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BALTIMORE, Md. - In emergency rooms across the state, doctors and nurses are working around the clock to treat their patients but getting checked out by one is taking more time.
Maryland has the longest ER wait in the country, according to data by the Centers for Medicare & Medicaid Services. Patients waited an average of 53 minutes in Maryland before they were seen by a health care professional. The national average is 22 minutes.
There are a lot of varying thoughts as to what may be causing the gridlock but there's agreement that fixing this problem is as urgent as the patients requiring treatment.
“It's just normal, if you go to an ER you're going to sit for an amount of time,” said Barbara Owens, who waited eight hours in her recent visit to the Howard County General Hospital Emergency Department. Owens’ boyfriend, Patrick Burke, brought her there on a Tuesday night in December after two days of not eating and drinking.
“They did the initial triage right away and then they took her blood pressure stuff and stuck us back in a waiting room and we were there just about 8 hours before we saw a doctor,” said Burke.
Burke shared their experience on social media. The general reaction was shock, others said they've been through the same thing. A nurse at an area hospital said she sees it almost every day.
“Physically, there are not enough places to put them,” the nurse said. When asked about the worst wait time she’s seen recently, the nurse responded 13 hours.
The nurse did not want to be identified out of fear of losing her job, but she felt compelled to share her concerns.
“You have a large amount of patients in a waiting room that are waiting a long period of time that aren't having their issues addressed. It’s a safety issue,” she said.
Like in Barbara’s case, what she thought was just the flu turned out to be sepsis, an infection in her blood that could have been deadly if she had waited longer or left in frustration.
“Patients come in because they're ill and there's nowhere else to go. If I had waited til the next day, I could've died, I could've really been serious,” Owens said.
The color-coded grid by the Maryland Institute for Emergency Medical Services Systems, or MIEMSS, shows an alarming pattern. In the last three years, there's been an overwhelming increase in yellow alerts, red alerts, and re-routes. Those are all medical alerts that point to a system overload.
“Your goal is to never go on any of these alerts, but you do what you have to do,” said the nurse.
A yellow alert is an indication the emergency department is temporarily overloaded. Hospitals in this region went on yellow alert 3,300 times in 2016, which is up from nearly 1,900 in 2014.
Red alerts, or when there are no more heart-monitoring beds, doubled over that same time period. And re-route is when an ambulance must be directed to another hospital because there are no available beds. In that same timeframe, re-routes nearly tripled.
American College of Emergency Physicians board member and professor at the University of Maryland School of Medicine Emergency Department Dr. Jon Mark Hirshon said it’s a combination of issues. He attributes the overcrowding to people going to the emergency room versus urgent care, mixed with a shortage of nurses and doctors, and a need for efficiency and getting "boarded" patients that need to be admitted upstairs faster. He also points to the global budget revenue, a newer hospital payment system incorporated in the Maryland All-Payer Model.
“In the old system, you got paid for every patient you saw, or fee for service, now it's kind of called capitated or there's a cap on how much you get paid,” Dr. Hirshon said.
It was implemented three years ago as a way to drive down Medicare costs, and it created incentives for hospitals to focus on quality care versus filling their beds.
“The problem with that is that you get paid a certain amount regardless of how much care you delivered therefore you look for ways to try to minimize your costs while maximizing the quality you deliver. But minimizing the cost, does that mean you have enough beds for the patients? Can you find other locations for them? So, it's a very complicated formula but I think that's making things worse here in Maryland,” said Dr. Hirshon.
Maryland is the only state with this kind of model, and Maryland has the longest average ER wait time in the country. And while the wait time in Maryland has gone up, in the same span the national average has dropped.
“The statistics were bad, but the next statistics when they come out I think are going to be worse,” said Dr. Hirshon.
The most recent data was collected between April 2015 and March 2016. Other statistics provided by the Health Services Cost Review Commission (HSCRC) shows that the number of annual patients visits treated at area emergency departments has declined the last four years.
“There’s a problem. We need to look at it seriously, we need to talk with the administration, and we need to talk with the folks who are hoping to operationalize this model so that we can deliver the care that our patients deserve,” said Dr. Hirshon.
Several hospitals in Baltimore, including the University of Maryland Medical Center, have opened urgent care facilities near the emergency departments. According to the hospital system, the UMMC Emergency Department averages nearly 170 patients each day; it is estimated that about 50 of those patients could benefit from the services of UM Urgent Care.
A spokesman for GBMC HealthCare said the hospital's primary care practices are conveniently located throughout Baltimore County, with offices both on the hospital campus and in the community. Those locations provide quality care in a reasonable amount of time.
Here are the average wait times for emergency departments in the region. The “average time” refers to the median time patients spent in the emergency department before they were seen by a health care professional. The data was collected from April 1, 2015 through March 31, 2016 by the Center for Medicare and Medicaid Services.
Anne Arundel Medical Center
Bon Secours Hospital
Carroll Hospital Center
Greater Baltimore Medical Center
Howard County General Hospital
Johns Hopkins Bayview Medical Center
Johns Hopkins hospital
Medstar Franklin Square Medical Center
Medstar Good Samaritan Hospital
Medstar Harbor Hospital
Medstar Union Memorial Hospital
Mercy Medical Center Inc
Northwest Hospital Center
Saint Agnes Hospital
Sinai Hospital of Baltimore
University of MD Upper Chesapeake Medical Center
University of Maryland Harford Memorial Hospital
University of Maryland Medical Center
University of Maryland St. Joseph Medical Center
University of MD Baltimore Washington Medical Center