Pittsburgh-area emergency rooms aren't much different than those across the country struggling to meet patients' needs in a timely fashion, if at all, a local emergency medicine expert said Thursday.
Nationally, half a million times a year -- about once every minute -- ambulances are turned away from full emergency rooms and diverted to others farther away, an investigation by the Institute of Medicine revealed this week.
The root of the crisis: Demand for emergency care is surging, even as the capacity of hospitals, ambulance services and other emergency workers is dropping.
There were nearly 114 million emergency room visits nationwide in 2003, up from 90 million a decade earlier. Yet, the number of hospitals fell by 703 and the number of hospital beds dropped by almost 200,000.
Pittsburgh hospitals are nearly as crowded and divert almost as many patients as their counterparts in larger cities, said Dr. Donald M. Yealy, vice chairman of emergency medicine at the University of Pittsburgh, who also is chief of emergency services at UPMC Presbyterian hospital in Oakland.
"Given that Pittsburgh has had a loss of hospitals in the past 10 years, most emergency departments in the region are experiencing higher volumes and having more and more difficulty caring for those patients," Yealy said. "Every site I know has these problems."
Presbyterian treated 48,000 patients in its ER last year, Yealy said. Ten years ago, it treated 32,000 patients.
Not once in that time did the hospital divert a patient, he said. "It's not that we don't allow it, but we set a very high threshold."
Other UPMC hospitals will divert patients, if necessary, Yealy said.
The Institute of Medicine report shed light on an important issue in the medical field that virtually has been ignored publicly, he said. It also cast doubt over the field's ability to handle an epidemic such as bird flu or a terrorist strike.
"(Unless) you need the emergency department," Yealy said, "you don't know about this."
West Penn Allegheny Health System attempts to avoid diverting patients, but "in extraordinary circumstances such as when no inpatient hospital beds are available and the emergency department is full, it is necessary to divert," said spokesman Dan Laurent. "Fortunately, in our system, those circumstances are infrequent."
A new patient enters the emergency room at Jefferson Regional Medical Center in Jefferson Hills once every 10 minutes, said hospital spokeswoman Charlene Frederick.
The medical center treated about 55,000 patients in 2004, ranking as the busiest emergency department in Allegheny County, according to the Hospital Council of Western Pennsylvania, and expanded its emergency facility last year to meet demand.
The Jefferson Hills department increased its space by 1,100 feet and added seven rooms, giving it 36 rooms.
"We typically don't divert here," Frederick said. "We can have very easily 140 people on a given day in a 24-hour period. And you don't know they're coming. We try to be staffed and prepared at all times."
Still, in ERs across the country, patients can wait hours, even up to two days, the Institute of Medicine report found.
"Ten years ago, it was unheard of," Yealy said. "That happens every day (now)."
