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Hospitals work to solve emergency room crisis

Paperwork from unnecessary patients is one factor contributing to a nursing shortage in Las Vegas emergency rooms
Paperwork from unnecessary patients is one factor contributing to a nursing shortage in Las Vegas emergency rooms  
By Joelle Babula
Las Vegas Review Journal
August 25, 2000
Web posted at: 11:58 AM EDT (1558 GMT)

LAS VEGAS, Nevada (Las Vegas Review Journal) -- To help alleviate clogged emergency rooms and open precious bed space, local health officials are working to keep the intoxicated and the mentally ill out of emergency facilities when medical attention is unnecessary.

The officials are trying to find immediate solutions to free up more beds and medical resources to combat a valley-wide emergency room crisis that is jeopardizing patient care and contributing to slower ambulance response times.

Besides working on a long-term plan to hire and recruit more nurses, officials hope to shuttle inebriates and mental health patients to more appropriate facilities outside the emergency room.

"Every day we have drunks tying up emergency room beds," said Davette Shea, nursing director of the emergency room at University Medical Center. "When we get these patients, we have to keep them until their blood alcohol level drops, and that can take from five to 10 to 12 hours. We don't have the capacity to take care of people who are really sick."

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Currently, if paramedics are called to pick up an intoxicated person, they must transport the person to an emergency room, regardless of their medical condition, said Brian Rogers, director of operations for American Medical Response.

And once in the emergency room, physicians and nurses usually end up baby-sitting until the person sobers up and can go home.

"They don't receive treatment, they simply sober up and take up valuable patient beds," said Dr. Ben Bobrow, the assistant medical director for the medical center's emergency room.

"We see several thousand patients a year whose sole problem is intoxication. ... The average intoxicated patient stays in the emergency room for 16 hours."

Bobrow is one of several local health care professionals working with Westcare Nevada on a proposal to allow paramedics to transport inebriates to Westcare rather than emergency rooms. Westcare is the largest nonprofit drug and alcohol treatment center in the state. The facility offers a nonmedical, 25-bed detoxification program that was developed in 1987 in response to crowded emergency rooms.

"We have a facility that can easily be expanded, and it's licensed for 52 beds," said Richard Mazzochi, vice president for Westcare. "The issue is one of funding. We need more beds and more medical staff."

The proposal would allow paramedics to medically assess an intoxicated patient and decide whether a trip to the emergency room is necessary.

"If the patient has no medical complaints, has normal vital signs and no evidence of trauma or acute medical problems, he'd be eligible for the sobering shelter (Westcare)," Bobrow said.

Mazzochi estimates an expanded detox program would cost an additional $1.5 million to $2 million a year. He says the current program, which helps out 4,000 people annually, saves the county at least $2.4 million each year.

Health officials plan to bring the proposal before the Clark County Commission in the next few months.

"We're going to make this presentation quickly," Bobrow said. "People don't get it. We can't keep going right now without some bad outcomes. We're going to start having some real problems."

Bruce Woodbury, chairman of the County Commission, said he was unaware of the proposal but thinks it merits discussion and will be considered.

Besides shuffling drunks out of emergency rooms and into Westcare, where rehabilitation programs can be accessed, officials also believe expanding local mental health facilities will help the flow of emergency departments.

Currently, mental health patients must be medically cleared in an emergency room before being transported to a mental health facility -- usually Southern Nevada Adult Mental Health Services. If no beds are available at the state-funded facility, the patients simply wait in an emergency room bed.

"We sometimes have up to seven patients at a time on hold for over 12 hours," said Dale Carrison, director of the emergency department at University Medical Center. "There's not a day that goes by when we don't have a mentally ill patient in the emergency room. We're the safety net in the community. We're the guys that are there to help you with your life-threatening problem, and we don't want anything to interfere with that."

Mike Keeler, program manager for emergency services at Southern Nevada Adult Mental Health Services, said more beds would help, but the real need is more staffing to deal with the "pockets of high-traffic times that are unpredictable." The facility wants to build a 20-bed observation unit to add to the 10 beds currently available.

Although health officials are striving to find a few immediate solutions to the dire emergency room situation, the real long-term solution is much more difficult -- recruiting, hiring and retaining nurses in a nation plagued by a severe nursing shortage.

"The inebriates and the mentally ill are the two we're working on now, but ultimately, the problem is still a function of hospital beds and nursing staff," Bobrow said.

There are no immediate solutions to the nursing shortage. Hospital administrators are recruiting nationwide and also work with nursing programs to lure graduates to area facilities. To acquire and retain nurses, some suggest pay increases, better benefits, more help with patients and limiting the deluge of paperwork nurses now wade through.



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