Health

As ER Wait Times Grow, More Patients Leave Against Medical Advice

Published

5 years ago

May 29, 2019

Emergency room patients increasingly leave California hospitals against medical advice, and experts say crowded ERs are likely to blame.

About 352,000 California ER visits in 2017 ended when patients left after seeing a doctor but before their medical care was complete. That’s up by 57%, or 128,000 incidents, from 2012, according to data from the Office of Statewide Health Planning and Development.

Another 322,000 would-be patients left the emergency room without seeing a doctor, up from 315,000 such episodes in 2012.

Several hospital administrators said overcrowding is a likely culprit for the trend. California emergency room trips grew by almost 20%, or 2.4 million, from 2012 to 2017.

Moreover, ER wait times also increased for many during that time period: In 2017, the median ER wait time for patients before admission as inpatients to California hospitals was 336 minutes — or more than 5½ hours.

That is up 15 minutes from 2012, according to the federal Centers for Medicare & Medicaid Services. The median wait time for those discharged without admission to the hospital dropped 12 minutes over that period, but still clocked in at more than 2½ hours in 2017.

California wait times remain higher than the national average. In 2017, the median length of a stay in the ER before inpatient admission nationwide was 80 minutes shorter than the median stay in California. Four states — Maryland, New York, New Jersey and Delaware — had even longer median wait times.

The growth in patients leaving California ERs prematurely was faster than the growth in overall ER encounters. About 2.4% of ER trips in 2017 ended with patients leaving the ER against medical advice or abruptly discontinuing care after seeing a doctor, compared with 1.8% in 2012.

“Most patients are sick but not critically ill,” said Dr. Steven Polevoi, medical director of the emergency department at UCSF Helen Diller Medical Center at Parnassus Heights. “Emergency care doesn’t equal fast care all of the time.”

When a patient leaves the ER after seeing a doctor but before the doctor clears them to leave, the Office of Statewide Health Planning and Development classifies that encounter as “leaving against medical advice or discontinued care.” The definition includes encounters in which a doctor carefully explains the risks to the patient and has the patient sign a form, but also instances in which the patient simply discontinues care and bolts out the door.

Patients leaving the emergency room too soon “are deliberately putting themselves at more risk for morbidity and even mortality,” Polevoi said — a point echoed by other physicians.

Dr. Veronica Vasquez-Montez, emergency room medical director at Good Samaritan Hospital in Los Angeles, said she sometimes finds herself having “tough conversations” with sick patients intent on leaving the ER, often citing pressing responsibilities.

“If you die from this,” she tells them, “you are good to no one you are caring for.”

One of her recent patients was at high risk for a major stroke but insisted he needed to leave the ER to take care of his pet.

“Guess what he came back for? A major stroke,” said Vasquez-Montez, also a clinical assistant professor at the University of Southern California’s Keck School of Medicine.

Compared with all ER patients, those leaving against medical advice were more likely to be men; people ages 20 to 39; and uninsured or on Medi-Cal, the government insurance program for the poor, state figures show. They were also more likely to complain primarily of non-specific symptoms such as chest pain or a cough.

Fresno, Shasta, Yuba, Kern, San Bernardino and Tulare counties had the highest proportion of ER encounters in 2017 that ended with patients leaving against medical advice or abruptly discontinuing care. Each of those counties recorded more than 4% of ER patients leaving too soon, state figures show.

From 2012 to 2017, the number of emergency room encounters in Fresno County increased by almost 95,000, or 37%. At Fresno’s Community Regional Medical Center, about 9% of ER encounters ended with a patient leaving too soon, more than three times the statewide rate.

Community Regional Medical Center is one of the busiest hospitals in the state. It recently instituted a “Provider at Triage” program that puts caregivers in the lobby area with patients, said Dr. Jeffrey Thomas, the hospital’s chief medical and quality officer. The hospital’s internal data now show fewer than 2% of patients leaving against medical advice or abruptly discontinuing care.

