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Perhaps more common than posting wait times are other attempts at easing the traffic jams:
In Nashville, Vanderbilt University Medical Center does "team triage," with a doctor, nurse and paramedics manning the ER's front door. They work the waiting room, ordering blood work or X-rays so that less urgent cases
-- like a sprained ankle -- may be diagnosed without ever tying up an ER bed and more complicated ones get a head start on diagnosis that can save 40 minutes a person.
Emergency medicine chief Dr. Corey Slovis says the ER averages a 20-minute wait to see the doctor, which he hopes to cut to 10 minutes. Team triage allows discharging about 15 patients a day directly from the waiting room.
The main cause of ER crowding isn't an influx of sprained ankles but a lack of hospital beds for patients so sick they need to be admitted, leaving them "boarding" in the ER so there's no room to bring in new patients, says Dr. Peter Viccellio of the State University of New York at Stony Brook. Mondays, when most hospitals fill inpatient beds with elective surgeries, are especially bad.
Viccellio pioneered "hallway medicine" to ease boarding, where patients are divided on gurneys among the hospital's wings to await available beds. Distributing the load shortened total hospital stays by a day, possibly as patients benefited from more nursing attention, he says.
That jam is where Medicare is focusing first, as hospitals are to begin reporting in 2012 how quickly they move patients from the ER to inpatient beds. Still to come is a final decision on reporting additional wait times, such as how long it takes to see a doctor.
Paradoxically, in the last year some ERs have deliberately started keeping certain patients longer: About 10 or 15 patients a day at Stony Brook have chest pain but a normal EKG, and they need to be observed to separate out the 10 percent who really need heart care. Rather than admitting them all to the hospital, some ERs now keep them for up to 16 hours to do repeat testing that shows who can safely go home, Viccellio says -- making it all the more important to avoid other logjams.
Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
Copyright 2010 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
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