[Noozhawk's note: This article is part of a Noozhawk special project for The California Endowment Health Journalism Fellowships, a program of USC's Annenberg School for Communcation & Journalism. On Thursday, Day 6.]
Shallan Daly nervously held her two toddlers in the Santa Barbara Cottage Hospital emergency room before being led back to an area used for urgent care-type cases.
Daly’s 15-month-old daughter, Ryan, had a rash that had spread — within a few hours — from a few pink spots on her little nose to all over her back and legs.
Dr. Brett Wilson, an emergency room physician, looked the little girl over while nurse Jenael Rose crouched next to her big brother, age 2, and helped him pick out a movie to watch on his mother’s iPhone.
“And do you know what we have?” she asked. “We have stickers. Do you like stickers?”
Rose carries a stack in her pocket for all the children who come into the emergency room.
Daly tried calling her pediatrician because she didn’t want to “flood the ER,” but she didn’t pick up the kids from her ex-husband until 6 p.m., and it was too late.
There are no after-hours care options in Santa Barbara except the emergency room, so Daly brought them to Cottage Hospital.
Ryan’s age and the spread of the rash made Daly worried enough to come to the emergency room that night, and not wait for an appointment in the morning.
It turned out the rash was nothing serious, but the case was a common one for the ER, where medical personnel see a lot of urgent-care and primary-care issues in addition to emergency and trauma cases.
Santa Barbara Cottage Hospital’s ER is packed from about 3 to 10 p.m., and it sometimes has a “rush hour” in the middle of the night from the drunken downtown crowd and Isla Vista parties, Rose said.
She’s been working the 12-hour night shift — 6 p.m. to 6 a.m. — there for almost three years, having started in the ER after graduating from the CSU Channel Islands nursing program.
Even when the emergency room starts to slow down, the doctors and nurses don’t say anything.
It’s seems to be a superstition, because a big rush can come any time.
“We can’t control the ambulances and we can’t say no,” Rose noted.
It’s not just people coming into the waiting room. The medic phone in the nurse’s station rings to warn the ER staff of ambulances coming in and helicopters flying in patients from as far away as San Luis Obispo.
There are five emergency rooms in Santa Barbara County, but only two state-designated trauma centers: Santa Barbara Cottage Hospital and its sister, facility, Goleta Valley Cottage Hospital.
Marian Regional Medical Center in Santa Maria has been designated as a trauma center by the Santa Barbara County Emergency Medical Services Agency.
The levels go from one to five, with one being the highest designation, depending on the on-call surgery and specialists available.
If someone has a heart attack in Buellton, he or she likely will be taken to Santa Barbara, since that hospital does cardiac catheterizations (an invasive heart imaging procedure), even though Santa Ynez Valley Cottage Hospital is much closer, Rose said.
Santa Barbara Cottage Hospital also has qualifications to be a pediatric trauma center and the only stroke center — of a certain level — between Los Angeles and San Francisco.
People largely give credit to Dr. Alois Zauner, a local neurosurgeon who performs more than 600 surgeries a year.
Before this resource, Cottage and other hospitals sometimes would have to wait three days for a bed to open up at the UCLA Medical Center’s neurological intensive-care unit, said Ron Werft, CEO of Cottage Health System.
Now, patients can be getting care in minutes, he said.
The severe trauma cases are the reason adding a helicopter pad with the new hospital construction was so vital, Rose said.
“As much as the community hates the helicopter, the helicopter saves lives,” she said.
The ERs have to treat everyone coming in by ambulance, too.
Santa Barbara County mandates that anyone who calls 9-1-1 be transported by American Medical Response ambulance to the hospital, even if they’re calling because of a sunburn or stubbed toe, Rose said.
Some people just want a ride or believe arriving by ambulance lets them jump the waiting room line, but it doesn’t, she added; the ER staff still see people by urgency.
When the ER is busy — which is often — the 11 beds are full, and patients are offered a bed in the hallway while they wait for a room to open up.
Most patients opt for a hall bed, separated from other beds by a curtain.
There’s also the “launch pad” — the area next to the doors leading to the rest of the hospital where doctors put patients who are about to be admitted, so it opens up the room.
When the ER is very busy, the nurses even get patients started on labs and tests and then have them go back to the waiting room, to try to get them to a doctor faster.
The hospital also uses the pre/post-surgical area, which is adjacent to the ER, as overflow when it’s empty on weekends or nights to run as an urgent-care center.
Nurses and physician assistants can help take care of simpler cases such as small lacerations and colds, Rose said.
Turnover is key in an emergency room, Dr. Chris Flynn said. The hospital plans to double the ER’s size with construction by 2018, but the space is crowded for now.
The emergency department was designed for 25,000 visits a year, but doctors had 43,800 visits last year, Werft said.
Marian Regional Medical Center has had even more growth, more than doubling its emergency room visits over 15 years to almost 53,000 in 2011. The new hospital, which opened in May 2012, is twice the size of the previous facility.
Half of the ER’s cases are dedicated to mental health or “social failure” like untreated mental illness and/or drug addition, Flynn said.
Years ago, cases coming into the emergency would be broken arms, lacerations, appendicitis, gallstones and the like.
Now, Flynn said, they’re much more complicated problems that don’t belong in an emergency room.
“We don’t have the resources and our system is overwhelmed,” he said.
Santa Barbara Cottage Hospital’s emergency department and case management program meets with community organizations every week for a “Monday huddle” to try to reduce the number of frequent emergency room visitors among the local homeless population.
The strategy has significantly reduced the emergency department visits for that population, Werft said.
The number of inappropriate ER visits was almost 700 in 2009, but that number was down to 32 in 2012, according to Cottage Health System spokeswoman Maria Zate.
The number of inappropriate visits for the more recent group, with completely different patients, dropped 56 percent from 2011 to 2012, she added.
“What we’re doing seems to be working based on the data,” she said.
Sixteen different groups are involved in the homeless roundtable to collaborate and get people signed up for social services.
The organizations include Santa Barbara CARES, WillBridge, Safe Parking Program, the Santa Barbara Rescue Mission, Casa Esperanza, Salvation Army, Parish Nursing, the Santa Barbara County Public Health Department, CenCal Health, the Santa Barbara City Housing Authority, the Santa Barbara restorative policing program, the Cottage Health System case management group and medical social work program, and the Cottage transfer center.
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