BALTIMORE - About five years ago, Baltimore’s emergency rooms started overflowing.
The city’s emergency rooms are not alone. In 2003, the General Accounting Office reported that ERs throughout the state and nation are overcrowded.
But Maryland’s ERs force patients to wait longer than most in the country. Fortunately, two city departments and area hospitals are trying to do something about it.
Around the state, more backup units have been asked to respond to medical emergencies while other ambulances idle until hospital beds become available. This strain on Baltimore City Fire Department’s emergency medical services prompted William J. Goodwin Jr., the city fire chief, to ask area hospitals for help.
In just over a month, the city and its hospitals have set a fine example of what regional cooperation can do to address a serious problem that affects all levels of government and social services. “We took a proactive approach to a growing national problem,” said Goodwin.
“This problem was growing into a pending crisis earlier this year when the backup system would go into effect seven to eight hours a day, Monday through Friday,” he said. “We used to take patients without consideration of what the whole system looked like. So, we reached out to the hospitals and health commissioner and began to talk about things,” said Goodwin. “The good thing about getting everyone together was the hospitals were not aware of our crisis and the crisis of other hospitals. That initial finding was the buy-in from everyone to cooperate.”
In May, Goodwin and Baltimore City Health Commissioner, Dr. Joshua M. Sharfstein, contacted all city hospital CEOs. “Our hope was to identify common problems among ERs and their common solutions,” said Goodwin.
Right away, 11 hospitals responded by sending representatives to join the city, state and the Maryland Institute for Emergency Medical Services Systems in a task force to study the issue. A few weeks later, the group created a group of policy and hospital management recommendations to ease emergency department overcrowding.
Participating hospitals included Bon Secours, Good Samaritan, Harbor Hospital, Johns Hopkins, Johns Hopkins Bayview, Maryland General, Mercy, Sinai Hospital, St. Agnes, Union Memorial and University of Maryland.
The task force measured the problem in terms of numbers of patients handled by city ambulances or seen in city emergency departments. It found that city ambulance transports increased 8 percent from 2002 to 2005 and patients in city emergency departments by 11 percent. Yet over the same period, the average time ambulances waited at the hospital before returning to service jumped by 45 percent, and the total number of hours that hospitals were placed on “re-route” status by EMS personnel increased by 165 percent.
With this information, the group members set strategies to reorganize emergency services and notification systems. Some of the report’s recommendations include creating a reverse alert system to notify hospitals when EMS resources are strained and setting up emergency department diversion centers for care of certain patients.
The Maryland Institute for Emergency Medical Services Systems will work with the city to manage the system on a daily basis in the region in the way they manage the dispatching of the helicopters and transport as the system becomes live, said Goodwin. Other task force recommendations include triage bypass and short stay units, as well as more long-term suggestions such as to expand access to primary care in the city and to increase recruiting of registered nurses.
Goodwin and Sharfstein said the report is “a framework for progress” and that they plan extensive follow-up to support its recommendations. The Baltimore City health and fire departments, the state and all participating hospitals should be commended for their decisive and quick approach to a complex problem.
This task force has demonstrated that public and private entities can and should cooperate in a holistic, system-wide manner to solve shared challenges. As Chief Goodwin said, “We put great minds together and can make this thing work.”
Alison Lake is managing editor at the Maryland Public Policy Institute and D.C. bureau chief for a government information technology journal. She can be reached at alake@mdpolicy.org.
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