“When patients bring themselves into the ED, they are seen in about 5 minutes by a qualified registered nurse and, on average, are seen by a provider within 30 minutes of arrival,” Thomas said in a statement.

Phillip Reese is a data reporting specialist and an assistant professor of journalism at California State University-Sacramento.

Phillip Reese, Kaiser Health News

Posts by Phillip Reese, Kaiser Health News

Alameda County

Access Better Health with Medically Tailored Meals – Transforming Health Through Nutrition for Medi-Cal Patients

Launched in 2018, the Medically Tailored Meals pilot program was designed to help Medi-Cal patients with congestive heart failure by reducing hospital readmissions and emergency department visits by providing tailored meals meeting specific dietary needs. The program’s success in improving health outcomes and reducing costly emergency room visits encouraged the Department of Health Care Services (DHCS) to expand the Medically Tailored Meals program to all 58 counties through Medi-Cal transformation and a new set of services called Community Supports.

Published

4 days ago

October 29, 2024

Oakland Post

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Advertorial

The program’s success in improving health outcomes and reducing costly emergency room visits encouraged the Department of Health Care Services (DHCS) to expand the Medically Tailored Meals program to all 58 counties through Medi-Cal transformation and a new set of services called Community Supports.

Medically Tailored Meals are one of 14 new services offered through Medi-Cal that provide members with access to new and improved services to get well-rounded care that goes beyond the doctor’s office or hospital.

Medically Tailored Meals: Overview

Malnutrition and poor nutrition can lead to severe health outcomes, especially among Medi-Cal patients with chronic health conditions. Medically Tailored Meals aim to improve health outcomes, reduce hospital readmissions, and enhance patient satisfaction by providing essential nutrition.

Key Features:

Post-Discharge Delivery: Meals are delivered to patients’ homes immediately following discharge from a hospital or nursing home.
Customized Nutrition: Meals are tailored to meet the dietary needs of those with chronic diseases, designed by registered dietitians (RD) or certified nutrition professionals based on evidence-based guidelines.
Comprehensive Services: Includes medically tailored groceries, healthy food vouchers, and food pharmacies.
Educational Support: Behavioral, cooking, and nutrition education is included when paired with direct food assistance.

Key Benefits:

Address Food Insecurity: Mitigates poor health outcomes linked to food insecurity.

Support Complex Care Needs: Tailored to individuals with chronic conditions.

Improve Health Outcomes: Studies show improvements in diabetes control, fall prevention, and medication adherence.

Patient Testimonial:

“My diabetes has gotten better with the meals. I’ve kept my weight down, and I feel much better now than I have in a long time. I’m one of the people this program is meant for.” — Brett

Eligibility:

Eligible Populations: Eligible Medi-Cal members include those with chronic conditions like diabetes, cardiovascular disorders, congestive heart failure, stroke, chronic lung disorders, HIV, cancer, gestational diabetes, and chronic mental or behavioral health disorders. Also, those being discharged from a hospital or skilled nursing facility or at high risk of hospitalization or nursing facility placement are also eligible.

Service Limitations: Up to two meals per day for up to 12 weeks, extendable if medically necessary. Meals eligible for reimbursement by alternate programs are not covered.

Cost Savings and Improved Health Outcomes:

Health Outcomes: Research indicates a 22% to 58% decrease in emergency department visits and a 27% to 63% decrease in inpatient admissions among Medically Tailored Meals recipients, translating to significant health care cost savings.

Project Open Hand: A Success Story

Project Open Hand has been a leader in providing Medically Tailored Meals, significantly impacting the lives of Bay Area Medi-Cal patients with chronic illnesses. Since its inception, Project Open Hand has delivered nutritious meals to individuals with diabetes, HIV, and other serious health conditions, demonstrating remarkable health improvements and cost savings.

Key Achievements:

Improved Health Outcomes: Project Open Hand’s research found a 50% increase in medication adherence among recipients of Medically Tailored Meals.

Reduced Hospitalizations: Their program showed a 63% reduction in hospitalizations for patients with diabetes and HIV.

