Maine's ER emergency
By Lindsey Tice
,
Staff Writer
Sunday, August 26, 2007
LEWISTON — It’s just after noon on a recent Monday, and St. Mary’s Regional Medical Center’s emergency room has just gotten slammed.
Two trauma patients. A guy from a car accident. A handful of mentally ill patients and addicts. People with various illnesses, injuries and levels of pain.
A man in jeans and an open-back johnny walks unsteadily down the hall. From a corner bed, a woman’s staccato snores are drowned out every few minutes by the sound of a man retching.
In a curtained cubicle at the far end of the ER, Florence Doe, 84, and her daughter, Diane, patiently wait for a doctor. Florence had been feeling sick and weak that morning. After she passed out, an ambulance brought her in.
“I’ve been here a couple of times this year,” said Florence, who was a nurse during World War II. “They give very good care. Very good care.”
Good care is what St. Mary’s prides itself on. But 17 years after it built its current ER, and about seven years after the department’s last expansion, the hospital says it needs a bigger, better place if that level of care is to continue.
It plans to spend — and has gotten state approval for — $8.5 million to triple the size of its ER.
And the Lewiston hospital isn’t alone.
• Less than two miles away, Central Maine Medical Center — struggling with its own 17-year-old facility — says it will seek state approval next year for an ER expansion.
• In Portland, Maine Medical Center plans to nearly double the size of its ER, while Mercy Hospital renovated its ER two years ago and is discussing plans to expand again.
• In Norway, Stephens Memorial Hospital got a new ER four years ago, while Rumford Hospital debuted one last year.
• Maine General Hospital overhauled and expanded two ERs — one at Augusta and one at Waterville — several months ago.
More patients come in every day, Maine hospital officials say. There are greater mental health issues. More medical technology to consider. Increasing demands for privacy.
They need the space, they say. Now.
During its worst days — days just slightly busier than that recent Monday — St. Mary’s moves its least serious patients from the ER back into the waiting room. It has 21 beds, and sometimes that’s just not enough.
“The actual need is there,” said Nurse Manager Anita Lalonde.
Gurneys in the hall
On average, U.S. hospitals get 383 ER visits for every 1,000 area residents, according to the Maine Hospital Association. New England averages 439. Maine averages 540, ranking it fourth in the nation per capita.
And the number is growing.
Emergency room visits rose 26 percent between 1993 and 2003, according to a national survey. Local hospitals say their ER visits increase up to 8 percent every year.
National experts say a shortage of primary care may be to blame. Or a lack of health insurance. Or an aging population. No one really knows for sure.
In Maine, experts believe substance abuse and mental health crises are sending a greater number of people to the ER.
“Our behavior population has increased, my gosh, I don’t know how many fold. Maybe four or five,” said Marge Powell, a longtime nurse at St. Mary’s. “Some of it is truly sick, sick stuff. I’ve seen a psychotic child at 4 (years old).”
Maine experts also say high quality emergency care — and the immediate availability of that care — may be leading some patients to use the ER instead of a family doctor, even though ER visits are often more expensive.
“Consumer expectations have increased,” said Mary Mayhew, vice president of the Maine Hospital Association. “People don’t necessarily want to wait to get into a doctor’s office or squeezed into an appointment.”
But the ER’s popularity causes problems for both hospitals and patients. When an ER gets busy, wait times skyrocket. When people rely on expensive emergency care, health-care costs skyrocket.
Right now, capacity is the biggest problem, local hospitals say. When an ER can’t handle a sudden influx of people, patient privacy and medical care can suffer.
At Central Maine Medical Center, for example, patients end up lying on gurneys in the hall.
CMMC’s emergency room was built in 1990 to handle about 25,000 visits a year. It now gets 52,000 and is full “almost every day, usually by midday,” said spokesman Chuck Gill. The hospital wants to spend about $15 million to $20 million to expand the ER.
“We don’t want to get to the point where we’re not providing good care,” said Peggy McRae, nurse manager for the emergency department. (While still commonly referred to as ERs, most hospitals now call them emergency departments, reflecting their growth in size and the types of problems they treat — from sprained ankles to psychiatric patients.)
Of central Maine’s six hospitals, four have either built a new ER, dramatically expanded or plan to. The fifth, Bridgton Hospital, just opened its doors in 2002.
The sixth, Franklin Memorial in Farmington, has no immediate plans for an expansion, but officials expect the issue will come up.
“In the long-term plan, in the next three-to-five-year plan, it’s being looked at, that’s for sure,” said George Long, nursing manager for Franklin Memorial.
