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Emergency rooms struggle with long waiting times

Kristin Consillio; Honolulu Star Advertiser; September 18, 2017

Kaila Toetuu spent 3-1/2 hours in the emergency room Wednesday with her left ear swollen shut and throbbing pain on the side of her head.

The 26-year-old mother of two, who lives in Manoa, arrived at the ER at around 4 p.m. but wasn’t seen by a doctor at Kapiolani Medical Center for Women &Children until about 6:45 p.m.

“It wasn’t even that crowded,” said Toetuu, who left the hospital at 7:30 p.m. “I was in a lot of pain. Going to the ER sucks because you know you’re going to be waiting at least two hours. I’ve never gone to the ER and waited less than that.”

Hawaii’s emergency rooms see more than 500,000 patients annually, and the most common complaint is long wait times, according to Dr. Eileen Hilton, CEO of Crown Care Hawaii, a patients advocacy group.

The Queen’s Medical Center in Honolulu and West Oahu, which see more than 21 percent of all ER patients in the state, have the longest average time of three hours in the ER, from entering the emergency department until discharge; while Wahiawa General Hospital has the shortest time at one hour and 50 minutes, according to data from the Centers for Medicare &Medicaid Serv­ices from October 2015 to September 2016, compiled by the Wall Street Journal. That doesn’t include time spent in the waiting room before entering the emergency department.

The average time spent in Kapiolani’s emergency room by patients who were treated and sent home was two hours and six minutes.

“Everybody hates going to the ER,” Hilton said. “Once they finally get in, they’re there forever. People who aren’t in critical condition usually have to wait quite a while, and they may be in pain. When (patients) routinely go to emergency rooms … rather than your own physician, that’s when waits get longer and longer, and potentially the care suffers.”

ER waiting times are longer for patients who need to be admitted into hospitals. Patients on average wait six hours and 22 minutes at Queen’s — the busiest emergency department in the state with 70,000 patient visits a year — before being admitted to the hospital. People admitted at Kapiolani wait an average four hours and 24 minutes.

Emergency departments are increasingly full and often have to divert ambulances. That’s largely because there are not enough long-term care and rehab facilities to move patients into once they’re ready for discharge, and more people — primarily the uninsured and homeless — are using the ER for nonemergency services.

“That’s really a big challenge because it gets scary for us in the ER when we’re holding patients and we need that space to see the next patient,” said Dr. Howie Klemmer, Queen’s chief of emergency medicine. “We’re one of (the) worst states in the country when it comes to the number of hospital beds per capita. We’re the worst when it comes to number of ICU beds and surgical beds as a state. Our state is struggling with capacity, and that’s where it’s scary.”

He added that Queen’s — which increased capacity this year to 575 beds from 505 — tries to see patients who come into the ER within 15 minutes and immediately for high-acuity cases, despite the lengthy time it takes to be admitted or discharged.

Time spent in the ER is also long on the neighbor islands.

Kona Community Hospital logged an average two-hour-49-minute wait time until discharge and five hours and 9 minutes before admission. The rural Big Island facility has been working to improve that for the past few years, said spokeswoman Judy Donovan.

“(Emergency department) waiting times are notoriously long,” she said. “We’re aware we have a problem, and we’re constantly trying to improve it. In a larger community like Honolulu, you have multiple ERs and lots of access. We don’t have a lot of resources available for emergencies because it’s such a rural area.”

The Kealakekua medical center has seen a surge in patients this year as ER use continues to grow, she said.

“When we’re at capacity, the number of beds that are in the hospital available to take an emergency patient is strained,” Donovan said, adding that the 21-bed emergency department saw 21,807 patients from October 2015 to September 2016.

The hospital expanded the emergency department to add six more beds last year and hired more physician assistants to see patients faster in the ER. The organization has also adjusted schedules so that there are more doctors overlapping in the peak hours, she said.

Hilo Medical Center said the average wait time upon arrival at the emergency department, which saw more than 48,500 visits in fiscal 2017, to getting into an ER bed is 19 minutes, despite patients having to wait two hours and 46 minutes before being discharged and five hours and 52 minutes before being admitted.

“Do I think that this is too long? Absolutely,” said Dr. Jon Martell, Hilo’s medical director for acute care. “It involves not only the triage nurse and ED doctor, but involves the admissions clerk, various aides that transport patients to X-rays and back. It involves housekeeping. It’s a somewhat surprising array of pieces that have to all move together to make it happen.”

That’s in addition to how fast existing patients can be discharged from hospitals to free up beds, he said.

“It sounds like a really simple thing,” he added. “In the old plantation hospitals you came in, got seen and the doctor either put you in a hospital bed or you went home, and it was really quick. We don’t live in that era anymore.”

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