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Dc general er removed { May 2 2003 }

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   http://www.washingtonpost.com/wp-dyn/articles/A2828-2003May1.html

http://www.washingtonpost.com/wp-dyn/articles/A2828-2003May1.html

At D.C. General, a Drop in Tempo
24-Hour ER Becomes Part-Time Urgent Care Center Tonight

By Avram Goldstein
Washington Post Staff Writer
Friday, May 2, 2003; Page B01


The 24-hour D.C. General emergency room tonight begins to change to a part-time urgent care center that will treat only lumps, bumps, sprains and fevers.

After decades of delivering patients to the facility at 1900 Massachusetts Ave. SE, District ambulances will stop those runs at midnight, sending patients to hospital emergency rooms elsewhere in the District and in Maryland. Walk-in emergency patients will continue to be accepted without interruption until midnight tomorrow. But beginning Sunday, the center will be open for 12 hours a day on weekdays and eight hours on weekends and holidays.

D.C. General's emergency room was part of a 195-year-old public hospital until city officials ended inpatient services there in June 2001. All low-income patients were then sent to private hospitals under a major city contract.

The emergency room has continued as a satellite facility for patients who are not in life-threatening situations. The vast majority of cases are not emergencies. Emergency rooms are required by law to treat and stabilize anyone who comes in.

Such treatment, though, rarely results in follow-up care with a community physician. The urgent care center will refer patients to clinic physicians who can become their regular primary care doctors, officials said.

James A. Buford, director of the D.C. Health Department, said the urgent care center would save $2 million a year for city taxpayers and about $5 million for Greater Southeast Community Hospital, the city contractor that runs the facility.

He said the urgent care schedule was developed after analysis of two years of customer patterns at D.C. General and was designed to accommodate 19,000 patients a year who seek non-emergency care. Urgent care hours will be 11 a.m. to 11 p.m. weekdays and 11 a.m. to 7 p.m. weekends and holidays.

Buford said the change would improve the District's health system by providing urgent care in a city that has few, if any, health care providers who offer non-emergency service without an appointment.

He acknowledged that the changes were forced on the city by the financial woes of Greater Southeast, whose parent company, Doctors Community HealthCare Corp., of Scottsdale, Ariz., filed for bankruptcy court protection last fall. The company said it lost $8 million while running D.C. General's ER last year, so its creditors insisted that the company cut those losses as part of the court case. Eight vacant positions were eliminated, and seven workers were transferred to fill vacancies at Greater Southeast.

"We would have made these changes anyway, but [the bankruptcy case] escalated our review," Buford said. An ambulance will be stationed at the site round-the-clock for at least three months in case a major emergency is mistakenly brought to the urgent care center, officials said.

The plan was cheered by the D.C. Primary Care Association, an advocacy group for clinics that care for low-income residents. "It's preferable to people wandering into the ER for fevers, flu, colds . . . and sprained wrists," said Executive Director Sharon Baskerville. "I see it as a real improvement."

In January, when the plan was first suggested, the hospital industry predicted that it would cause a disaster, shifting thousands of uninsured patients from D.C. General to their emergency rooms.

They went to bankruptcy court to ask the judge to block the plan as a matter of public safety. But the day of the hearing, the hospitals reached agreement with Buford and City Administrator John A. Koskinen and withdrew their petition.

Since then, hospital officials have participated in planning for the urgent care center's conversion, but it was clear yesterday that they continue to have misgivings. Sources said D.C. Hospital Association President Robert A. Malson declined to show support for the conversion by attending Buford's news conference.

Later, Malson said hospital executives still worry that patients from D.C. General will flood their emergency departments.

"We'd like to have them open [the urgent care center] for 24 hours a day, but if they're not able to do that, we'd like them to have more than 12 hours," Malson said.

City officials said only two patients a day who go to D.C. General wind up being admitted to hospitals other than Greater Southeast, so the impact should be negligible.

In recent years, emergency room use in the District and across the nation surged, increasing the pressure on hospitals. Exacerbated by a shortage of nurses, ERs have grown more crowded. Critics of the closure of D.C. General's inpatient services said ER crowding was worsened by the loss of the public hospital, but many health care officials disputed that.

Now, Koskinen said, new figures show an unexpected twist in the status of the city's hospitals: sharp declines in ER volume.

Total emergency room visits citywide in February -- the heart of the flu season and usually a busy time for hospitals -- were down 4.7 percent from the same month a year before, and visits for the three months ending Feb. 28 were 7.9 percent lower than they were the same period a year earlier, Koskinen said. For the 12 months ending in February, he said, ER use was off 3.2 percent from the preceding year.

The city plans a 90-day, $250,000 advertising campaign to educate residents about the urgent care center and the fact that 27 other outpatient specialty services in the adjacent building are unaffected.



© 2003 The Washington Post Company



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