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Hospital works to address rise in patients

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Patient visits to the emergency department at Columbus Regional Hospital have doubled in the past 40 years and have remained at record levels.

“We’ve got an emergency department that was built to take 25,000 patients a year, and we’re seeing more than 40,000,” said Carolyn O’Neal, the hospital’s director of nursing.

The hospital is on track for that string to continue for a fifth straight year.

In 2012, the emergency department had 41,675 patient visits. The number for this year was 33,631 at the end of October, but often the final two months of the year are some of the busiest, according to Dr. Jason May, medical director for emergency services at Columbus Regional Health and former hospital chief of staff.

Hospital-wide, volume often picks up in November and December as more patients seek medical care after they have met health-insurance deductibles.

Spokeswoman Denise Glesing said hospital leaders recognize the need for a new or expanded emergency department and are exploring options.

The emergency department had been slated for remodeling and expansion before the historic flood in 2008, which closed the hospital for nearly five months and changed its physical and financial landscape.

Today, meanwhile, other health systems across the country — including Indiana — are reacting to market volatility, in many cases reducing hospital staffing.

“We realize that many changes are facing hospitals and health systems across our country, and we want to make the best decision in how to best use a facility to serve our patients and community,” Glesing said. “We are close to concluding our planning and anticipate a decision in the near future.”

The increase in patient volume in emergency departments dates back to 1986, when federal legislation required hospitals to see patients regardless of their ability to pay.

Fast-paced area

Doctors and nurses in the emergency department at Columbus Regional Hospital are used to juggling multiple tasks and patients at a time. A typical day might find them treating victims from a car accident, helping patients with abdominal or chest pains and educating others about health care options in the community.

The fast-paced department on the first floor of the hospital rarely has staff waiting around for some thing to do — even at 2 or 3 in the morning.

“We’re always busy,” May said.

He said a workday could have him dashing among eight patients at a time, quickly taking time to type up notes and orders on his laptop computer.

A quiet waiting room can be misleading to patients or visitors, he said.

“They don’t see the patients that come in the back door in the ambulance,” May said.

Other changes

Along with the general increase in the number of patients, May said the emergency department in recent years has seen:

A steady flow of patients around the clock.

More patients without health insurance.

An increase in the severity of illnesses.

Dr. Kevin Terrell, one of 12 emergency physicians who work at CRH, said the economy likely has played a role in sicker patients coming to the emergency department. He treats some patients who are struggling to find jobs or have jobs that do not have health insurance, so they wait longer to see a doctor.

“It’s a communitywide challenge,” Terrell said. “We’re trying to help patients find what they need.”

Case managers are available in the emergency department to help patients connect with health care providers or resources in the community.

Pamela Missi, CRH vice president and chief nursing officer, said every one in the emergency department is involved in helping educate patients about finding the best health care options for them.

This might include assisting patients in finding a primary care doctor, showing them how to sign up for Medicaid, providing information about the Volunteers in Medicine clinic or making sure those with a chronic condition, such as high blood pressure or diabetes, receive the follow-up care they need.

Case managers can help patients find care so that a return trip to the emergency department might not be necessary.

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