ER FACES SHORTAGE OF BEDS HIGH PATIENT VOLUME SWAMPS AVH STAFFERS.

Byline: Karen Maeshiro Staff Writer

LANCASTER - Operating the second-busiest emergency room in Los Angeles County, Antelope Valley Hospital continues to struggle with long waits in getting patients admitted due to a shortage of beds.

The 28-bed emergency room sees on average 250 to 260 patients a day, but at times the numbers get as high as 450, and patients who need to be admitted can lie in emergency room beds for as long as five days, possibly longer if they need to go into a critical care ward.

``It's not going to change until we have more beds to put patients in. The problem is not coming into the emergency room - you will be seen and be seen promptly. The problem is trying to find a place to put patients who need to be admitted to the hospital,'' hospital director June Snow said.

``What this means is the emergency room staff will have to care for you until somebody on a floor can do it. This is not optimal patient care. You can't turn off the light. There's not a lot of privacy,'' Snow said.

In terms of the number of people seen, Antelope Valley Hospital's emergency room ranks behind Los Angeles County/USC Medical Center's, county officials said.

``Of all the paramedic-receiving hospitals, if you just look at the volume of patients seen in the emergency room and the volume of 911 transports, they get the most, second only to L.A County/USC,'' said Carol Guenther, acting director of the emergency medical services agency of Los Angeles County.

County fire paramedics said emergency room crowding reached a critical stage about two years ago, when wait times to drop off patients averaged an hour to 1 1/2 hours, said Mike Metro, chief of emergency medical services for the Los Angeles County Fire Department.

Once a paramedic squad had to wait four hours when the emergency room was extraordinarily busy, an incident described by Metro as an ``anomaly.''

Except for a spike in December during a surge in reported flu cases, waits lately have been 30 minutes or less, he said.

``It was critical two years ago. It's gotten much better over the last two years but it's still longer than it should be,'' Metro said. ``We would like to see it between 10 and 20 minutes.''

Both Antelope Valley Hospital and Lancaster Community Hospitals have taken steps to ease the wait for emergency crews, including opening up more beds, developing triage procedures and having quicker turnaround times for inpatient beds.

``(Antelope Valley Hospital) instituted triage nurses so as soon as a person came in, either they were taken off the gurney or put in the waiting room if it was minor. Tests were oftentimes ordered right away so results were ready for the doctor,'' Metro said.

County fire officials developed strategies to augment resources if Antelope Valley Hospital's emergency room beds were being used by patients waiting for beds to open up.

If 17 of the beds are occupied, fire officials add one additional paramedic squad in the Antelope Valley by paying staff overtime; if 20 beds are being used, two squads are added, Metro said.

``When it hit 25 beds, we would augment two additional squads and then bring up another squad from the basin,'' Metro said.

Metro said he is working with other local health and government officials to come up with other ways to lessen emergency room crowding.

``We are trying to brainstorm new and innovative ideas to redesign the way we deliver pre-hospital care. The health care system has changed so much in the past 20 years that our pre-hospital care system hasn't necessarily changed with it,'' Metro said. ``A lot more people are going to emergency rooms now for things 20 years ago they wouldn't have gone to an emergency room for.''

One idea is to transport nonemergency 911 calls to clinics rather than to a hospital.

``Currently, any time you call 911 and are transported via 911 you must go to the emergency room. We need to look at opportunities of using clinics - advanced clinics to take minor patients to and not clog up the ER,'' Metro said.

Doctors and hospital officials said the crowding is in part due to the Antelope Valley's population growth.

In 1990, the Antelope Valley had a population of about 200,000 and five hospitals.

Three hospitals - Desert Palms Community Hospital in Palmdale, a small hospital at Edwards Air Force Base and the county-run High Desert Hospital in Lancaster - have since closed, and now the valley's population is more than 400,000.

Since November, Antelope Valley Hospital has opened up about 50 beds that were previously not being used. That has helped, but not as much as if the other hospitals had not closed.

``We didn't get to enjoy the fruits of that labor. We immediately got High Desert patients, and previously had Palmdale's patients. We were inundated already,'' Snow said.

Antelope Valley Hospital is planning to convert its skilled nursing facility into a center for women and infants, which will free up another 40 beds at the hospital in about 18 months, Snow said.

``There's no doubt in my mind that we take care of patients as quickly as they can be seen. The problem in our emergency room is that if you are so sick that you need to stay in the hospital, we can't get you out of the emergency room because there is no place to put you,'' Snow said.

Karen Maeshiro, [phone]

karen.maeshiro(at)dailynews.com