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Studies Confirm Gulf Coast Trauma Care System Crisis
People in Counties Surrounding Harris At Greatest Danger
November 21, 2002
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HOUSTON, TX-(November 21, 2002). Trauma patients in the Greater Houston area who need immediate emergency care are dying more often because of delays in being transferred to Houston's Level I trauma centers, according to the results of a newly released study by The University of Texas School of Public Health. Moreover, people living in the outlying communities surrounding Harris County are at the greatest risk because patients with serious injuries and illnesses, who need to be transferred from small suburban and rural hospitals to Level I hospitals that provide the most specialized care, are more likely to face delayed treatment. These delays are due to overcrowded Level I hospitals being too full to accept more patients. As a result, valuable time elapses while a search is made to find a specialized hospital that can accept the transfer patient.
"We have definitive proof from three separate studies that the crisis we have been warning of over the past several months is frighteningly real and intensifying daily," said Dr. Guy Clifton, Chief of Neurosurgery at Memorial Hermann Hospital. "An increasing number of Houston-area trauma patients are dying because they're not receiving the emergency care they need within the 'Golden Hour'-the first hour after the onset of an injury or illness when doctors have the best chance of saving a patient's life."
Clifton is a founding member of Save Our ERs, a coalition organized to enlist public support for legislative action to address Houston's and the State's emergency care crisis. Save Our ERs' members include community leaders, prominent physicians and administrators from hospitals throughout Harris County, including noted trauma surgeon Dr. Red Duke.
The newly released study, "Hospital ED Diversion and Mortality: Evidence from Houston," was conducted by three University of Texas School of Public Health researchers, Charles Begley, YuChia Chang and Robert Wood. They studied the correlation between trauma mortality rates and ambulance diversions in the cases of 15,966 trauma patients admitted over the past two years at Houston's two busy Level I and five Level III hospitals. The study incorporates corresponding data obtained from the Houston Fire Department Emergency Medical Services on diversion hours, those time periods when hospital trauma and emergency departments are too full to accept additional patients.
The three UT researchers identified "significant diversion days" as days when both of Houston's Level I trauma hospitals were forced for eight or more hours to divert ambulances to other hospitals or turn down transfer requests from smaller hospitals due to lack of capacity. These significant diversion days increased sharply during the first ten months of 2001, to 39.6% of all days. Further, 25% of
severe trauma patients who were transferred to Level I hospitals from smaller hospitals on significant diversion days died, as opposed to 14.4% of non-transfer patients who went directly to Level I hospitals for care.
Perhaps most frighteningly, the UT study places the relative risk of mortality for the most severe transfer cases at 2:0, meaning that trauma patients transferred on significant diversion days had twice the risk of dying as those transferred on days when ambulances were diverted at both hospitals for less than eight hours.
"We cannot allow this trend to continue," said Clifton. "Documentation now exists that patients throughout the region are at risk of not receiving timely care when they need it. Indisputably, the evidence points to an urgent need to develop an effective, cooperative strategy to improve the efficiency of Houston's regional trauma and emergency medical care system. Additional capacity in the Level I trauma system and in the public primary care system also is needed to prevent ER overcrowding."
The findings of the UT study are consistent with those of another study conducted for Save Our ERs last spring by The Abaris Group, one of the Nation's leading EMS consulting firms.
The Abaris study, "Assessment of Houston Area EDs," surveyed 48 emergency rooms and trauma centers in Harris and the surrounding seven counties. The study noted a sharp increase in emergency room intakes and ambulance diversions, with emergency rooms being forced to divert ambulances 77% more often during 2001 than in 2000. The primary reasons cited for the diversions were shortages of beds (75% of the time) and shortages of nurses (24% of the time).
Patients taken to emergency rooms in small hospitals 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 30% of emergency patients within two hours of arrival. Transfer times of over 3 hours are reported by 70% of the respondents with 8% reporting transfers requiring more than six hours. These hospitals all (100%) reported that patients' lives are endangered by transfer delays.
Clifton said that the circumstances are becoming more dire every day-even in the absence of any major catastrophe, the prospect of which is far more real today than we would have imagined only a year and a half ago, particularly in a major port and petrochemical city such as Houston.
"Studies by The University of Texas School of Public Health and 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. "These studies should provide ample data to support the calls from lawmakers and other decisionmakers for additional emergency care funding."
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