Contra Costa Emergency Medical Services
Study of West County ED and Critical Care Access/Capacity Issues
By The Abaris Group
Summary of Report - April 2004
Tenet Healthcare Corporation has recently announced that it will terminate, effective July 31, 2004, its contract with the West Contra Costa Healthcare District for the operation of Doctors Medical Center San Pablo Campus as part of Tenet's downsizing. Tenet will be selling or divesting 18 other California hospitals. The West Contra Costa Healthcare District is seeking to continue hospital services after July 31.
Doctors Medical Center San Pablo is a 234-bed hospital, with 6 burn beds and a 24-bed emergency department (ED) with 43,000 visits including 7,900 ambulance arrivals annually. The hospital also has 29 intensive care beds (ICU).
Because of Tenet's announcement, Contra Costa Health Services' Emergency Medical Services Agency undertook an analysis of the potential impact of a change in services or closure of the hospital on the provision of emergency care in the West County area. The Abaris Group, an independent consulting firm, was asked to conduct that analysis, which focused only on emergency care issues.
Summary of Abaris Analysis
- Downsizing or closure of the Doctors Medical Center San Pablo ED will have a substantial effect on local health care providers and on West County residents.
- Kaiser Medical Center Richmond will be disproportionately affected, with a significant increase in ambulance traffic.
- Kaiser Medical Center Richmond's ED and inpatient capacity would not be sufficient to handle the new volume of cases from the ambulance and ED walk-in traffic and subsequent hospital admissions.
- It is unlikely that walk-in patients would travel to considerably more distant EDs for their care, thus creating higher volumes at Kaiser Medical Center Richmond and long waits.
- The long waits for walk-in patients would be frustrating for these patients, delay their assessment and ultimately may discourage patients that need an ED from seeking care there.
- Waiting times at Kaiser Medical Center Richmond will likely reach 10-12 hours for walk-in patients.
- The significant increase in ambulance volume at Kaiser Medical Center Richmond will likely lead that hospital to substantial increases in ambulance diversions to other local EDs and long "off-load" time for ambulance cases arriving at the hospital.
- Increasing ambulance diversion at Kaiser Medical Center Richmond will mean higher volumes to other EDs in the region who are already at maximum capacity and cannot handle this additional load.
- It is not likely that all ambulances could be safely diverted to other regional EDs without some risk to patient care.
- There is insufficient intensive care bed (ICU) capacity in the region to handle the potential new volume of admissions from Doctors Medical Center San Pablo.
- Burn patients now treated at Doctors would need to be admitted to more distant Burn Centers in San Francisco, San Jose or Chico.
- The fire and ambulance delivery system is likely to be moderately or substantially impacted depending on the type of provider (first responder, air or ground ambulance).
- Without Doctors, there would be a significant drop in emergency resources available in the event of a major emergency.