Rising costs
While expansions may help hospitals keep up with patient demand for ER services, there is a question of cost. When a hospital does a building project, patients often end up paying in the form of higher hospital bills.
Consumers for Affordable Healthcare, a Maine-based advocacy group, hasn’t tracked ER expansions in particular, but it does watch hospital expansions in general.
“That’s an issue we very much care about because it drives up costs,” said Policy Director Hilary Schneider.
Before hospitals spend millions to dramatically expand their ERs, she’d like the hospital industry to find out exactly why ER visits are increasing. She’d like to see doctors’ offices — many of which are now hospital-owned — provide an on-call doctor so patients don’t have to go to an ER after business hours. And she’d like to see ERs refer non-emergency patients to local primary care doctors rather than treating them, as long as the patients can wait.
She believes those changes could help ease the burden on ERs, without the expense of major expansions.
“Hospitals are a billion-dollar, several-billion-dollar industry,” she said. “They should be able to figure out this issue.”
In an effort to control health-care costs, Maine does require hospitals to seek state approval for any large building project. Four hospitals applied this year. Three of them asked for ER expansions.
All of the ER projects — at Mid Coast Hospital in Brunswick, Maine Medical Center and St. Mary’s — were approved. Each will cost between $8.5 million and $25 million.
St. Mary’s plans to triple its ER space with a design that calls for 30 exam rooms instead of 16 curtained areas, a second triage room, a separate ambulance bay for psychiatric patients and a decontamination suite. The current ER was built in 1990 to handle up to 25,000 visits a year. The hospital now gets about 30,000. The new ER will accommodate 37,000.
At $8.5 million, it’s the cheapest expansion of the three approved this year. The hospital will fund-raise the money, and officials say they won’t pass down the cost to patients.
“I don’t think it (the cost) will impact patients, especially those here,” nurse manager Anita Lalonde. “But they should be entitled to the very best possible care.”
CMMC will seek formal approval for its expansion early next year. To pay for the $15-million-to-$20-million project, the hospital will use some of the money it already has and borrow the rest.
“We need to have the facilities that match the demand for our services,” said Gill. “With the wrong facility we can’t guarantee patient safety and quality of care.”
Hospitals say they’ve tried to work around their ER issues, tried to put off expensive expansions.
Because primary care physicians seemed to be lacking in the area — a problem that draws patients to the ER — both CMMC and St. Mary’s routinely recruit family practice doctors to Lewiston-Auburn. Because non-emergency cases can quickly clog an emergency room, CMMC and St. Mary’s also offer separate fast-track areas for sprains, colds and other minor health issues.
They say they’ve also tried to nudge ER patients toward primary care doctors. At St. Mary’s, for example, the ER gives patients a card with the number of its physician referral line. The goal: Get ER patients to follow up with, and sign up with, a regular doctor.
“We do our best to get them out of that groove and get them into primary care,” said spokesman Russ Donahue.
But hospitals say demand still outpaces their ER capacity. Expansion, they believe, is their last best option.
“We probably should have done it five years ago,” said Gill at CMMC.
‘It’s always been busy when we’ve been here.’
Back at St. Mary’s, the ER quiets down.
It’s just after 1 p.m. and patients with minor problems have been treated and sent home. Three of the five psychiatric exam rooms have been cleared. The two trauma patients have been moved.
Of the 10 or so ER patients left, some are waiting for tests, some are waiting for doctors and a few, including Florence Doe, are waiting to be admitted. After examining her, Florence’s doctor still isn’t completely sure why she passed out.
As she and her daughter, Diane, wait for her to be moved upstairs, they talk about the hospital. Florence had visited the ER twice in six months, once for pneumonia and once for the flu.
“They get right at you,” she said.
Although she’s never had to wait long or go back to the waiting room during an ER rush, Florence and her daughter said they would support an expansion.
“It’s always been busy when we’ve been here,” Diane said.
ltice@sunjournal.com |
 CLICK HERE To Show/Hide Discussion Thread - (8 Comments)
Comments
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Posted By:Anne at August 26, 2007 12:38 PM (Suggest Removal)
This story makes me so angry! I have been an LPN for 18 years. I have more experience than 3/4 of the RN's who work in the local hospital yet, the hospitals will not hire LPN's. Up until about 15 years ago, LPN's were just as good as RN's. I worked on the Med/Surg and Maternity Units right beside the RN's. Then someone decided LPN's shouldn't be used in hospitals. Suddenly no one would hire us. Our jobs were dissolved and we had to find work elsewhere. We can only get jobs in nursing homes or doctors offices. Good jobs are few and far between for LPN's. I would love to go back to school and become an RN but thats just not possible with my current financial situation. I have applied at many hospitals, as recently as last month, and been told "If only you were an RN, I'd hire you in a minute." I have the knowledge, skills, and experience to be an awesome asset to patient care, but no one will give an LPN a chance! So, it is hard for me to feel sorry for the hospitals who cry nurse shortage. There are many LPN's out there who are just as good as RN's, who are excellent workers with a wealth of knowledge, they just won't hire us! they should use their LPN resources, we went to nursing school too!
