By Paul Leighton
Ambulance patients could be facing longer waits at local emergency rooms under a new state policy prohibiting overcrowded ERs from closing their doors.
Starting Jan. 1, hospitals will no longer be able to "divert" patients to another hospital when their emergency rooms are full. Local hospital officials say they have been preparing for the change for months, but waiting times could be longer, especially during flu season.
"I think you'll see patients on ambulance stretchers an extra 10 to 15 minutes while they're trying to find a bed," said Jonathan Epstein, executive director of NorthEast Emergency Medical Services, which coordinates ambulance service in the area.
The new policy has been adopted by the state Department of Public Health to force hospitals to deal with the problems that lead to backups in emergency rooms, such as the lack of available inpatient beds to move patients out of the emergency room.
Officials at Salem Hospital and Beverly Hospital say they have adopted new strategies to improve the flow of patients and lessen the strain on their emergency rooms. Salem Hospital holds daily "bed huddles" where nurses from all floors meet to identify when and where beds will become available. Beverly Hospital has a "bed czar" whose job is to keep patients moving from the ER to inpatient beds.
Lou Woolf, chief operating officer at Salem Hospital, said one strategy is as simple as making sure empty inpatient rooms are cleaned as quickly as possible when the emergency room is crowded.
"We can send an all-points-bulletin to housekeeping that whatever else you're doing, seven rooms on the inpatient unit need to be cleaned and prepared with the highest priority," he said.
Lahey Clinic in Peabody rarely diverts patients because it can admit them to its Burlington campus, which has undergone a $100 million expansion, said Jeff Doran, senior vice president of operations at Lahey.
All three local hospitals have been steadily decreasing the number of hours on diversion, according to statistics from the state Department of Public Health. Through October, Salem Hospital and Lahey Clinic had cut their totals by more than half from the same time last year, while Beverly Hospital had reduced its total by nearly one-third.
In October, Beverly Hospital was on diversion for only four hours and Salem Hospital for two hours. Lahey Clinic did not turn away patients at all.
Salem Hospital is voluntarily banning diversions this month as part of a pilot program to prepare for Jan. 1.
"Our goal is not to have any hallway patients anywhere," said Jane Clarke, director of patient care for the Salem Hospital emergency department.
Emergency room overcrowding is caused by several factors, hospital officials say, including a shortage of primary care doctors that leads people to rely on the ER for their health care. It can also be difficult to find an inpatient setting for psychiatric patients, forcing them to wait in the emergency department for days.
Diversions send patients to less crowded emergency rooms, but the practice also puts them in unfamiliar hospitals that don't have their medical records. And it ties up ambulances that are forced to travel farther from the areas they cover.
Epstein, the emergency medical services director, said the diversion problem on the North Shore is not as bad as in Boston at the bigger hospitals. But the Jan. 1 ban will force hospitals into "behavior change," such as surgeons operating seven days per week instead of five and primary care doctors making rounds earlier in the morning so that patients can be discharged earlier.
"It'll be interesting to see what the true impact is," he said.
Hours on diversion
Hospital 2008* 2007
Salem 201 528
Beverly 79 245
Lahey North 23 50
* Year to date
