Increase in ER visits force expansions

Lancaster General Hospital's emergency room in Lancaster was designed to handle 40,000 patients per year. The hospital passed that mark years ago.

It had almost 55,000 emergency room visits during FY 2001, an average of 41 extra patients per day. As in other hospitals, patients with the most

A planned $10 million expansion will double the emergency room's size, to 34,000 square feet, and reduce patient waiting times. Lancaster General may also hire additional staff once the expanded space is opened, Lines said.

An increasing demand for emergency services is not a phenomenon isolated to Lancaster General. Hospitals throughout Central Pennsylvania are reporting growing numbers of emergency room visits. Officials said the two main factors contributing to these increases - a growing population and an aging population - won't disappear anytime soon. That issue is compounded by the fact that, despite years of education, many people still inappropriately use emergency rooms, some officials said.

For patients, increased emergency room volume may mean longer waiting periods and more people in the emergency room. For employers and health insurers, it means continuing to make an effort to educate people about alternatives to emergency care. For hospitals, it means additional investments to expand and improve emergency services.

"I think this is going to continue," said Dr. Daniel Oberdick, attending physician at the emergency department of Memorial Hospital, part of Memorial Health Systems Corp. in Spring Garden Township, York County. "I don't see things changing much in the future."

Visits on the rise

Almost all hospitals operating in Central Pennsylvania reported an increase in the annual number of emergency room visits between FY 1997 and FY 2000, according to the Pennsylvania Department of Health.

The size of these increases varied throughout the region. For example, Community Hospital of Lancaster in Lancaster Township reported a 2.4 percent increase, while Holy Spirit Hospital in East Pennsboro Township reported a 58.4 percent increase.

Harrisburg-based PinnacleHealth System was the only hospital of health system in the area to report a decrease. Annual emergency room visits at the system's hospitals declined by 15.9 percent between FY 1997 and FY 2000.

Emergency room usage has grown nationwide, as well. The number of emergency room visits per year nationwide grew from about 85 million in 1990 to almost 100 million in 1999, according to the Chicago-based American Hospital Association.

A growing Central Pennsylvania population is one reason for the region's increase in visits, said Diane Bomberger, director of community relations for Community Hospital of Lancaster.

"With the growth of the number of people in the area, there's going to be a greater need for emergency care," Bomberger said.

Many people who have recently moved to the area often wait a while to find a primary care physician and use the emergency room in the interim, Oberdick added. For example, some of the increase in emergency room visits at Memorial Hospital is coming from residents who have recently moved to York County from northern Maryland, Oberdick said.

In addition, the region's population is getting older. The number of residents age 65 or older in Cumberland, Dauphin, Lancaster, Lebanon and York counties increased by an average of 30 percent between 1990 and 2000, the U.S. Census Bureau reported.

As people get older, minor illnesses such as colds are more likely to present medical problems that require emergency attention, said Dr. Kym Salness, chair of the emergency medicine department at Penn State Milton S. Hershey Medical Center in Derry Township, Dauphin County. Senior citizens are more likely to have chronic diseases, such as heart disease, that may require more frequent emergency room visits, Salness said.

There are also hospital-specific reasons for the increase in emergency room visits. For example, Community Hospital of Lancaster started a marketing campaign in 2000 to encourage tourists shopping at the outlets in eastern Lancaster County to use the hospital's nearby emergency room, Bomberger said.

PinnacleHealth System closed the emergency room at Polyclinic Hospital in January to expand services at Harrisburg Hospital and Community General Osteopathic Hospital. That closure has attracted some patients to Holy Spirit Hospital in Cumberland County, said hospital spokeswoman Lori Moran.

'Constant education'

The Emergency Medical Treatment and Active Labor Act, or EMTALA, is a federal regulation requiring hospitals to treat all patients coming into an emergency room, whether these patients can afford to pay for that treatment or are uninsured.

Hospital officials said a number of patients coming into local emergency rooms are uninsured, but these patients don't seem to be contributing to the increased number of emergency room visits. In fact, the percentage of Pennsylvanians without insurance dropped from 9.2 percent in 1998 to 7.5 percent in 2000, according to the U.S. Census Bureau.

Officials pointed out that most people using the emergency room truly need emergency services. There has not been an increase in the number of people using emergency rooms to get convenient treatment for minor illnesses such as colds, Salness said.

"My personal experience is that the majority of people have true emergencies," he said. "If patients have emergencies, then the best place to serve them is in the ER."

Hospitals and health insurers throughout Central Pennsylvania are working to provide options to those who may not necessarily need emergency room care.

Many hospitals have urgent care areas to serve patients with minor illnesses and injuries. For example, PinnacieHealth's four First Place Centers in the Harrisburg area have seen their volumes increase from about 1,500 patients per month in early 2000 to about 2,700 patients per month now, said Nancy Bonalumi, the health system's director of emergency services.

Hershey Medical Center started a print advertising campaign in October to make residents aware of the hospital's network of primary care physicians. The advertisements are designed to make patients aware of alternatives to emergency care, said Sean Young, the center's director of public relations.

Pennsylvania Blue Shield in East Pennsboro Township offers wellness and disease management programs to help its members prevent visits to emergency rooms, said spokesman Leilyn Perri. The Cumberland County health insurer also requires higher co-payments for emergency room visits, Perri added.

Lancaster General often provides patients and local residents with educational information to help them make decisions about what ailments need emergency care, Lines said.

"It's a constant education the medical community provides," Lines said. "It also takes the involvement of health plans and employers to help people make those decisions."

Lancaster General expects to begin its emergency room expansion in January and complete it sometime in 2003, Lines said. Like Lancaster General, hospitals throughout the area are preparing for the number of emergency room visits to increase in the future.

Hospitals' investments in emergency care include new facilities and technologies. For example, Lines said Lancaster General invested between $400,000 and $500,000 for an electronic patient tracking system used in the emergency room. The system tracks such things as how tong a patient has been waiting for emergency care and a patient's location within the emergency room.

PinnacleHealth completed expansions of its emergency rooms at Harrisburg Hospital and Community General Osteopathic Hospital earlier this year, Bonalumi said. The health system now has a total of 67 beds available for emergency care use.

Officials at Community Hospital of Lancaster, Memorial Hospital and Lancaster Regional Medical Center said they are considering or planning future expansions to emergency services.

Denyse Kling, spokeswoman for Lancaster Regional Medical Center, said such expansions improve the quality of care patients receive and affect the perception patients have of the hospital as a whole.

"We do recognize the emergency room as a front door to the hospital," Kling said.