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Columbus Dispatch - Ohio State hospitals turn away ER patients

By Ben Sutherly - Columbus Dispatch, December 30, 2014

Ohio State University's emergency departments have been turning away patients far more often in recent months as a result of overcrowding.

From July through November, Ohio State diverted patients to other local hospitals for approximately 378 total hours, or the equivalent of nearly 16 days, from emergency departments at the main hospital and University Hospital East.

For the same five-month period a year earlier, Ohio State diverted emergency-department patients for an estimated total of 49 hours, or about two days.

"Diversion is not something that we want to do," said Dr. Thomas Terndrup, chairman of Ohio State's emergency-medicine department. "There's a lot of (holding onto) patients who should be admitted who are still in the emergency department."

The spike in diversion time coincided with the opening in early August of the new emergency department on Ohio State's main campus.

Though the new emergency department increased Ohio State's available emergency beds from 54 to about 74, a backlog remains among patients who are waiting in the emergency department for an inpatient bed to become available, Terndrup said.

That backlog has been aggravated in part by a considerable increase in patient transfers from other hospitals, said Dr. Andrew Thomas, chief medical officer for the university's Wexner Medical Center.

Ohio State accepts thousands of such transfers each year, and those transfers essentially compete with OSU emergency-department patients for inpatient beds.

The emergency department also has seen a 1.1 percent increase in emergency-department visits so far this fiscal year compared with the year-earlier period, Thomas said.

Such a modest increase "is noticeable in a setting where you already have crowding problems," Terndrup said.

University officials said they hope the opening of the new Arthur G. James cancer hospital this month will reduce the backlog. Since mid-December, university officials say there are signs of a " decompression," though they said it was too soon to say whether there had been a clear improvement.

The emergency department's capacity will increase to 106 beds by April 1, after a renovation of University Hospital's old emergency department is complete, according to Terndrup.

In the meantime, Thomas said, a 12-bed transition unit on the seventh floor of Rhodes Hall has helped somewhat with the overcrowding during the past several months.

The use of diversion by Franklin County's hospitals and free-standing emergency departments has dropped off significantly since mid-2012, according to data The Dispatch obtained from Ohio State through a public-records request. The data were compiled by the Central Ohio Trauma System.

Marie Robinette, the trauma system's executive director, cited several possible reasons for what she described as a "drastic decline" in the use of diversion in a letter to Ohio State in August. Among them:

  • An increase in free-standing emergency departments.
  • Hospital efforts to improve moving patients through emergency departments.
  • Modified procedures for handling surges in behavioral-health patients.
  • An overall increase in hospital beds in Franklin County.
  • Emergency-department expansions.
  • An increase in patients who aren't as sick going to urgent-care centers instead of emergency departments.

Robinette could not be reached to comment.

In recent years, Ohio State's emergency department has been vexed by some of the longest emergency-department stays in the state, averaging more than 6 hours.

A full hospital is good for business. But turning patients away also has a fiscal impact, costing the university's Wexner Medical Center an estimated 2,800 admissions during the five-month period, according to Peter Geier, chief executive officer of the university's health system.

Geier anticipates it will be April or May - several months after the opening of the new James - before officials have a clearer picture of the emergency department's "new normal."

bsutherly@dispatch.com

@BenSutherly

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