Enhanced Quality of Life: Patients reported better health and increased energy levels.

Project Open Hand ensures that each meal is prepared using fresh, wholesome ingredients tailored to meet the specific dietary needs of its clients. By partnering with Medi-Cal managed care plans, Project Open Hand continues to provide life-saving nutrition to those who need it most.

Join Us in Our Mission

You can experience the profound impact of Medically Tailored Meals by joining the Medi-Cal Community Supports services initiative. Your involvement can make a difference in promoting your health through nutrition.

Learn More

For more information about Medically Tailored Meals and how to get involved, call the state’s Medi-Cal Health Care options at 800-430-4263 or contact your local managed care plan.

In Alameda County, Medi-Cal recipients can contact:

* Alameda Alliance for Health: 510-747-4567

* Kaiser Permanente: 855-839-7613

In Contra Costa County, Medi-Cal recipients can contact:
* Contra Costa Health Plan: 877-661-6230

* Kaiser Permanente: 855-839-7613

In Marin County, Medi-Cal recipients can contact:
* Partnership Health Plan of California: 800-863-4155

* Kaiser Permanente: 855-839-7613

In Solano County, Medi-Cal recipients can contact:
* Partnership Health Plan of California: 800-863-4155

* Kaiser Permanente: 855-839-7613
Your health and well-being are your health care provider’s top priority. Medically Tailored Meals are designed to enhance quality of life by advancing health care through the power of nutrition. Experience the benefits today, and take the first step toward a healthier you.

Oakland Post

Posts by Oakland Post

California Black Media

Not So Sweet: California State Health Campaign Highlights Dangers of Sugary Drinks

The California Department of Public Health (CDPH) and CalFresh Healthy Living, the state’s nutrition assistance program, recently launched a health campaign to illuminate the risks of drinking sugar-sweetened beverages and the health benefits of hydrating with water. The “Not So Sweet Side” initiative encourages families to make informed decisions about the drinks they choose and to be aware of the sugar content present in them.

Published

4 days ago

October 29, 2024

Oakland Post

iStock Photo

By Edward Henderson, California Black Media

The California Department of Public Health (CDPH) and CalFresh Healthy Living, the state’s nutrition assistance program, recently launched a health campaign to illuminate the risks of drinking sugar-sweetened beverages and the health benefits of hydrating with water.

The “Not So Sweet Side” initiative encourages families to make informed decisions about the drinks they choose and to be aware of the sugar content present in them.

According to the campaign, consuming too much sugar has been associated with an increase in chronic conditions and diseases such as type 2 diabetes, heart disease and tooth decay. African Americans face a higher risk of developing diabetes mellitus, heart disease and tooth decay.

Dr. Redieat Assefa is a pediatrician at Riverside University Health Systems. She spoke at a webinar hosted by California Black Media introducing the campaign to ethnic media publishers across California.

Assefa underscored the importance of reading labels on sugary drinks you may consume and how to identify drinks that contain too much.

“When reading a nutrition label, there are a few key components that I would like us to consider. The first thing is the serving size of your sugary drinks. Is it one can? Is it one bottle? Then you go down to your total carbohydrates, which can be broken down to your fibers and sugary, added sugars or non-added sugars.”

To simplify the process, compare the grams of sugar in a box of Apple Juice with preservatives that could be around 40 grams of sugar and that of natural juice which averages around 6 grams.

Assefa also added that research indicates that African American women who drink one to two sugary beverages daily have an increased risk of type 2 diabetes. Sugary drinks can lead to high blood pressure, hype, and hypertension, contributing to a greater risk of heart disease among African American young adult men who, on average, consume sugary beverages at a higher level than other groups.

Assefa pointed out that there are about 10 teaspoons of sugar in a single can of soda.

Dr. Maxmillian Chambers, a dental professional and public health advocate, also spoke on the panel promoting the campaign highlighting the impact sugary drinks can have on dental health.

