Baylor Medical Center And Emergency Care Issues

Andrea Watts

Professor Johnson

HSM 420

10 December 2005

Baylor Medical Center and Emergency Care Issues Paper

Description of Organization

Baylor Health Care System is a medical network that services seven counties in the Dallas/Ft. Worth metroplex. It is a not-for-profit, faith-based network of hospitals, primary care centers and practices, rehabilitation clinics, senior health centers, affiliated ambulatory surgery centers, and the Baylor Research Institute. According to the 2003 fiscal year statistics, Baylor has "$543.9 million total long-term debt, $2.0 billion total assets $1.7 billion total operating revenue and $180 million in community benefits (Baylor.com).

On an annual basis its emergency rooms treat over 54,800 patients each year (Hoover). In 2004, the total number of patients seen for emergency room visits (combined facilities) was 247,224 (Baylor.com). Baylor has full emergency services available 24 hours a day, 7 days a week. "The physicians and staff in the emergency room have years of experience and training" (Baylor.com). According to an article in WebMD, "eighteen people in the U.S. die every hour due to injuries". In a report published by the Centers for Disease Control, "accidental or unintentional injuries are the fifth leading cause of death in the U.S. and are responsible for sending one of every three people to the emergency room for treatment" (WebMD).

Constraints and Roadblocks

"The emergency room, like other hospital departments, has undergone radical

transformation in recent years. It has expanded in the services once offered and in complexity" (Williams 57). According to Stephen Williams due to recent changes in healthcare and the number of uninsured and underinsured, medical emergency rooms now treat more individuals for primary care (57). The intent of emergency rooms was to treat only individuals who were in a medical crisis and under distress; not to treat those for preventive services such as a runny nose, or bad cough. Emergency rooms have been routinely misused in the last 20 years or so. "They have been integrated with other community resources such as drug and alcohol treatment centers, mental health centers, and voluntary agencies" (Williams 57). At a time when many hospitals are closing their emergency department down due to over-utilization and staffing issues, Baylor is continuously focused on its ability to service its communities. In most hospital settings the normal emergency visit lasts anywhere from 4-6 hours and many emergency rooms are burdened with a lack of inpatient beds and space. In a general emergency situation many of the staff of emergency rooms have to be able to provide immediate medical attention to a large number of people without becoming overwhelmed. They must be able to quickly assess and prioritize (triage) the patients that are seeking care and provide care in a manner that allows them to treat the most injured or ill patients first (Williams 57). Hospitals are essential, irreplaceable resources for planning, response, and recovery associated with emergencies, but they carry a unique set of constraints that makes effective participation in such efforts challenging at best. Hospitals as a whole face difficult financial times: approximately 30% of U.S. hospitals are operating at a financial loss (JCAHO.com). Costs haven't been the only increasing item. Healthcare facilities are hardly exempt from government regulations (a recent example is the Health Insurance Portability and Accountability Act, HIPAA) and are strongly affected by changes in Medicare reimbursement patterns, but accredited hospitals also deal with the nongovernmental Joint Commission for the Accreditation of Healthcare Organizations (JCAHO). "To achieve and maintain accreditation, hospitals must adhere to JCAHO's consensus standards as demonstrated during periodic onsite and remote surveys. Standards are diverse in scope and generally derived from clinical, ethical, technological, environmental, or occupational indications. Like many government regulations, they tend to add expense and are not accompanied by new revenue streams" (JCAHO).

Hospitals rely on public trust as much as on reimbursement revenue. "More than most corporations or government agencies, a healthcare facility that suffers a crisis that they can't respond to stands to lose both funding and patients along with its reputation" (Baylor.com). Expectations, commonly in the form of blind assumptions, are that hospitals should be able to handle whatever they receive--and do it right the first time. With respect to emergencies, this includes:

* Managing medical assessment, treatment, and continuing care for acute incidents involving large numbers of patients

* Effectively managing contaminated patients

* Recognizing, identifying, and managing consequences of bioterrorism

* Protecting employees, patients and their families, and anyone else within the facility

* Dealing