State of emergency

Jennifer Blomer was not seriously ill, and she wanted to keep it that way.

"I didn't want to take a chance on getting sick and going to the hospital," said Blomer, who is diabetic. So after several days of aches and vomiting recently, she called her doctor.

The doctor was out. So the nurse directed Blomer to St. Joseph Health Center emergency room, just as she had several times before. Blomer's ailments turned out to be sinus and kidney infections.

"I wanted somebody to just do something," she said. "I'd been sick for a few days, and it was just getting worse."

Emergency rooms across the country are seeing more and more people like Blomer with illnesses that could be treated in a doctor's office. That's one of the reasons why waits for treatment now can stretch to four hours - and sometimes longer.

A study based on American Hospital Association data showed 672,225 emergency room visits to Kansas City area hospitals in 2000, up 6 percent from 1999. By comparison, the number of visits increased 5 percent in 1999, 3 percent in 1998 and 2 percent in 1997.

Several hospitals are adding staff or expanding emergency departments to meet the demand.

"I think everybody's busy," said Betty Moon, director of emergency services at St. Luke's and St. Luke's Northland hospitals, adding that patients "want the convenience of coming whenever they want to."

While the situation in the metropolitan area is not yet critical, it is in some other locations.

In February, the California Medical Association declared the state's emergency medical system overloaded.

In January, overburdened hospitals in Pennsylvania diverted ambulance patients to overflowing emergency rooms in neighboring Delaware. That pushed Delaware emergency room waiting times to six- plus hours for patients with minor ailments.

Health-care officials attribute the growing dependence on emergency rooms to several factors:

Shortages of primary care physicians and nurses.

A growing and aging population.

Increasing numbers of uninsured and poor patients.

Patient demand for quick attention.

Underuse of urgent-care clinics, designed to treat lesser ailments.

Realizing the situation is getting worse, health-care organizations and the MidAmerica Regional Council recently instituted new ambulance diversion policies to ensure that the most critical patients get proper care.

But population growth already has spread doctors thin, experts say.

"Obviously, as an area grows ... they're going to need more doctors," said Perry A. Pugno, director of medical education for the Leawood, Kan.-based American Academy of Family Physicians. "Perhaps more importantly, as the population ages, there's going to be an increased need for primary care physicians to take care of the older population."

Physicians can be overworked in areas where there are 1,200 to 2,000 people per doctor, said Joyce Volmut, director of the Kansas Association for the Medically Underserved.

And according to federal and state statistics, many parts of metropolitan areas are particularly short of primary care physicians willing to treat patients who are uninsured or on Medicaid, the federal-state insurance program for the poor.

It's a "sad but true economic reality" that Medicaid reimbursements frequently do not pay physicians enough to cover the cost of doing business, said Richard Hellman, a Kansas City endocrinologist and former president of the Metropolitan Medical Society of Greater Kansas City.

Patients without insurance long have sought medical care in emergency rooms. Now, lower-income people who drop employer- sponsored health insurance because they can't afford the co-payments are heading to emergency rooms, too.

"As the cost of housing goes up and that takes more of their money," Hellman said, "they have to cut somewhere."

Adding to the physician supply problem is that primary care doctors are retiring earlier than they used to, Hellman said.

One reason is stress. It's not unusual, Hellman said, for hospital affiliates that own many area physician practices to expect primary care doctors to see 40 or more patients a day.

"If they see 40 or more patients in their office in a day, then they may barely have enough time to see their patients who are hospitalized," he said.

Nurses, crucial to meeting patients' needs in primary care, also aren't plentiful enough.

Nursing schools have seen a 5percent to 6 percent decrease in enrollment over the past five or six years, said Rose Porter, dean of the Sinclair School of Nursing at the University of Missouri- Columbia.

All this adds up to impatient patients.

Rebecca Gaughan, an Olathe, Kan., ear, nose and throat doctor, said people get frustrated when a machine answers the doctor's office phone or when they can't get an appointment for a few days.

Absent advice from their doctor or nurse, people get tired of waiting and head for the emergency room, Gaughan said.

Others feel pressure from their employer to see the doctor quickly so they can get back to work rather than wait a long time for an appointment.

"Patients want an instant fix to their health care problems," Gaughan said.

Urgent-care clinics could help relieve the strain on emergency rooms because they're set up to handle minor cases. But such clinics often are underused, health care professionals say.

Many people are unaware of the clinics or don't understand what they're for, said Martha Shelver, former manager of the Oak Park Mall Urgent Care Clinic operated by Shawnee Mission Medical Center. Patients enrolled in health maintenance organizations also sometimes aren't clear on which clinics are available to them, she said.

Seeking solutions

The health care community is trying a variety of ways to relieve overburdened emergency rooms, increase the pool of medical personnel and curtail long waits for a doctor appointment.

Some hospitals are expanding their emergency departments and hiring more physicians. Others are splitting their emergency rooms. Many ERs now offer their own urgent-care clinics for lesser ailments.

The clinics, often staffed by nurse practitioners, allow better treatment for all patients, health professionals say.

Children's Mercy Hospital in Kansas City, for example, offers a rapidcare clinic between 2 p.m. and midnight. Nurses place patients arriving in the emergency room in one of three categories. Patients with emergencies or urgent but not life-threatening ailments go one way; non-urgent patients go to the clinic.

About 30 percent of the patients arriving between 2 p.m. and midnight are sent to the rapid-care clinic, said Laura Fitzmaurice, division chief of emergency medical services. Under the split system, patients in both places get more timely treatment.

"In the evening time, it's decreased our wait time easily by 30 to 45 minutes," Fitzmaurice said.

Other hospitals are discussing or adding similar programs. Meanwhile, freestanding urgent-care clinics are trying to publicize their services.

Of course, the best way to alleviate long waits for a doctor's appointment is to train more family physicians, Pugno said.

To that end, some medical organizations have developed recruitment and financial assistance programs. Some employers pay off the student loans of doctors and nurses, offer accelerated degree programs or get young people interested in the profession through "medical explorer" programs.

Pugno said doctors are trying to work in more patients through more efficient scheduling.

Meanwhile, Carol Creek, Research Belton emergency department unit manager, emphasizes that people should seek immediate help if they think they might be experiencing a medical emergency but aren't sure.

"If you can't get in to see the doctor and you're hurt, then we're the backup," Creek said.

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