“As we continue this dialogue, it’s crucial to turn our focus to oral health, a key component of our overall well-being that doesn’t often receive the attention it deserves. Sugary drinks are a significant contributor to tooth decay. Research shows that drinking more than two eight-ounce servings of sugary beverages per week can drastically increase the risk of cavities. And for our youth, particularly those aged 9 to 18, sugary drinks are primary sources of added sugar in their diets.”

Lakeysha Sowunmi, a mom and public health advocate who has worked to influence state policy and mobilize communities, including churches, around health issues, said, “I work with families on a budget, for example, and help them understand CalFresh and the resources that are available. We talk about portion control. We talk about feeding big families.”

The CalFresh Healthy Living Program is led by CDPH’s Nutrition and Physical Activity Branch. To explore recipes, resources, and tips for making healthier beverage choices, visit http://uncoverhealthyhabits.com/

Oakland Post

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Black History

Health is Our Wealth: An Afrocentric Perspective to Health & Wellness

When I was an early-career mental health professional, my close friend was coming up in his construction career. We came up in the hood together, learning life lessons from living the street life. As we grew in our fields, we wanted to showcase our hard work and income though our appearances and the valuables we owned. I flaunted the flyest sneakers, and he customized his car rims as status symbols. Our understandings of wealth, worthiness, and wellness as young Black professionals reflected Eurocentric materialism, which we have now discovered is unhealthy.

Published

4 days ago

October 29, 2024

Oakland Post

Courtesy of Art Harris.

By Art Harris

It became imperative for us to re-align our concepts of health, wealth and wellness with African-Centered philosophies. This is what Baba Dr. Wade Nobles refers to as Sakhu (Skh), the illumination of the spirit via African science, study, understanding, and knowledge in his book Seeking the Sakhu: Foundational Writings for an African Psychology. It takes awareness, intentionality, and commitment to raising our consciousness and shifting from Eurocentric paradigms of health, wealth and wellness to Afrocentric ones.

Baba Wade teaches us that racism is the pre-existing condition in America and in The Island of Memes: Haiti’s Unfinished Revolution, he explains that the liberation of the African mind can only happen when we return to an African consciousness. Only a healthy mind can produce a healthy body. Many of the unhealthy urges African Americans experience are a result of imagery planted by the mentally ill White supremacist culture. In enslaving and oppressing Africans in America, the White supremacist culture destroyed our ancestral memories, rituals, and conceptions of health.

African-centered anthropologists and scholars have looked to the Nile Valley civilizations of ancient Kemet (Egypt) and Kush to illustrate the historical greatness that is our legacy. Profound teachers, ministers, researchers, and psychologists like Malcolm X, Tony Browder, Dr. Ivan Van Sertima, Dr. Asa Hilliard III, Chiekh Anta Diop, and Drusilla Dunjee Houston highlight the great contributions of African people to the fields of medicine, science, religion, politics, architecture, and more.

In his books Spirituality Before Religions and the Shabaka’s Stone, Professor Kaba Hiawatha Kamene teaches that the principles of Ma’at (truth, justice, harmony, balance, propriety, order, reciprocity) ensured morality and justice were at the center of maintaining a healthy, righteous Kemetian society.

For myself, it took a growth mindset and reading books like New Visions for Black Men and Breaking the Chains of Psychological Slavery by Dr. Na’im Akbar. Now, about 20 years later, my friend and I both have advanced in our fields and we now value health and wealth as it pertains to physical, familial, financial, mental, and spiritual wellness.

As we reconnect to natural approaches to healing and attune with what is/is not healthy for people of African ancestry, then we can realize health, wellness, and joy for our families and communities.

About the Author

Art Harris is a Bay Area native, veteran of the U.S. Navy, licensed marriage and family therapist, and school psychologist. He is the Bay Area Chapter of the Association of Black Psychologists (Bay ABPsi) Continuing Education Unit Co-Coordinator. Bay ABPsi Chapter is a healing resource committed to providing the Post Newspaper with monthly discussions about critical Black Mental Health issues. Please join us at our meetings every 3rd Saturday via Zoom or contact us at bayareaabpsi@gmail.com.