It’s an emergency … or perhaps it isn’t. In either case, Oahu emergency rooms are having to cope with a jump in the number of patients who head for hospital ER departments.
The Honolulu Department of Emergency Services has noted a patient surge in the new year and, officials said, ambulance crews are having trouble finding a hospital that can take them, at least without a wait. Dr. Jim Ireland, department director, said EMS personnel are encountering four to five hospitals over capacity at the same time.
And it can get worse than that: On Wednesday Hilton Raethel, president and CEO of the Healthcare Association of Hawaii, told the Honolulu Star-Advertiser that at mid-afternoon, 7 of the 9 Oahu hospitals with ER facilities were at 100% capacity or higher. The ERs have been overtaxed for the better part of a month, said Raethel, adding that this is not typical.
Disease flare-ups have been an issue fairly routinely — the pandemic had that effect in the extreme — and the state’s shortage of primary-care physicians is well documented. The aging population is growing, as is the number of people living in certain parts of the island.
But there are other factors now that the patients themselves could address.
Patients brought in by ambulance generally do need acute care, Raethel said. But there are many patients who drive themselves or have a family member do so because they want immediate attention and know they’ll get it in the ER.
Some may not realize how much emergency services cost, he said, perhaps four times as much as a clinical visit, or even more. Depending on their insurance or health coverage, their share of the bill can be pretty high.
Or patients do know it, Raethel said, but they’ve just been conditioned to expect immediate attention: They may have to wait, but they will be seen.
However, if capacity is well over 100%, Raethel said, patients who truly need full care may be in a chair or
on a gurney, with doctors and nurses making do with less-than-optimal conditions.
“We want people to know that the issue with the ERs is (that) they’re very, very full, and that puts a lot of pressure on the staff,” he said.
For those who are in the emergency room because they’ve postponed routine care — they’ve procrastinated on vaccinations, perhaps, or they missed a preventive-care appointment and haven’t rescheduled it — the best course is to handle health issues before they become potentially serious concerns. Alternatively, there are urgent-care centers that can treat less-serious illnesses far more economically.
Hospitals are working to increase their capacity. The Queen’s Medical Center, at both its West Oahu and Punchbowl campuses, is planning an expansion to accommodate its high emergency-medicine census.
For its part, the state has done considerable work to establish medical-respite “kauhale” locations to help the homeless, who have recurrent illnesses and circle back frequently to the ER. And there has been success in creating programs to attract new doctors through relieving their education loan debts.
These are longer-term solutions, though, Raethel said. The more immediate crisis will require patients to be more strategic in their consumption of health care.
For example, Queen’s West Oahu is devoting additional space for telemedicine technology, which should help. Unfortunately, Raethel said, Hawaii residents have begun resisting telemedicine, insisting on face-to-face care, since the pandemic began to wane.
When medical resources are limited, as they are in Hawaii, all the options should be tapped — a consideration that largely falls to the medical consumers themselves. Health care is self-care, too.
