A car accident victim is on the way. The ER is already a blur of action, with doctors and nurses in green and blue scrubs darting through, grabbing ringing phones behind a long desk, and conferring quickly. On a white board, nurses keep track of the patients already admitted. "Cough/back pain," reads one line. "Assault," says another.
A security guard clears the admissions area, shuffling patients' worried relatives into a waiting room. As they await news about a sick father or a niece who's been hit by a car, a young man walks in holding his side, too sick to talk.
One elderly woman is waiting to see her mother, who was picked up by an ambulance crew earlier in the day. For years, her mother went to Mt. Sinai Hospital, near their home around East 105th Street in Cleveland -- until last month, when that hospital closed. Her mother was reassigned to St. Michael's, but now that hospital is also scheduled to close. So when the ambulance crew came, the woman told them to take her mother up Euclid Avenue to Huron Hospital in East Cleveland.
A lot of people have taken that trip lately. The closing of Mt. Sinai in University Circle left only two adult trauma centers on the East Side -- Huron and Hillcrest Hospital in Mayfield Heights. Given its proximity both to Mt. Sinai and the inner city, Huron has become a bottleneck for many of the worst emergency cases: shootings, stabbings, car accident victims, people who have fallen from dangerous heights.
"Huron has taken the brunt of the overload coming from Mt. Sinai," says Richard Fox, senior vice president and CFO at the Center for Health Affairs in Cleveland. "Other hospitals in the area are [also taking in more patients], but the majority of the flow is going to Huron, because it's listed as a Trauma II center." (A Level II center is capable of handling nearly all trauma cases.)
At the close of 1999, the 211-bed hospital had 80-some beds filled on most days; now, the average is about 130 patients. Total emergency room visits are up more than 20 percent. In raw numbers, that translates to about 70 ER patients a day.
"We've increased staffing in every area of the hospital," says John Singleton, Huron's director of emergency and surgical services. Huron began preparing to absorb patients and staff from shuttered hospitals in late 1998, when the demise of St. Luke's Medical Center on Cleveland's southeast side was imminent. Anticipating a surge in emergency cases, Huron renovated its surgical intensive care unit and expanded its trauma resuscitation area.
As it turned out, not many St. Luke's patients came to Huron. "There's no easy way to get there from here," notes Singleton. But it's a different story now that Mt. Sinai is gone.
"Things have been busier, and we're responding to that need," says Singleton. Huron has added six people to its emergency department and four to surgery. The hospital took part in a job fair on the Mt. Sinai campus right after that hospital's closing was announced and brought on several temporary workers. Mt. Sinai nurses have been among the new hires.
"When there are less hospitals, there are more skilled people who are out of work," says Singleton. "We're absorbing them as they're ready to come back to work."
Huron sits on a small street a block from Euclid Avenue, between the leafy expanse of Forest Hills Park and a neighborhood of old, weathered homes. The hospital is a jumble of wings constructed at different times; a busy, brand-new community health center is just steps away from the small emergency waiting room, with its windowless beige-and-vaguely-pink-speckled walls. With a service area that includes East Cleveland, Cleveland Heights, and parts of Cleveland and Euclid, Huron will likely continue to see an increase in its workload -- a challenge the staff seems enthusiastic to take on.
"I think we're all kind of thriving on it," says Irene Herzog, a senior surgical assistant. "To people who enjoy their jobs and like what they're doing, the busier you are, the happier you are."
For Herzog, who first worked at the hospital as a student in 1992, it's like old times. "Huron used to be a very big, thriving hospital," she says. "This is putting us pretty much back to where we were before."
Huron's smaller patient load in recent years is consistent with a national trend of shorter hospital stays and more outpatient care, says George Weiner, the Center for Health Affairs' vice president for policy analysis and research. Still, like most hospitals -- especially those in troubled areas -- Huron has struggled under the pressures of Medicare and Medicaid cuts, managed care, and other changes in health-care economics. When its open-heart surgery unit moved to Hillcrest six years ago, some wondered if Huron would last. But the hospital has added various new centers and clinics since then, including its $3.5-million community health center just last year.
The hospital already provides $12 million a year in charity care, and the new influx of patients will probably drive up that number. But Singleton says Huron's openness to indigent patients won't change.
"Our commitment is unwavering," he says adamantly. "We're here to take care of anybody who needs care."
Huron still faces many of the same financial pressures that ultimately closed Mt. Sinai -- so simply staying in the game is a noteworthy achievement.
"Our costs to provide care continue to rise, while our reimbursement continues to fall," admits Singleton. "So the ability for us to continue to provide the same level of care is more challenging each day.
"We're doing more with less. That's a difficult thing to do."
Erick Trickey can be reached at email@example.com.
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