Hospital E.R. visits increase

Recent area hospital closures and a nationwide nursing shortage led to a 27 percent surge in emergency room visits at the GW Hospital between June 2002 and June 2003. While the hospital has been forced to turn away some patients because of overcrowding, officials said they are making a concerted effort to treat all students needing medical attention.

The closing of D.C. General Hospital, which stopped providing inpatient care in 2001 and downgraded its emergency department last May to an urgent care center, is now only suited to treat minor ailments. The status of Greater Southeast Community Hospital, which suffers from staffing shortages and is under review by the D.C. Health Department for having inadequate treatment facilities, exacerbated the closure.

The result is an increase in traffic at other D.C. hospitals, particularly GW. Besides the Children’s National Medical Center, which registered a 28 percent increase in emergency room visits, GW’s visit increase is the highest, according to a report from the D.C. Hospital Association.

“Over time, we have seen an increase, and a lot of those patients seem to be coming from (the Southeast) quadrant of the city,” said GW Hospital spokeswoman Marti Harris said.

Harris said the GW Hospital’s emergency room is so full that incoming ambulances are sometimes directed to other hospitals.

“Sometimes if emergency rooms are full they will tell ambulances that they need to be diverted to other hospitals,” Harris said. “On occasion, that does happen here … We do our best not to divert ambulances, but we need to take care of the patients that are here. So when we are at our maximum, it’s in the safety of all our patients that we call on ambulance diversion.”

Harris said while backups in the emergency department can occur, the hospital does its best to treat students who arrive at the hospital.

“We work very closely with the University when there’s a student who needs medical attention to try and accommodate their needs,” she said.

The problem is not confined to GW. Since the closing of D.C. General, which is the only city-funded hospital in the District, all of the city’s non-federal hospitals have seen a boost in emergency room visits. Joan Lewis, vice president of the D.C. Hospital Association, said the problem is serious.

“[The issue] affects all of us,” Lewis said. “It doesn’t matter if you have good insurance or no insurance. If you can’t get into an emergency room because of overcrowding it can have an impact on how quickly you’re treated.”

Lewis said many local healthcare providers worry with winter approaching, emergency rooms will be ill-prepared to deal with a potential infectious disease outbreak.

“Right now we have these kinds of heavy increases in the summer months,” he said. “If there’s a flu epidemic or there’s some infectious disease like SARS, it could make it even worse.”

A nationwide nursing shortage, which runs at nearly 20 percent in the District, also boosted emergency room traffic, said Lewis, who described the shortage as a “driving force” behind the District’s overcrowding problem.

“Hospital directors are saying, ‘Even if I could build another ward or change the configuration of my hospital to add another 10 double rooms, I don’t have the nurses to staff it,'” Lewis said.

GW nursing officials said while the waning number of nurses is an issue, a variety of steps have been taken to confront the problem, and nursing vacancy rates are lower than at other area hospitals.

“We do have a shortage of nurses in terms of filling all the positions, but I don’t think it’s as bad as other hospitals,” said Madeleine Cooper, head of nurse recruiting at the GW Hospital. “I get calls from all over the country from nurses wanting to work at GW.”

Aggressive recruitment efforts have provided a boost in staff at the hospital.

Quinn Collins, director of clinical operations for GW’s nursing department, said the hospital’s internship programs have played a major role in alleviating the problem. On Monday, 33 new nurses began internships that will last for three- or four-month periods; they will temporarily fill staff vacancies.

Collins said technology has also played a role in retaining nurses and easing some of the pressure on the hospital staff.

“We increased our technology,” said Collins.” We’ve got new computers and X-ray machines on the floors. We’re going to computerized medication administration.”

Medical and emergency department directors representing District hospitals met this past week with D.C. Health Department Director James Buford to discuss the burdens on the city’s hospitals, with another meeting planned for next week, Lewis said.

While no specific actions have been taken, Lewis said area hospitals are talking to city officials about improving the efficiency of Greater Southeast and D.C. General. Last week, Greater Southeast established a permanent nursing staff, to reduce reliance on on-call nurses from other hospitals, Lewis said.

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