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Column One

A night in the ER: adrenaline, chaos and very long waits

At Los Angeles County/USC Medical Center, as many as 550 patients a day pass through the emergency room. 'It's like a battlefield in here.… It just doesn't stop,' says a nurse supervisor.

September 30, 2011|By Anna Gorman, Los Angeles Times
  • A patient sleeps in a hallway near the ER at L.A. County/USC Medical Center. He was moved there to make room for incoming trauma cases.
A patient sleeps in a hallway near the ER at L.A. County/USC Medical Center.… (Robert Gauthier / Los Angeles…)

A wall-mounted computer screen in the call center at L.A. County/USC Medical Center showed the emergency room was full. Ambulances were supposed to take patients elsewhere on this Friday night. But they kept coming — some because it was the closest ER, others because the injuries were so severe only a trauma center could handle them.

"We get them from outside hospitals, from clinics, from the field, from the jail, from police, from everywhere — everywhere," said Alma Aviles, a nurse supervisor. "It's like a battlefield in here.… It just doesn't stop."

Four patients waited on gurneys in a hallway: a homeless man with maggots in a leg wound, a jail inmate with a broken jaw, a quadriplegic with a high fever and chills, and a paralyzed homeless man with severe bedsores.

"I'm trying to get beds," nurse Kristie Nunez told the paramedics lined up alongside the patients. "But I have none."

This is the county's safety net hospital, the place where the ill come for medicine, the wounded come for help, and the dying come for miracles. As many as 550 patients a day pass through its emergency room, one of the busiest in the nation. They wait an average of four hours to see a doctor — and then longer for further evaluation, treatment or an open bed.

The total wait from the time a patient arrives until he is admitted or discharged has averaged nine hours recently.

The economy has made the delays worse. More jobless and uninsured people rely on the ER for primary care and prescriptions, and by law the hospital cannot turn them away. But much of the crowding stems from the decision to replace the old County/USC, an aging, earthquake-damaged relic, with a smaller hospital.

The new hospital, which opened three years ago, has 137 emergency room beds, up from 96. But there are only 600 inpatient beds, compared with 824 before. County health officials believed that 600 would be enough because improved medical technology and case management would shorten patient stays and other hospitals would pick up the slack.

That hasn't happened. Inpatient wards are perpetually full, so people sick enough to be admitted to the hospital often wait hours or days in the ER for a bed. While they take up space there, other patients are backed up in waiting rooms or corridors.

The crowding has become so severe that county officials acknowledge something must be done. They are discussing adding inpatient beds and transferring more patients to other hospitals, among other steps.

"A nine- or 10-hour wait is never a good thing," said Dr. Arthur Kellermann, a Rand Corp. expert on emergency medicine. "At the least, it is demeaning, frustrating, uncomfortable, and when tempers flare, it can be dangerous."

During a 12-hour period beginning Friday afternoon, Sept. 9, there was no letup. By 7 that evening, the big computer screen in the ER call center said "SAT," for saturated. A nurse took a call from yet another ambulance crew.

They were bringing in a 43-year-old man who had fallen on the sidewalk after leaving a liquor store. He was confused, his head was bleeding, and his heart rate was high.

3 p.m.

The first person patients meet when they walk into the ER is nurse Joanne Rimmer. From her desk just inside the front door, she peppers them with questions. Then she decides, usually in 30 seconds or less, whether they should be fast-tracked to a physician, sent for further evaluation or parked in the waiting room.

"What's the problem today?" she asked a man at the head of the line.

"I just want to see a doctor," the man said, wincing and holding his stomach. "I just keeping throwing up."

Rimmer, calm and decisive, conducted a speedy interrogation: How long have you been throwing up? Do you have a fever or chills? When was the last time you went to the doctor?

The stream of walk-in patients is nonstop — they come with chest pains, eye infections, allergic reactions, dog bites, stomachaches. Rimmer judges the severity of each one.

She sent this patient to the waiting room, where he joined dozens of others sitting in plastic chairs. An electronic sign flashed above their heads: "Patients are seen by severity of illness, not in order of arrival. Thank you for your patience."

Jennifer Lopez, who is unemployed and lives in El Sereno, was waiting to see a doctor for a lingering kidney infection. Earlier in the week, she had borrowed $400 from her parents to pay for an appointment and antibiotics at a clinic, but the infection didn't go away and she couldn't afford to go back. "I came here as a last resort," she said.

Teresita Acierto, 66, had taken two buses from Glendale to see a doctor about a swollen finger. "Even though I have Medi-Cal," she said, "I feel more comfortable with the doctors here."

Some afternoons, Rimmer's line stretches out the door and she barely leaves her seat for the entire shift.

"It's overwhelming," she said. "I walk out and I have sensory overload."

4:45 p.m.

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