Public Health

Online Solution Helps Alleviate the Emergency Room Surge

Maryland’s County Hospital Alert Tracking System provides real-time assessments of emergency room backlogs.

[Photo: The Washington County Hospital in Maryland is the only medical facility in its county. The hospital sometimes experiences two- to three-hour waits for ambulances at its back door. Photo courtesy of the Washington County Hospital.]

All it takes is a single major incident, or just a run of bad luck, for emergency responders in Baltimore to find themselves in a holding pattern.

“Even with 15 hospitals in the immediate area, it’s not hard at all for us to flood a single hospital,” said Capt. Jim Matz, an infection control officer in the Baltimore City Fire Department. “When that happens, our people end in a holding pattern, and with only 24 units to handle 180,000 calls a year, we can’t afford to get hung up.”

Fortunately for Matz and other first responders throughout Maryland, the state offers an easy-to-access, real-time system called CHATS, the County Hospital Alert Tracking System, which lets emergency departments give notice when they temporarily can’t accept ambulance-transported patients because of hospital overload.

Giving Notice

Emergency room overcrowding can be a serious issue. Each year, half a million ambulances are diverted from full emergency rooms to hospitals farther afield, according to the Centers for Disease Control and Prevention. In Maryland, some hospitals’ emergency rooms diverted ambulances at least 15 percent of the time in 2008, according to a Washington Post analysis.

The CHATS solution covers 48 acute care hospitals statewide. There’s no cost to users, and the system is managed by the Maryland Institute for Emergency Medical Services Systems (MIEMSS). Online since 1993 and updated repeatedly since then, the system replaced a two-decades’-old method of phone calls and whiteboards.

Hospitals self-report their status to a Web-based application that’s available to emergency personnel through any browser. By putting up a color-coded alert, “the hospitals are asking ambulances: Can you go someplace else because we are kind of busy right now?” said MIEMSS Director of Field Operations John Donohue.

“Busy” can take multiple forms: Yellow indicates overly hectic conditions and a red alert means there are no critical care beds available. Ambulance personnel also can enter a “reroute” signal, letting other emergency responders know that ambulances are starting to pile up at the door. “It’s for when you know the ambulances are going to get stuck big time,” Donohue said.

Emergency department staff typically post an alert to CHATS as directed by the nurse or doctor in charge. However, whatever the alert code may be, critical patients still go to the closest facility.

Most recently, CHATS’ functionality was wrapped into the commercial software package HC Standard from vendor Global Emergency Resources. A dashboard application for tracking health-care operations, HC Standard brings enhanced scalability and reliability to CHATS’ original homegrown capabilities.

The application also incorporates the functionality of the state’s Facility Resource Emergency Database, a tool for communicating succinct information in the face of large-scale mass casualty incidents.

Before implementing HC Standard, “we were filling up their screens, we were giving them too much input,” Donohue said. “Now it’s all under one roof.”

Easing the Pressure

At the 270-bed Washington County Hospital, CHATS has helped keep the switchboard clear, freeing up hands for work other than dialing.

“It used to be when we went on alert, we had to make a lot of phone calls to hospitals and to the 911 dispatch,” said Susie Burleson, trauma emergency medical services manager of the hospital. “You can have other calls coming in, you can take up multiple lines, all while you are busy trying to deal with all the craziness. CHATS takes away five or six phone calls. That is a big help.”

As with any emergency room, Washington County Hospital has seen its share of backlog. “We’ve gotten five ambulances in the back door with a two- or three-hour wait, with 30 people waiting,” Burleson said. “In the winter it might be the flu or in the summer it might be respiratory cases, but there is no rhyme or reason for the day or the time.”

As the only hospital in its county, Washington County doesn’t always have the luxury of redirecting incoming traffic. What CHATS can do that’s equally important is help hospital administrators allot their resources when an alert goes off in an adjacent county. “It gives us a chance to prepare for extra patients, to see how our bed situation is, to make sure we have all our supplies,” Burleson said. “If you know you’re going to get a couple of extra people, you want your staff to be prepared for that.”

First responders say the system gives them a clear look into traffic conditions at local emergency rooms, which helps guide their decisions.

Take for instance Prince George’s County Fire/Emergency Medical Services Department. With six hospitals in the county, it can be hard to know where to turn when conditions extend beyond the ordinary, said Paramedic Capt. Roland Berg. “If I have a mass casualty incident and need to determine where I am going to dispatch these patients, CHATS will give me real-time situational awareness to show me which hospitals I can send these people to,” he said.

The information is clear, concise and color-coded, which helps in making quick decisions. Perhaps most significant is the technology platform MIEMSS chose for the system: the Web. “Anywhere I can get an Internet connection, I can get this information,” Berg said. “I have sat on the scene, looked at my BlackBerry and brought up that Web page in real time to see what that hospital’s status is.”

Although CHATS can provide a snapshot, Berg said the system has limitations. In his experience, yellow and red alerts don’t always deliver the kind of granularity he needs when making fine-point decisions. In cases where more detail is needed, Berg said, it can help to augment the system’s data with more traditional in-person contacts.

Adam Stone  |  Contributing Writer

Adam Stone is a contributing writer for Emergency Management magazine. Stone writes on business and technology from Annapolis, Md. He also contributes to Government Technology magazine.

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