Doctors in Jackson Memorial’s emergency room say their work is hindered by a hugely dysfunctional system that has trouble processing blood samples, getting basic diagnostic imaging and finding hospital beds for patients.
Public documents requested by The Miami Herald revealed that the doctors had plenty of complaints when a manager asked them what they would like to see changed in the ER.
The issue is crucial because Jackson Health System executives now are studying bids from nine outside companies about taking over doctors’ services in the emergency rooms — a step that has already brought vehement objections from a half-dozen county commissioners and protests from leaders of women’s groups who fear the move will hurt the rape treatment center at the hospital.
At a county commission hearing last month, Jackson Chief Executive Carlos Migoya complained that a Jackson ER doctor takes care of only one patient an hour. That compares to a national average of two to 2.5 patients an hour, Migoya said. “We are very slow.”
The average patient now spends six hours in the ER if they’re sent home, according to Jackson’s statistics. Those being admitted to the hospital average 13.7 hours in the ER. Jackson officials say they’re working to improve those figures, but that they’re far better than the 26 hours the average admitted patient spent in the ER in December 2010. The national average for all ER patients is four hours, four minutes, according to the American College of Emergency Physicians.
The documents obtained by The Herald were emails from ER doctors replying to ER Medical Director Lilly C. Lee’s request for “top 10 items that you want to change.”
Julie Kanter, a veteran ER doctor, wrote that “many hours of patient delays” were caused by not having a hospital cell phone to communicate with other doctors about a patient’s problem. “In every other [ER] I have worked in, we carried a hospital cell phone.” What’s more, “I’m running upwards of four hours ... just to get the X-ray taken.”
Another doctor, Vanessa Price Davis, wrote: “ER physicians waste too much time looking for [intensive care] beds,” often making many calls trying to deal with the Jackson bureaucracy to get a patient admitted.
What’s more, “it is not uncommon for patients to wait for hours after being admitted to have orders written by the hospitalist,” Price Davis wrote, meaning the ER physician has to continue taking care of the patient.
Several doctors complained there are often lengthy delays in getting blood samples analyzed because the sample goes bad — a process called hemolyzed — and the test needs to be redone, sometimes two or three times. Veteran ER doctor Art Diskin said he has never seen a hemolyze problem other than at Jackson.
Alex Contreras-Soto, chief administrative officer of Jackson Memorial, said he’s well aware of the doctors’ complaints, and his managers are working hard to correct many of them, such as finding a way to provide doctors with cell phones so they’re not perpetually playing phone tag with consulting doctors, and adding 40 more beds to the hospital floors so that ER patients can be more quickly admitted to the hospital.