacity, diversion hasn’t worked, according to health care authorities.

As soon as one hospital would go on diversion, the next closest hospital would get all the ambulance traffic and go on diversion, as well, said Roy Ryals, senior vice president of Southwest Ambulance and director of emergency medical services.

Once four hospitals were on diversion, rules required that they begin rotating off of diversion for an hour.

"That ensured that the hour you were off of diversion, you were going to be overwhelmed" with ambulances, he said. "It just cascaded and it would domino in the southeast sector."

The one-year pilot program, which started June 20, replaces the diversion system followed by ambulances going to Banner Baywood, Banner Mesa and Banner Desert medical centers, as well as Chandler Regional, Tempe St. Luke’s and Mesa General hospitals.

Instead of hospitals diverting ambulances, Southwest Ambulance is using its paging system to alert emergency medical workers once three or more ambulances are waiting at an emergency room, or when one ambulance has waited longer than one hour.

Patients with less critical medical needs will then be given the choice to go to a hospital that is less busy. Critical patients will still be taken to the nearest hospital.

"It’s just to try to help people make an informed decision about where they may be seen sooner," said Mesa deputy fire chief Kenny King.

But the program, which is modeled after a similar one that was made permanent in Tucson, has limitations. Patients may still choose the busiest hospital, usually because it’s closest to their home, it’s where their doctor wants them to go, or it’s where they feel comfortable.

And even if most ambulance patients choose less busy hospitals, such patients make up about 18 percent of people seen in the emergency department. The rest come to the emergency room on their own, and many of them are more critical than patients who arrive by ambulance, said Mindy Richardson, associate administrator at Banner Baywood.

Still, any reduction in emergency-room overcrowding is welcome, and hopefully the pilot program will help, she said. Relief could also come from hospital expansions and at least four new hospitals planned in the East Valley.

So far, the pilot program seems to be working, said Ryals. "We’re having fewer long backups at single facilities."

Nonetheless, the backup is still there for patients like Poppy, who was moved from her ambulance gurney to the waiting room in Banner Baywood’s emergency department. The Mesa woman waited to be treated for high blood pressure starting about 6 p.m. Tuesday. She didn’t get home until 11 a.m. Wednesday, she said.

"There’s a constant, steady stream of traffic," Poppy said. "You have to wait your turn."

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