Old ills plague new hospitalBacklog in emergency now typical at Stroger
Sunday, January 15, 2006
by Ray Quintanilla
Millie Thomas was rushed to Stroger Hospital gasping for breath, her heart racing, head dizzy, but it wasn't until she arrived in the emergency room that she broke into a cold sweat.
Thirty moaning patients lined the hallways while doctors and nurses rushed about--frustrated by the growing backlog, as other parts of the hospital filled up.
"I prayed, `Lord, I'm in pain. Don't let me have to wait like all those people,'" Thomas, a 59-year-old diabetic, said, turning to a row of beds cramped inside the hospital's hallways.
It's another typical day inside Chicago's largest emergency room, a place where dozens of patients doze in the waiting room during the long delays to see a physician. Children cry, while the refrain from adults is, "When am I going to be seen?"
It's a familiar problem across the nation and in Illinois, where ER visits soared 14 percent between 1998 and 2004, according to a study released last week by the American College of Emergency Physicians.
Stroger's predecessor, the aging Cook County Hospital, became a national icon for beleaguered emergency rooms; its overflowing waiting areas were a running subplot in a hit TV show.
That was all supposed to change three years ago, when it was replaced with Stroger, a 1.2-million-square-foot, state-of-the-art medical facility costing $562 million.
But emergency room overcrowding in the new facility has become every bit as bad as it was at the old facility, according to some County Board members.
And the waiting occurs before and after treatment. Doctors often have no choice but to park patients who need further care in emergency room hallways, while they wait for beds to open up in other parts of the hospital, slowing down delivery of medical care to hundreds waiting in line.
Though nurses and other medical staffers usually examine patients sooner, 40 percent of emergency room patients wait six hours or more to be seen by an attending physician, county hospital officials said. Twenty percent of them wait 12 hours or more for the first available bed to open for overnight treatment and observation.
In some cases, patients will wait for more than 24 hours for an available bed.
Stroger also has a separate level 1 Trauma Unit, one of the finest gunshot treatment centers in the nation. In that room, every second counts and those patients are seen immediately.
But the bulk of Stroger's clientele enter across the hall--away from the bustle of newly arriving ambulances--in a unit treating patients for everything from broken limbs and head injuries to those with serious internal aches and pains. Many are there because they have no other way of getting medical care.
"Given the issues we confront here, I'd say we're doing pretty well," said Dr. Jeffrey Schaider, who oversees Stroger's emergency room, as he glanced at charts on the wall.
"But when you look down the road, it's clear we need to make some changes," Schaider added.
Some of the reasons for the delays are familiar in emergency rooms around the country.
Dr. James Adams, professor and chairman of the Department of Emergency Medicine at Northwestern Memorial Hospital, said similar hospitals in Boston and New York City are seeing a growing number of emergency room visits.
"The problem of hospital crowding is a national one," Adams said. "In the emergency room you can't turn off the inflow of people. So that leads to long waiting times."
Another factor in the delays, emergency doctors say, seems, at first, counterintuitive: the advances of medical care.
As modern medicine becomes better at curing infectious diseases and staving off quick killers such as heart attacks, people live longer, and become more susceptible to long-term diseases that require medical care, such as diabetes and cancer.
Perhaps the most contentious explanation, however, is the lack of beds--or the lack of the right kind of beds--elsewhere at Stroger.
County Board Chairman John Stroger, the man the hospital was named after, said the problem shouldn't surprise anyone. The new hospital has 134 fewer beds than the hospital it replaced, making it difficult to locate an available bed for a patient needing to be admitted.
"This hospital is doing a remarkable job. But, the number of beds in the new hospital is all the State of Illinois would approve for us," Stroger said.
Also, unlike the old Cook County Hospital, which sits idle across the street, Stroger Hospital has dedicated units for obstetrics and pediatrics and an intensive care and burn unit. Each of Stroger's 464 beds is private or semi-private and has its own bathroom. For the first time, each patient has his or her own television and telephone.
But the dedicated units mean that an empty bed in, say, pediatrics, cannot be used by an adult in the emergency room who needs to be admitted to the hospital.
A study commissioned by the County Board last fall looked at how to address the issue, Stroger said, and he backs its key recommendation: adding 176 beds to reduce the long waits.
County Commissioner Forrest Claypool, Stroger's opponent in a heated campaign for County Board chairman, agrees that beds in the wrong places are part of the problem. But he blames it on bad planning from the beginning, not on the state.
"We ended up with too many pediatric beds that are just going unused," Claypool said. "We need to be moving toward a less centralized system, not a one-hospital kind of health care delivery system."
Mike Quigley, a commissioner and Claypool ally, offers an even more politically volatile proposal: turning the hospital's management over to the private sector, which Quigley said would help reduce wait times right away. Referring patients to the underutilized Provident Hospital on the South Side would help take a load off as well, he said.
But expanding Stroger Hospital is out of the question, Quigley said: "Where is the money going to come from?"
Back at Stroger's emergency room, the politics of running a hospital takes a backseat to the dozens of frustrated patients filling an emergency room criss-crossed with fast-moving people and filled with the sounds of medical technology.
On a typical day, there are about 30 to 40 patients in beds, waiting to be admitted for an overnight stay or longer. That leaves little room for physicians to examine the 100 to 150 patients packed in the waiting room.
"When you put patients in the emergency room hallway, it slows everything down," said Dr. Isam Nasar, a veteran Cook County emergency room physician, as he examined patients in beds parked inside Stroger's hallways one evening.
"These are patients who should be getting care upstairs," he added.
No one disputes that the hospital offers quality medical care. In fact, before doctors see emergency room patients, other medical staffers have already given many of them brief examinations, to make sure that the most urgent cases get timely care.
Still, waiting times have become so long, Nasar said, that patients dread coming to the hospital. Some will leave the emergency room before being seen by a physician.
That's not good, he said, especially when it comes to children.
Gabriela Estrada, standing near her sedated husband, who rested in a bed after treatment for intense abdominal pain, wondered if prolonged waits at Stroger were causing some prospective patients to treat their own medical conditions.
Estrada rushed her husband Jose to the hospital around 4 a.m. one day, when the pain in his stomach was so intense he said he lost his vision for a short time.
The attending physician didn't see him until around 7 p.m. "While we were waiting, I had this thought of my husband's appendix rupturing," said Estrada, 34.
"We have no health insurance. What choice do we have?" she wondered.
Down the hall, Chicago cabdriver Steve Fleischman said he was lying in the hallway for "prolonged observation." Getting a room was out of the question, even though his leg was so swollen he couldn't walk.
"When you wait around here for 14 hours, it gives you a lot of time to think," he said, yanking a sheet over his leg. "All this waiting makes you wonder if those people who planned the new hospital had any idea these problems could occur."
Additional material published Jan. 19, 2006:
CORRECTIONS AND CLARIFICATIONS.
Millie Thomas, who was quoted in a Page 1 story about Stroger Hospital's emergency room published on Jan. 15, died at Roseland Hospital on Dec. 29 -- after the interview at Stroger, but before the story appeared in the Tribune.