Patient load puts squeeze on Oahu medical centers

A physician’s dining room at the Pali Momi Medical Center has been converted into a waiting room for patients. A corridor at Wahiawa General Hospital and a consultation room for the Straub Clinic & Hospital’s emergency services section have both become triage areas for incoming patients.

Oahu’s leading hospitals are confirming that the December shuttering of Hawaii Medical Center facilities in Ewa and Li­liha has placed tremendous stress on their facilities through higher occupancy, overflowing emergency rooms and longer waiting times for noncritical patients to receive attention. But they are adamant that critical-care patients are being cared for and that the situation is not jeopardizing lives.

"Nothing has changed in two months. Things are not worse; they’re just not better," said Toby Clairmont, emergency services director for the Healthcare Association of Hawaii, which represents Hawaii’s hospitals and other health care providers. "The workload is very high, and we don’t expect (the situation) to improve until an emergency department opens on the west area of the island to replace Hawaii Medical Center."

The closures have caused not just emergency rooms to swell, but hospital populations in general.

Clairmont said the closures exacerbated a situation caused by the lack of long-term care facilities on Oahu. Many patients who belong in long-term care are instead staying in acute-care hospital beds, he said. In turn, people in emergency room beds who should be transferring to overnight acute accommodations are sometimes staying in ERs, thus backing up the system, he said.

At the Queen’s Medical Center, the state’s largest hospital, the nightly population has been about 7 percent higher than at this time a year ago, said Cindy Kami­kawa, the hospital’s chief nursing officer and vice president of nursing, emergency department and trauma.

The emergency room population has increased by about the same amount, Kami­kawa said.

"We are able to manage that volume," she said.

Pali Momi communications director Shawn Naka­­moto said emergency room visits have increased by 28 percent at the Aiea facility since the Hawaii Medical Centers closed. Pali Momi was almost always full, or nearly full, even before the HMC closures, she said.

Nakamoto said Pali Momi will dispatch a doctor to people entering the emergency room to provide a quick triage, or diagnosis, to help the hospital determine the order in which patients should be seen.

Straub, which like Pali Momi is part of Hawaii Pacific Health, has seen about a 10 percent increase in its emergency room traffic since the HMC closures, said Claire Tong, Straub communications director. The total population at the King Street facility fluctuates, she said.

Another key concern of health care observers in the wake of the HMC shutdowns has been the increase in frequency in which hospitals declare themselves under reroute or diversionary status. For a time Tuesday evening, six of nine Oahu hospitals, including all those in urban Hono­lulu, were telling ambulances to take noncritical patients to less busy facilities. At 8:20 p.m. Thursday night, five were diverting ambulances elsewhere.

Hospital officials emphasize, however, that reroute status does not affect critical-care cases, which have top priority at all times.

"Someone in critical condition or has a heart attack or a stroke needs to be treated first," Naka­moto said.

Emergency room patients with noncritical ailments are most affected, Clairmont said. Such a patient previously may have waited up two hours to receive attention but now may have to wait four to six hours, he said.

Clairmont said regardless of the increased pressure on Oahu hospitals, people who believe they are seriously ill should not hesitate to call an ambulance.

Deputy Health Director Linda Rosen said the addition of two more city ambulance units in West Oahu has helped ease the situation immensely. The Health Department and the city Depart­ment of Emergency Services say once someone is in an ambulance, that person’s chances of survival are immensely improved.

The increase in reroutes means patients may not be taken to the hospitals of their choice, "but I think they will get the care that they need," Rosen said.

The state Senate Health Committee is scheduled to hear testimony today on House Bill 1953, which allocates state funding for the additional West Oahu ambulance service as well as additional money for the state-run Wahiawa General Hospital.

EMS District Supervisor Kelly Yama­moto said the HMC shutdowns have caused all Oahu hospitals to be busy much more frequently. "All the emergency rooms are full, nearly all the time," she said.

But Yamamoto stressed that even then, those being transported are cared for by paramedics up until the time they are seen by hospital staff. "We don’t just drop a patient off and leave."