Rethinking the county hospital alert system

Local,Karl B. Hille

The shortest route to the emergency room might not be to the closest hospital.

Yellow alerts used to inform ambulances about which emergency rooms are too crowded to accept more patients tend to tie the hands of hospitals and emergency responders, Baltimore County fire officials said.

"We would prefer to manage the transportation of patients ourselves," said Baltimore County Emergency Medical Service Director Joseph Brown.

"Yellow alert doesn?t mean anything to us. By 1 p.m. this afternoon, all hospitals in the area will be yellow, because it?s Monday."

That view was a surprise to Larry Merlis, CEO of Greater Baltimore Medical Center, who was visiting the fire department headquarters as part of a ride-along with Baltimore County EMS Capt. Paul Burke.

"Should we stop doing it?" he asked about the alerts.

"We?ve been trying to do that at the state level for two years," Brown said.

"We already know the situation when our people are waiting to discharge patients at the emergency department and are saying ?We?ve been here for 45 minutes,? ... and we?re still basically caring for the patient."

The amount of time a hospital is on alert status has been cited in the past few years by elected officials, hospital leadership and fire and emergency services throughout the Baltimore region in arguing that emergency rooms are overwhelmed.

The system is not perfect, said nurse Lisa Myers, who oversees the alert system for the Maryland Institute for Emergency Medical Services Systems.

"During the flu season, they?re all going on yellow alert. They?re justpacked," she said.

Yellow alert, as defined by the state, means the hospital has requested no new patients in need of urgent care. Hospitals may stabilize high priority patients before passing them on if they don?t have any more beds or monitors for patients.

Some hospitals have said they continue receiving patients even when they are on yellow alert, Myers said. "It?s really hard to enforce."

She also credited Baltimore County with being ahead of the alert system most of the time.

Waits in the emergency department circle have improved somewhat, Brown said. The number of patients waiting 90 minutes or more to be seen in the emergency room has dropped, although waits as long as 30 and 45 minutes are "creeping up."

On the other hand, while hospitals are logging less time at yellow alert status, ambulances are spending more time on a call, taking care of patients in the hospital parking lot, Myers said.

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