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Posted By:Just a thought at August 26, 2007 3:21 PM (Suggest Removal)
Anne...you are so right on! Everything is about money and hospitals basically gave up on an entire profession--LPN's.
In their rush to expand their ER's, who do you think ends up paying for it.....the patient! And why is St. Mary's ED so much more expensive? It is time that patients take charge and become wise shoppers for health care.
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Posted By:James at August 26, 2007 5:47 PM (Suggest Removal)
LPN's have never been "just as good as RN's." Sorry, Anne: two completely different educational and professional philosophies, licensing procedures, responsibilities, KNOWLEDGE. If you felt so highly of yourself and your skills, you would have found a way to become an RN these past eighteen years. As for patients and what they want - they want the best - and unfortunately for you, the RN is the gold standard (and too bad for the ADN and Diploma nurses, too - there has been talk for years of phasing them out, too, and making the BSN the entry level to nursing practice.)
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Posted By:NightCrawler at August 26, 2007 6:38 PM (Suggest Removal)
It's par for the course for the LSJ that they are, once again, tap-dancing around the PRINCIPLE cause of, in this case, overcrowded emergency rooms. Put the blame where it squarely lies, LSJ! The blame lies with the state of Maine and MaineCare. Period. Did anybody bother to ask any of these hospitals what percentage of emergency room patients are insured by MaineCare? OF COURSE NOT! I bet the percentage is well above 70%. MaineCare recipients don't care about rules, and therefore don't care about first seeing their primary care physician BEFORE getting their hangnails and headaches treated at the emergency room. Emergency rooms should be reserved for EMERGENCIES. I wonder how many TRUE emergency medical situations have occurred where "MaineCare Mary" and her ingrown toenail took up an emergency room bed that could have been used for "Cardiac Charlie", who ended up receiving delayed treatment or ended up dying.
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Posted By:reggie at August 26, 2007 6:52 PM (Suggest Removal)
Steve you are right on the money. However if you read the article, it states the percentages of Mainecare for both hospitals in Lewiston. I have seen patients become extremely aggrivated in a waiting room when "Cardiac Charlie" comes in and goes to be seen before the person with a cough. I wish that people could realize this....IF YOU ARE COMPLAINING ABOUT THE WAIT AND HOW MANY PEOPLE ARE BEING SEEN BEFORE YOU, THEN YOU ARE NOT SICK! GO HOME AND LEAVE THE ER FOR EMERGENCIES. People just don't understand, what if that heart patient or trauma patient was a family member of yours, wouldn't you want them to be seen first? It's triage categories and our population in Lewiston will never be smart enough to understand it.
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Posted By:Horse lover at August 26, 2007 7:30 PM (Suggest Removal)
Steve T. You are correct. I am a medical transcriptionist for a local emergency department. The majority of the patients are Mainecare with problems that should be taken care of in their physician's office. But why wait? We have a local ED to go to, and we don't have to pay anywhere we go any way, so why wait to get an appointment like those who have insurance or are self-pay? It is now a + if you speak Somalian in the L/A area...I hope the ED employees are brushing up on their Spanish, because soon they will be treating Mainecare Hispanics.
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Posted By:Anne at August 26, 2007 9:19 PM (Suggest Removal)
James, You have obviously never known or worked with a GOOD LPN. I can't tell you the number of "gold standard" RN's who have come to ME, in your opinion, a lowly LPN, for assistance when they don't what to do or how to handle an emergency. All I'm really saying is that there is ALOT of work that I could do to alleviate some of the stress and work from the RN's if given a chance.
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Posted By:Bill at August 27, 2007 3:19 PM (Suggest Removal)
Having been an LPN and returned to school to receive my ADN and then later my BSN (currently working on my MSN) I have to agree with James. There is a major difference and I was a GOOD LPN and still work with many exellent LPNs whose skills I treasure. But they are not RNS and the difference is truly there. I too thought, as an LPN, I knew as much and was as capable as any RN... I was wrong. And there is a difference between the associates and the bachelors degrees as well. Don't gripe, go back to school(you are never too old) and make yourself more marketable.
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