N.J. emergency rooms are 'maxed out'

By BOB GROVES
STAFF WRITER
http://www.northjersey.com

Congested emergency rooms leave hospitals in New Jersey unprepared to handle the surge of patients that could accompany a disaster or terrorist attack, a group of physicians said Tuesday.

To make matters worse, it’s not people with routine problems who are overcrowding emergency departments, they said. Instead, it’s the so-called boarders — seriously ill patients who spend hours or even days in hallways waiting for an available bed, hospital staffers said during a panel discussion on health care held at Tuesday afternoon at the State House.

Large hospitals in North Jersey are not immune to the problem, said Anna Mannino, an emergency department nurse at Morristown Memorial Hospital. When Mannino ended her shift Monday night, there were 15 patients on stretchers in the emergency room who were waiting for admission, she said. The patients had a variety of health problems, including heart attack and pneumonia, she said.

“We want the public to know that, when you come in, we’re certainly able to provide safe care,” said Mannino, 58. “But frankly, sometimes we have no place for patients to go. We’re maxed out. We have no surge capacity.”
Report cards

Hackensack University Medical Center experiences emergency department overcrowding about five times a week because the hospital is usually full, said Dr. Edward Yamin, vice chairman of the emergency trauma department.

“We’re running at a 100 percent capacity,” said Yamin, who did not attend the Trenton event, which was hosted by the New Jersey chapter of the American College of Emergency Physicians.

“We are frequently overcrowded,” he said. “As soon as a bed opens up, we fill it. … The overcrowding is from patients already admitted but waiting for assignment to go upstairs.”

When an overcrowding situation occurs, Hackensack holds about 20 emergency patients on stretchers until a bed becomes available, Yamin said. Usually the patients wait from six to eight hours, but are moved to a bed in a separate holding area if their wait exceeds 12 hours, he said.

New Jersey was among the four states that scored the lowest in the fourth annual “Ready or Not?” study of preparedness for disaster and bioterrorism released last month by Trust for America’s Health, a non-profit organization that examines national readiness. The state received low marks for hospital bed surge capacity and a nursing workforce shortage.

Inpatient hospital beds for emergency patients are limited because many are reserved for more profitable surgical patients, according to an Institute of Medicine report. Other hospital beds cannot be used because of the nursing shortage and because of emergency specialists such as neurosurgeons who limit their practice because of skyrocketing malpractice premiums.

An influx of mental health patients also contributes to emergency department overcrowding, said Dr. Ty Hartman, chairman of emergency medicine at Somerset Medical Center in Somerville.

“We need to improve overall emergency preparedness, and the mental health safety net,” Hartman said.

The event, attended by two dozen doctors and nurses, included a “report card” by the American College of Emergency Physicians, which gave New Jersey an A-plus for quality of emergency care. But the state received only a C-plus — 12th in the nation — for overall access to emergency care, and a failing F mark for having some of the highest medical liability insurance rates.
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