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Three New Studies Confirm: Day of Reckoning at Hand for Houston's Emergency Rooms
July 18, 2002
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HOUSTON, TX-(July 18, 2002). People in the Greater Houston area who need immediate emergency care are dying because Houston's trauma hospitals don't have the beds or staff to treat them within the first hour after injury-the "Golden Hour"-when the best chance exists to save their lives. Three studies released today confirmed dire deficiencies in the emergency care system in Houston and throughout the State.
"Studies by two of the most respected emergency healthcare consulting firms confirm the implosion of the emergency care system in our City and statewide," said Dr. Guy Clifton, Chief of Neurosurgery at Memorial Hermann Hospital. "Decision-makers have asked repeatedly for data to support the call for additional emergency care funding, and now they have that proof."
To illustrate the crisis, Dr. Clifton cited the case of a 72-year-old man who was taken by ambulance last January to McAllen Regional Hospital, where a CT scan showed a large blood clot on his brain. The small hospital could not perform surgery to remove the clot and called nine regional hospitals before finding one intensive care bed 300 miles away in Houston. The man was flown there immediately, but the surgery was performed 13 hours after injury, too late to save his life.
Several similar incidents have occurred in hospitals in this region, Dr. Clifton said. "These are just the cases we know about. There is no way to determine just how often this is happening. Most of us believe that there are many other instances of preventable deaths and disabilities due to delays in definitive treatment. With these kinds of cases reported, you can be sure that the problem runs deep."
The three new studies surveyed 48 emergency rooms and trauma centers in Harris and the surrounding seven counties. The first study, entitled "Assessment of Houston Area EDs," was conducted by The Abaris Group (TAG), one of the Nation's leading EMS consulting firms. Bishop+Associates, a national leader in trauma center development finance and management, performed the other two studies.
The Abaris study noted a sharp increase in emergency room intakes and ambulance diversions. Emergency rooms were forced to divert ambulances 77% more often last year than the previous year, with 39% of facilities reporting diversions more than 1,000 hours per month. The primary reasons cited for the diversions were shortages of beds (75% of the time) and shortages of nurses (24% of the time).
Fifty-nine percent of all emergency rooms reported that patients are at risk due to delays in transfers to higher level-of-care hospitals. Patients taken to emergency rooms in small hospitals outside of Houston are at the greatest risk. These facilities, which merely stabilize patients before sending them to facilities that can provide definitive emergency services, reported that they are able to move only about 20% of emergency patients within two hours of arrival. Transfer times are 3-6 hours in 70% of cases, and transfers require more than six hours in 8% of cases. These hospitals all (100%) reported that patients' lives are endangered by transfer delays.
The Bishop study, entitled "Houston Trauma System Survey," examined data from every trauma hospital in the Greater Houston area to determine the reasons for their limited capacity to handle trauma care patients or to expand their facilities. The study found that the hospitals have suffered huge financial losses due to an increasing number of uninsured patients. Houston-area hospitals have provided approximately $32 million in care to uninsured trauma patients in 2001 and have sustained losses of more than $17 million from that care.
"In addition to trauma beds there is a statewide shortage of pediatric intensive care beds," said Clifton. "Hospital administrators throughout the State report that children requiring intensive care beds are being flown out of virtually every urban area in the State in search of beds. The problem is related to Texas' 800,000 uninsured Texas children, almost all of whom are eligible for the federal/state CHIP program."
Bishop's statewide study, entitled "Texas Trauma System Assessment," reported that more than 30% of Texas' 21 major trauma centers are unable, at times, to accept severely injured trauma patients because of lack of bed capacity. The financial losses of these hospitals were $175 million, with losses on trauma care of more than $120 million.
"Ideally, ICUs should run at 75% capacity, but the average capacity in Houston is 85-90%, and many times these facilities are at 100%," said Dr. Clifton. "If you are severely injured or ill on a good day, you'll receive the care you need, but if it happens to be a bad day, you won't. You won't know until you or your child is sick or injured whether it's a good day or a bad day."
All three studies were commissioned by Save Our ERs, a coalition organized by Dr. Clifton and Dick Hite, Houston businessman and President of Norton Ditto. Its members include community leaders, prominent physicians and administrators from hospitals throughout Harris County, including noted trauma surgeon Dr. Red Duke. The group is working to enlist public support for legislative action to address Houston's and the State's emergency care crisis.
"There is an enormous need to increase surgical and medical intensive care bed capacity," Dr. Duke said. "At the moment, we are not able to care for everyone in need. Unfortunately, to meet these requirements there must be a significant infusion of money, but this is only part of the problem."
Hite said that the Texas Legislature must take decisive action during its next session to avert an almost certain disaster. "There is no other issue on the legislative agenda that comes close to the magnitude of the emergency care crisis," he said. "The Legislature is in the driver's seat."
Save Our ERs encourages concerned citizens to attend a public hearing of the Texas Senate Subcommittee on Trauma Care in Houston on Thursday, July 18, at 10:00 a.m., at One Reliant Park, 8400 Kirby, Room 500. The subcommittee is chaired by State Senator Rodney Ellis (D-Houston) and co-chaired by State Senator Chris Harris (R-Arlington). Dr. Clifton will be the lead witness.
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