When Emergency Medicine chief Bob Norris asked a group of about 100 people gathered May 22 in Palo Alto to raise their hands if they or a family member had ever visited the SHC Emergency Department, nearly every single person put an arm in the air.
Norris did not ask whether anyone had ever left the ED without being seen, but the dramatic numbers he shared made it very clear that the need for more space is growing much faster than the resources: The ED was built in 1976 with 30 beds – enough to treat 70 people daily. Now, between 125 and 150 people arrive for help each day.
And those arreiving are likely to have complex medical needs. Stanford’s ED is the only Level-1 trauma center between San Jose and San Francisco, A full complement of specialistis are available or on call to cope with the most dire injuries or illnesses. Those resources triple the likelihood that patients who arrive at the ED will need admission to the Hospital.
Last year, 44,000 people arrived looking for help. That was up 5 percent from the year before. This year, visits to date are up 5 percent. Norris said he and his ED colleagues have devised several strategies, including deployment of portable diagnostic equipment, to overcome the ED’s physical inadequacies.
Seven beds now line ED hallways, a less than ideal but safe accommodation when patient numbers surge beyond 30. Space for another 11 beds was found outside the ED’s area where patients can be held for observation up to 23 hours. Each of those beds, Norris said, protects two to three hospital beds needed by inpatients. The staff has worked to streamline care delivery and added a nurse callback program for ED patients that was recently recognized as “Best Nursing Team” by ADVANCE, a national magazine for nurses of all specialties.
And still, Norris said, the ED has to turn away patients. In the last 12 months, the Stanford ED could not take new arrivals, except for trauma patients, for 222 hours. (Santa Clara County limits ED closures to no more than 90 minutes at a time). Too often, Norris said, the ED backs up because no inpatient beds are available. Meanwhile the staff remains mindful that a major disaster would create a patient surge.
Paul Auerbach, clinical professor of surgery, and former ED director, followed Norris’s delivery with a one-two punch of recent national statistics. Two dynamically-opposed trends are in play, he said: visits to emergency departments are up and emergency departments are closing. Between 1992 and 2003, the visits rose 26 percent — to 114 million from 89.8 million. At the same time, 703 hospitals and 425 emergency departments closed for a total loss of nearly 200,000 beds, a 14 percent decrease.
California sits at or near the bottom of a list of state-by-state comparative data on emergency medicine and hospital care compiled recently by the American College of Surgeons. That data placed California 46th in the U.S. for both the number of hospital-staffed beds per 1,000 people and annual per capita spending on hospital care.
Hospital emergency departments are at a breaking point, he said.
“We need more than band-aids,” Auerbach said. “We never know what’s coming through the doors — it could be a child with an earache or a transplant patient in organ rejection.” And often, the ED is so overwhelmed he tells the staff, “Put on your track shoes and get ready to run.” Ninety percent of the time, he said, the ED is operating at or above capacity.
“What it really needs to be effective is more space and more people.”
The Medical Center’s renewal project will include 144 additional adult beds at the hospital and 104 beds at Lucile Packard Children’s Hospital. The project awaits local planning approval. As currently scheduled, the five-year construction effort would begin in 2010.
Within the project, the ED will be signifiantly expanded.
Community philanthropists Marc and Laura Arrillaga-Andreeson announced last November that they would contribute $27.5 million to the Hospital to build a state-of-the-art emergency department double the current size, add new technologies and increase staff to include a patient advocate program. The gift also includes an endowed position for a medical director for disaster preparedness.
The May symposium was the third in the “Healthcare Tomorrow” series, presented by the SUMC Renewal Project and co-sponsored by the San Francisco and Santa Clara Valley chapters of the American Institute of Architects.
The next free public forum will focus on back-to-school healthcare for children. It is scheduled for Sept. 18 at 6 p.m. at the Palo Alto Art Center, 1313 Newell Road, Palo Alto, where the ED seminar and others have been held.
— Courtesy Sara Wykes and SHC Department of Communication
