ER wait times at NEPA hospitals longer amid lack of beds, staffing challenges, service reductions

May 28—It happened fast — a late-night fall. A broken glass. A lot of blood. Laureen Spindler and her husband rushed to Geisinger Community Medical Center's emergency room in Scranton late March 17, minutes after she fell in her city home. She shattered a drinking glass and suffered a laceration that severed a tendon in her right thumb.

It took about 20 minutes from their roughly 10 p.m. arrival for staff to inspect and wrap Spindler's sliced hand. It was hours more before a doctor stitched the wound.

"It was just a very traumatic event in my life," said Spindler, who spent about seven overnight hours at GCMC. "I know in the past when I went to emergency rooms, which was maybe years ago, you waited. But this is just outrageous."

Hourslong ER waits have become a common occurrence at other hospitals in the region.

Geisinger acknowledged longer wait times and lack of ER capacity at GCMC as officials pushed for zoning to accommodate a planned hospital expansion in Scranton's Hill Section. But doctors and experts say crowding, lengthy waits and longer visits — challenges not unique to any one hospital or health system — reflect a broader reality of emergency care, and Northeast Pennsylvania facilities aren't immune.

"(Emergency department) crowding is a problem and it is a problem across the entire United States," said Penn State assistant professor of health policy and administration Charleen Hsuan, Ph.D. "It's been a problem that was longstanding and it's been exacerbated by COVID."

Changes and challenges

Hsuan and John Wiercinski, a University of Scranton health administration professor and a former Geisinger senior vice president, said lack of inpatient beds, pandemic-worsened staffing challenges, hospital closures and service reductions all contribute to ER crowding.

They're many of the same factors, Ron Beer, chief administrative officer for Geisinger's northeast region, noted last month.

"Each of you probably have a personal anecdote about the challenges you or a loved one have faced accessing health care over the last few years," Beer told Scranton City Council. "There's a growing concern in the region about the stability of our health care market, and, quite frankly, it's for good reason."

Lehigh Valley Health Network broke into the local market last year when it launched Lehigh Valley Hospital Dickson City, where Emergency Medicine Director Dr. Danielle Deitrick said ER visits have increased month over month since the facility opened.

But soon after the region gained that resource it lost others, putting more pressure on providers left to absorb the volume.

Last year, Commonwealth Health shuttered the ER at the former Tyler Memorial Hospital near Tunkhannock and closed First Hospital in Kingston, the region's only private psychiatric hospital. The for-profit health system also closed Moses Taylor Hospital's ER earlier this spring, consolidating operations at nearby Regional Hospital of Scranton.

Dr. Patricia Ihnat-Shroff, Commonwealth Health's emergency department medical director, said the Dickson City hospital's opening prompted a shift in volume that made Commonwealth realize it was splitting resources and duplicating services at Scranton facilities about two blocks apart.

"That gave us the opportunity to really think about this and how can we best serve the patients in Scranton, and that was to consolidate our team and our resources," she said. "Yes, we have seen an increase in our volume at Regional Hospital. It was something that we were planning for. It's something that we still prepare for daily. We have a very strong team in place now at Regional."

The consolidation also increased patients at other local ERs, including GCMC's, which was already struggling to meet high demand. Dr. Steven J. Brunetti, a founder of the firm Emergency Services PC, which staffs physicians at GCMC's emergency department, said last month the department saw a spike of sometimes 40 or so more patients a day since Moses Taylor's ER closed.

Lehigh Valley Hospital Dickson City also experienced an increase in ER patients with the closure of Moses Taylor's ER, hospital President Kim Jordan confirmed.

"We're also seeing those volumes continuing to escalate in the beginning of May," she said. "We're new, and our numbers have been increasing month over month over month over month."

First Hospital's closure also had an impact, as behavioral health patients can spend protracted time in ERs waiting for an inpatient bed to open somewhere. That's been the case at Wayne Memorial Hospital in Honesdale, emergency department director Dr. Todd Holmes said, noting the pandemic worsened the mental health crisis in America.

"There are not a lot of inpatient beds available for those patients, and so they can wait in the ER for extended periods of time waiting for an appropriate inpatient site," Holmes said. "All that boarding ties up beds, ties up real estate in our department, gives us less space to work with, and that contributes to the longer wait times."

Officials from numerous hospitals and health systems were quick to note that triage systems are in place so patients experiencing heart attacks, strokes, traumatic injuries and other critical health emergencies are seen first.

Time in ER

Changes to the local emergency care landscape aren't reflected in recent data on ER visit times published by the U.S. Centers for Medicare & Medicaid Services, which covers July 2021 through June.

One metric measures the median time in minutes from ER arrival to discharge. In most cases, Northeast Pennsylvania hospitals lagged behind the state and national averages for facilities with comparable ER volumes.

The state and national averages for medium-volume facilities were 178 and 171 minutes, respectively. Regional Hospital of Scranton exceeded both at 189 minutes, as did Wayne Memorial, 198 minutes; Wilkes-Barre General Hospital, 212 minutes; and Lehigh Valley Hospital Hazleton, 242 minutes. Moses Taylor's now-closed ER performed far better, with a median time of 146 minutes.

High-volume facilities also fell short of the state and national figures. The median length of an ER visit at GCMC was 222 minutes, compared to the 210-minute state and 204-minute national averages for high-volume hospitals.

Geisinger Wyoming Valley Medical Center in Plains Twp., which CMS puts in the very high volume category, reported median visit times of 204 minutes. The state and national averages for such facilities were 191 and 190 minutes, respectively.

Geisinger provided updated median figures for the past year showing the lengths of ER stays increased at several hospitals. The newer figures put the median length of a GCMC emergency department stay, from arrival to discharge, at 291 minutes. Geisinger Wyoming Valley Medical Center's median time was 320 minutes, the longest in the system.

High acuity

As for why most local hospitals' median ER visit times fell short of state and national averages, Wiercinski pointed to Northeast Pennsylvania's older population and other demographic characteristics.

Older, sicker, high acuity patients require more health care, while patients without access to primary or preventive care often don't pursue treatment until their conditions escalate. When they finally do, they visit ERs, which can contribute to crowding.

"You have to read those statistics and take into account the demographics of the population, the availability of services," Wiercinski said. "You need to make sure you compare apples to apples, and just because we may be lagging behind doesn't mean that the care is of any lesser quality."

Ihnat-Shroff agreed a patient population with more acute needs can contribute to longer ER waits and similar issues, noting sicker patients require more resources and testing.

Dr. Ronald Strony, Geisinger system chair of emergency medicine, said patient acuity rates at both GCMC and Geisinger Wyoming Valley are high. When those patients need operating rooms, inpatient beds or other resources things can get backed up and lengths of stay can increase, he said.

Many of the issues driving ER crowding aren't new. The newspaper previously reported on the national trend of increasing ER wait times in 2008, with experts then attributing the problem to fewer inpatient beds, a lack of qualified medical professionals and a high number of patients using emergency departments as their primary means of care. Locally, experts noted the area's large elderly population and a lack of primary care doctors.

While the causes of longer wait times are varied, the costs manifest in lost time for treatment, Brunetti said.

"Probably everybody here, when we think of emergency medicine we think of heart attacks, we think of stroke," he said. "I think of speed, so emergency medicine is all about speed. It's all about how quickly we can get the patient's head in the bed. ... The most precious resource that we have in emergency medicine is the bed. Without the bed, I cannot do anything."

Contact the writer: jhorvath@timesshamrock.com; 570-348-9141; @jhorvathTT on Twitter.

Contact the writer: jhorvath@timesshamrock.com; 570-348-9141; @jhorvathTT on Twitter.