Emergency physicians object to plan to cut hospital beds

Two groups say care would suffer if a University of Chicago facility reduces trauma center capacity, but the medical center calls concerns premature.

By Brian Hedger — Posted March 16, 2009

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Two emergency physician organizations are speaking out against a plan to reduce emergency department beds at the University of Chicago Medical Center.

The American College of Emergency Physicians and the American Academy of Emergency Medicine in February issued statements about a proposal to cut 30 inpatient beds at the medical center, including 10 of the 31 ED beds. Both organizations feared that fewer ED beds may mean worse care for trauma patients.


Dr. Jouriles

"This is a dangerous precedent that could have catastrophic effects in poor neighborhoods across the country," ACEP President Nick Jouriles, MD, said in a statement. "If other community nonprofit hospitals follow this example and shift the lion's share of resources to its high-revenue elective patients and procedures, it will leave many emergency patients virtually out in the cold."

But UCMC spokesman John Easton said in March that the plan is still being reviewed and that it no longer includes eliminating 10 ED beds. Part of the plan calls for working with physicians, clinics and hospitals in Chicago's South Side to direct patients to "medical homes" in the area that can give patients proper diagnoses, treatment and preventive care. Two high-ranking UCMC physicians quit their administrative posts because of the proposal.

The AAEM's statement urged UCMC leaders to meet with their emergency physicians and nurses to talk about triage and screening examination policies before anything is finalized. Easton said that would be done, but he could not elaborate on a timetable for making plans final.

"It sounds like we're turning away patients left and right, and in reality we haven't changed anything," Easton said. "We're still discussing the emergency room plan."

Boy's care triggered concerns

The 571-bed medical center came under fire after a Feb. 13 Chicago Tribune article about a boy who was attacked by a dog last summer and went to UCMC for treatment. The boy's mother said that after a lengthy wait, doctors cleaned her son's wounds and gave him pain medications before discharging him with a recommendation that he follow up in a week at John H. Stroger Jr. Hospital of Cook County The mother instead took the boy that night to the Stroger ED, where he was then rushed into reconstructive surgery on his lip.

UCMC stands by its recommendation for delayed surgery.

ACEP criticized the medical center's policy toward emergency patients, saying it is dangerously close to the "patient dumping" prohibited under the Emergency Medical Treatment and Labor Act.

UCMC issued a statement calling the ACEP comments "reckless, uninformed and based on hearsay."

While this specific case has received the most media attention, the bigger issue is emergency access, said ACEP President-elect Angela Gardner, MD.

"The concern is actually the general trend [UCMC] is taking in trying to limit beds," said Dr. Gardner, an assistant professor of emergency medicine at the University of Texas Medical Branch at Galveston. "We already have huge problems with people staying in the emergency department longer than they need to, because they can't be taken to beds upstairs.

"If they limit that further, then people won't be able to get into the hospital, and they'll have to be cared for in the ED. That's just not what you want."

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