Paramedics call it “hugging the wall.”
It’s what they do when they find a hospital emergency room is too busy to receive the patient they’ve brought in; they get off to the side and tend to the patient until he can be admitted to the emergency room.
In ERs across the country, hugging the wall has become standard practice. At Huntington Hospital, in the only remaining ER in Pasadena, it takes an average of 26 minutes before a 911 patient can be admitted and the ambulance is available again.
That only covers the instances when ambulance units get in the door. For an average of 214 hours each month (30 percent of the time), Huntington’s ER is in ambulance diversion mode, when the ER is full and ambulances that would normally come to Huntington are instead sent to nearby hospitals in Glendale
Walk-in ER patients have gotten used to waiting, too. Wait times at Huntington’s ER can extend up to six or eight hours during the busiest times in the afternoon, according to Jeanette Abunis, clinical director of Huntington’s emergency department.
With demand for care rising as the number of ERs falls, the overcrowding at Huntington is not uncommon.
“We’re not the only ER experiencing these capacity issues,” Abunis said.
In fact, the situation at Huntington is better than most places in the county. A February report by the Los Angeles County Department of Health Services found that the three county-run emergency rooms all had average wait times of more than nine hours.
“[Ambulance] units in Compton are waiting two to three hours [to admit patients],” said Ray Gordon, battalion chief of the Pasadena Fire Department’s emergency medical service. “There are a lot of other parts of the county that would love to only wait 26 minutes.”
Wait times at Huntington should improve, as the Pasadena City Council has approved an expansion that would more than double the size of Huntington’s ER, increasing the number of beds from 23 to 53. Hospital officials believe the expansion would allow the ER, which was designed to accommodate 30,000 patients per year but currently sees around 65,000, to treat up to 90,000 patients per year.
The expansion project, which would involve the construction of a new four-story tower on Fairmount Road, awaits approval by state agencies before work can begin. The hospital plans to fund the $65 million project, which is expected to take three to four years to complete and would not impact the hospital’s capacity during construction, entirely through philanthropy.
Gordon said the expanded ER at Huntington would be a great asset. But if current care demand continues, it would not be long before the expanded ER, too, would be overwhelmed.
“It will probably give us five or seven years of breathing room,” he said.
A federal Institute of Medicine report in 2006 found that the demand for emergency room care nationwide had increased 26 percent since 1993. More and more people are turning to ERs for care that had typically been provided by primary care physicians or at outpatient clinics.
“We have people coming in with bad head colds,” said Huntington spokeswoman Connie Matthews.
Much of the blame has been placed at the feet of uninsured illegal immigrants. Philip Chen, health deputy to County Supervisor Michael Antonovich, said that in order to relieve overcrowding at ERs, “we have to solve the problem of illegal immigration,” before acknowledging, “There is no panacea.”
But Dr. Brett Eastman, co-author of the Institute of Medicine study, cautioned against that logic. He noted that, while the numbers of both legal and illegal uninsured residents continue to rise, they don’t account for the entire scope of the problem.
“One of the misconceptions is that they’re overburdened because of the uninsured, but the data showed that wasn’t entirely the case,” Eastman said. “A great deal of the crowding was caused by the ER being utilized by people with non-emergent conditions who were fully insured.”
Eastman said that ERs have in some ways become victims of their own success.
“Our ER physicians are excellent, and the American public now views the emergency department as a very efficient place to go for primary care,” he said.
“People feel that, if they want an answer today, they’d come to the emergency department,” she said. “It’s viewed as a one-stop shop.”
In addition to the burden created by increased demand, ERs are constrained by capacity issues in the hospital in general. As the baby boomer generation ages, it becomes more common for the inpatient beds at the hospital to be full, meaning that emergency room patients who are ready to be transferred into the hospital often must remain in the ER.
“When the hospital gets backed up, there’re no beds at the inn,” Abunis said.
Meanwhile, the number of overall emergency rooms continues to decline. Since 2000, 12 emergency departments have closed in Los Angeles County, with only three opening in the same period.
Hospitals are providing more uncompensated care to uninsured patients while Medi-Cal reimbursements continue to shrink in relation to costs, meaning most ERs are money-losers. Huntington Hospital provided more than $26 million in uncompensated and charity care last year, much of it in the emergency department.
“It’s like any business, when one department is losing money you try to make up for it in other departments,” said Matthews of Huntington Hospital, which reported $9 million in income in 2006.
With each ER closure, the strain on neighboring ERs increases. Harbor-UCLA Medical Center, which saw increased traffic after the closure of Martin Luther King Jr.-Harbor Hospital in August, was recently reprimanded for its long wait times by federal regulators, who threatened to pull funding from the hospital. That threat has passed for now, but the underlying problem remains. Huntington Hospital officials say they started seeing about 50 more ER patients per day following the closure of St. Luke Medical Center in 2002.
There are some positives in Los Angeles County emergency care, including a highly coordinated regional trauma system that ensures victims of trauma — including car accidents, falls, gunshot or stab wounds — are taken directly to the hospital best suited to care for them and never diverted.
But the overall pressure on ERs shows no signs of abating. Gordon, the EMS battalion chief, said Pasadena residents are lucky to have a quality hospital in Huntington, and that its proposed expansion would be a blessing for the community.
“Hopefully it will carry us for several years,” he said. “But the unfortunate side of this is we’re at the tail end of a failed healthcare system. Until there’s a wholesale change in the way we do business, [the expansion] is a Band-Aid. It’s a very big Band-Aid, but just a Band-Aid.”