Saerom Yoo

Statesman Journal

A full hospital and increasing emergency room volume have led to long wait times and an increase in patients who leave before being seen by a physician, and Salem Health officials are seeking remedies.

On average, 1 to 2 percent of emergency room patients end up leaving before being treated in the U.S. Salem Hospital has seen its rate reach 16 percent, chief nursing officer Marty Enriquez said, and consistently sees 10 percent falling through the cracks.

The hospital census has been growing not only in the emergency department but the rest of the inpatient units, as well. This creates a bottle neck of patients who are stuck between getting stabilized in the emergency room and being admitted into a hospital bed. Meanwhile, in the crowded waiting room, hours mount as patients wait for their turn to be seen.

Depending on the person's condition and other factors at the time, patients seeking emergency care could wait anywhere from four to nine hours in the Salem Hospital emergency department, Enriquez said.

"As a result, for people that are sitting in the lobby, the wait becomes too long and they decide to leave and go home," Enriquez said. "When that happens we're of course concerned about them. They came to the ED with a problem."

So far, the hospital has opened a nine-bed transitional care unit, which is allowing the emergency department to see 15 more patients per day, she said. The new unit is a holding area for patients who are being admitted but are waiting for a bed to free up.

The emergency room also has implemented alert systems that seek support from the rest of the hospital staff when it reaches capacity. The support could include expedited discharges or staffers from other units lending a hand in the emergency department.

Enriquez said the hospital volume has been rising since the winter of 2012, and the increase has been continuing without the typical seasonal dips. The inpatient population has grown from 250 to 390 in the last few years.

Last month, the emergency department saw a record of 141 trauma patients — people in some type of a life-threatening crisis that arrive by ambulance.

It doesn't help that the hospital's oldest building is being remodeled, reducing the number of beds available also.

A study showed that the most common reason patients leave the emergency department without being seen was the long waits. Overall, 60 percent of them sought medical care within a week.

Enriquez said while it's difficult to pinpoint why the hospital's volume has grown so significantly, the Affordable Care Act's expansion of coverage likely is contributing to the increase.

"We are as concerned as they are about the long waits but we're being as proactive as we can, exploring options and exploring other places within the organization we can safely provide care," she said.

syoo@StatesmanJournal.com, (503) 399-6673 or follow at Twitter.com/syoo.

By the numbers

On average, 1 to 2 percent of emergency room patients end up leaving before being treated. Salem Hospital has seen its rate reach 16 percent and consistently sees 10 percent falling through the cracks.