Earlier this year, news outlets reported that John Peter Smith hospital in Fort Worth declared a Code Yellow due to high volume. While the emergency department at JPS is almost always crowded, an expansion is in the works.
It turns out, being inundated with patients is somewhat the norm for the county hospital, according to Dr. Jessica Kirby, Medical Director of the JPS Emergency Department. They spend around 90 percent of their time in crowded status, which is below code yellow. Code Yellow is reserved for a pending emergency, a missing patient, severe weather or another emergency.
But why was JPS on Code Yellow this spring? “We were having a high number of patients relative to care spaces,” Kirby says.
JPS is the only level one trauma center in all of Tarrant County, so any serious injury that requires that level of care ends up there. The facility also serves as the safety net hospital for the county, providing care for those that can’t afford to pay. From people experiencing homelessness to prominent business leaders, everyone in Tarrant County ends up at JPS.
For other health systems in the area, adding a level one trauma center might be a good way to boost business and attract patients. Emergency room visits are some of the most costly interactions with the health system, and the City of Fort Worth made avoiding visiting the emergency room a goal of its benefit plan, which is projected to save the city $11 million dollars next year. But for those who need a high level of care, expanding the capabilities of the trauma center might be a zone of opportunity.
JPS’ 54-bed emergency department, despite being less than half the size of the new Parkland’s 110 exam rooms, and will see 122,000 patients this year. Parkland sees over 177,000 patients a year and is one of the busiest in the nation.
The average ER sees around 1,600 patients per bed space in a year, but JPS averages 2,262 patients per bed space, nearly 140 percent of expected production. Kirby attributes that efficiency to coordination with hospitalists, nursing, social workers, and other colleagues to make sure patients are processed, healed, and sent home healthy.
The hospital incentivizes employees and physicians to come in and work during the busy times, and provides patient education to make patients aware of clinics that can handle things like the flu that often clog up emergency departments. Other efforts to alleviate the ER are a mobile clinic that administers medicine in the streets for the homeless. They also send 90 percent of patients home with a primary care appointment to follow up on the condition, as many end up in the ER because they have not been regularly seeing a doctor and managing their ailments.
Kirby says there isn’t any yearly pattern or trend that causes Code Yellows in the ER, but they have been seeing increasingly complex patients, who often have multiple medical issues that have been neglected by regular medical care. Texas has the worst uninsured rate in the nation, and social determinants like healthy food, behavioral health support, and other wrap-around services aren’t often accessed by those who need them most.
“The complexity of patients continues to increase. They don’t seek primary care, and by the time they come and see us, they are really sick, medically and socially,” Kirby says. “It continues to climb, and volumes are increasing.”
Kirby says that her team regularly discusses ER issues with hospital administration, advocating for more staff or materials, and the relationship has been a productive one. JPS is on the way for an ER expansion. In late October, the department is adding 26 care spaces, which may include a bed or a chair if treatment is better administered in a sitting position; there will be 12 beds and 14 chairs in the expansion.
In addition, the hospital will receive numerous upgrades after the $800 million bond was passed by voters, the first one requested since 1985. The Star-Telegram says the hospital is looking to add a new behavioral and mental health hospital, four regional medical centers, and more in a $1.2 billion upgrade.
