U. of C. emergency room to get more selective

The emergency room of the University of Chicago Medical Center may no longer be for every illness or injury.

Have a severe injury from a car accident? Head to the ER. Have pneumonia that can be treated with antibiotics? You may be led elsewhere.

That's because the hospital is changing the way it admits emergency room patients as part of its effort to deal with the worsening economy, a move underscored by Monday's announcement of 450 layoffs, or 5 percent of its workforce.

The U. of C.'s decision to introduce what amounts to a new version of patient triage represents an aggressive and unusual move by one of the city's premier hospitals to cope with spiraling costs and the long waits for emergency treatment.

Some don't like the plan, but the U. of C. says it has no choice.

The academic medical center in the Hyde Park neighborhood said 40 percent of the 80,000 patients who go to its emergency room each year do not need to be there. These visits cost the hospital tens of millions of dollars a year in time spent by staff and specialists whose attention is redirected to cuts, bruises and other less severe conditions that can be treated at community hospitals or through prescriptions.

In addition, the hospital has been dealing with the rising numbers of uninsured, as well as patients covered by Medicaid, which pays low rates and has been months behind on payments to doctors and hospitals in Illinois.

So the hospital is escalating steps to direct these consumers elsewhere, which it says will allow it to focus on treating the sickest of patients, as well as conduct research and train doctors. The U. of C. says its costs are 30 percent to 40 percent higher than community hospitals, which are better positioned to treat a variety of patients.

"We are trying to get the right patients to the right doctor at the right time for their disease and disorder," medical center Chief Executive Dr. James Madara said.

The hospital's effort to manage patient care began as the Urban Health Initiative with a group of executives that included First Lady Michelle Obama, who was involved in early efforts to educate patients on the best use of the emergency room.

Under the escalated program, the emergency department will be reorganized to provide more evaluations from doctors and nurses before care is provided. In the past, the U. of C. treated the patients and then educated them about health clinics, setting appointments at doctor's offices and community centers for follow-up care.

The medical center found in a poll that 60 percent of its patients did not know these community health centers were an option, said Dr. Eric Whitaker, who took over Obama's duties as executive vice president for strategic affiliations and external affairs in January.

Some analysts say the shift in strategy could be risky, particularly if a patient who had a condition that needed the medical center's attention were to be turned away.

"This is tricky," said Jim Unland, president of The Health Capital Group, a consulting firm based in Chicago. "If patients really need to be in an ER and the U. of C. is turning them away, I have a problem with that.

"But if patients can be better served at a primary care clinic or urgent care center, it is a good idea as long as they can get there."

Whitaker said the U. of C. has criteria that nurses and doctors use to make their best judgment—evaluations that routinely are done in emergency departments nationwide. There are times, he said, in any emergency situation where a person is treated and advised to go home only to find out they need to return for more care.

"At the end of the day, we want to have quality care and be sure the people are treated in the right place," Whitaker said.

In some cases, patients will be referred to any of about two dozen health centers throughout the South Side or to either of two community hospitals, Mercy Hospital and Medical Center and Holy Cross Hospital, which have agreed to be partners in the initiative. For some patients, The U. of C. will provide transportation or schedule appointments.

"We are trying to streamline the process so that patients get seen at our nearby partners in a much shorter time frame," Whitaker said.

But it can be confusing for patients who feel they should be able to come to the hospital and get the care they need, particularly from a place like U. of C., which is known for state-of-the-art care.

Take Mary Darden, who was rushed to the medical center by ambulance around 8 a.m. Monday and diagnosed with pneumonia. By mid-afternoon, U. of C. doctors recommended that she be transferred to Mercy Hospital, her family said.

"Why would you keep moving a 92-year-old woman with pneumonia?" said her daughter, Carol Thomas.

Joshua Darden questioned the hospital's judgment in not admitting his grandmother.

"That's what a hospital is for," he said.

The medical center would not comment on the case, but said pneumonia is a common condition that has resulted in many patients being referred elsewhere.

Critics have been looking at the role of non-profit hospitals in communities and how they balance business decisions against their missions to provide care.

Sen. Charles Grassley (R- Iowa) has been looking into the U. of C.'s Urban Health Initiative and said through a spokeswoman Monday that the announcement "raises questions that should be asked as part of the review."

Grassley has a say in how federal dollars are spent in health care as the ranking Republican on the powerful Senate finance committee.

The U. of C. was also criticized for Monday's layoff announcement. The hospital did not specify where cuts will be made, but said patient care will not be affected.

Representatives for the workers say the cuts will have an impact.

"Of course, sizable cuts are going to impact everything the university does, including patient care," said Joe Sexauer, union representative for Teamsters Local 743, which represents clerical, service and maintenance workers and licensed practical nurses. "It is important to have an adequate staff to provide accurate medical information, and it's important to have adequate environmental service workers [janitors] so you can kill enough germs."