ER Visits Up At Fort Smith Hospitals Following Health Care Act

Sept. 07--Almost a year after the first health insurance enrollment under the Affordable Care Act, local hospitals Sparks Regional Medical Center and Mercy Fort Smith have seen an uptick in emergency room visits.

Shelly Cordum, nursing chief executive for Sparks Regional Medical Center in Fort Smith, says the Sparks emergency department saw 6,700 patients in July. The trend is not expected to decline either.

"The Medicaid expansion and the health care option certainly has spurred this influx, without a doubt," Cordum said. "It's people from all walks of life. They're coming in with all different kinds of medical problems, and they enter the hospital through the ER because many don't have a primary care physician and they are very sick."

Mercy Fort Smith saw an increase of 527 emergency department visits in July, with 3,954 compared to 3,427 last July. Mercy's primary care visits at its many clinics also increased by 37,789 visits in one year, with 70,811 visits by the end of fiscal year 2013 and 108,600 visits by the end of fiscal year 2014.

"While there will always be a need for emergency departments to care for people who suffer trauma or have a sudden illness, we are building a delivery model of care that will better manage the health of our population and promote care, when needed, in the most appropriate setting for the patient," wrote Ryan Gehrig, president of Mercy Fort Smith.

Gehrig said Mercy will continue to grow primary care resources and work toward better health for the larger community.

"There is a demonstrated need for better access to care," Gehrig added.

People who are sick are not getting treatment at clinics because it takes take them longer to get an appointment, Cordum said. Fort Smith needs 30 to 40 more primary care physicians to meet demand. Complications from high blood pressure and diabetes make up a large part of the issues at the Sparks ER.

"Sometimes correcting a long-standing health care issues such as high blood pressure can spur several other disease processes that require immediate attention," Cordum said.

In the process of the body trying to self-correct, Cordum explained, sometimes when medication is given to a high blood pressure patient to correct the problem, his or her kidneys stop functioning, because the organ has adjusted to the higher pressure of blood to have everything work.

Winter Is Coming

The Sparks nursing chief said she has to open 32 more medical "surge" beds and 10 more ICU beds to meet the demand of more patients. The hospital is also hiring 30 more RNs and 20 health care support staff by Halloween.

Sparks employs 782 RNs in the hospital and 44 at its clinics. It also reintroduced the LPNs in recent years and has 135 of the mid-level nurses to conduct procedures and free the RNs for other duties. At least 11 LPNs at Sparks are studying to become RNs and four RNs studying for doctorates. There are 140 nursing assistants.

"Going into the winter, if we don't start projecting now people to care for those, we're going to get into the busy months and it's going to be really hard for everybody," Cordum said.

People with respiratory illnesses have a difficult time when the seasons change, Cordum added. They tend to have more pneumonia and other acute illnesses when the weather changes. An additional 12 nurses were added to the emergency department at Sparks to meet the demand of seeing between 190 and 225 patients a day, a number usually only seen during flu season. Flu shots are expected to be available soon.

Cordum said before Medicaid expansion the Sparks ER saw an average about 160 patients a day, and was the "busiest ER in the state" in 2013.

"The good news is that we'll be able to help a lot of people, but we have to be prepared for that surge and monitor it very closely," she said. "I think this winter is going to be very telling for us as we see the different disease processes."

Adapting, Expanding

Adapting to the change brought on by health care expansion is a challenge for the hospitals, but one they are willing to do in an effort to create a more healthy population.

Gehrig said the key to stabilizing emergency department visits is expanding primary care.

"Early intervention in the primary care setting will help many patients avoid the high-cost, resource intensive environment of the emergency department," Gehrig stated. "Mercy's commitment to recruiting more primary care physicians and creating new clinics is designed to help people get the care they need before it becomes an emergency situation."

In the last year, Mercy Clinic increases its primary care visits by 53 percent. It added more health care providers an care centers, Gehrig noted.

In addition to new primary care clinics, Mercy added four clinics in schools, one in a retirement living center and one dedicated to providing expanded access for Medicaid patients needing to establish with a primary care provider.

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