Thursday, August 14, 2008
Long waits at the ER are difficult to avoid

By Anthony Policastro

When I was in the Air force, my hospital had the second busiest emergency room in the entire Air Force. When you consider that it was the 16th biggest hospital, that is pretty impressive. When you consider that we only saw 4,000 patients a year less than the biggest Air Force Hospital, that was more impressive. To put it into a local perspective, My hospital was about one third the size of Nanticoke Memorial Hospital. However, we saw twice as many ER patients as Nanticoke does. As you might expect there were times when the ER was overwhelmed with patients. When that happened, I had the ability to do several things. First, Air Force hospitals have many out patient areas. For that reason, I could open the examining rooms in a clinic near the ER. It allowed me to have more patients in rooms. The second thing I could do was to call in the pediatrician, family practice physician and internist on call to help. Since they all worked for the hospital I could do that. The third thing I could do was to go to the medical dormitory and ask support personnel to come in and help the on call doctors. Those support personnel usually staffed the outpatient clinics and were off when those clinics were closed after hours. The result was a quick fix to the backlog. Many people have had very long waits in emergency rooms. Civilian ER's do not have the ability to get extra help. When the assigned staff gets overwhelmed, they must work through the backlog. There are no nearby additional exam rooms. There are no on call physicians who work for the hospital. They are all in private practice and only on call for patients that need to be hospitalized. There are no extra staff. People are either already working or just coming off a shift. For those reasons, most civilian ER's will have periods with very long waits. Those waits are created for multiple reasons. The first is that the purpose of an ER is to treat emergencies. There are very few people with life threatening emergencies. However, when one does arrive in the ER, all other patient care must stop until the patient is treated. Therefore, if there are life threatening emergencies when you are waiting, your wait will be longer. The second reason is that some people have emergencies that are not life threatening. However, they need to be seen before patients with minor problems. They take precedence as well. That will also prolong the wait for other patients. The third reason is that patients will fill an ER when they do not have an emergency. In some cases, it is because they could not get an appointment with their primary care physician (PCP). In other cases, it is because they could get an appointment with their PCP, but it would not be soon enough. In some other cases, they do not have a PCP to call. The result is that they have to go to the ER. They should not be there, but have no other choice. A fourth reason is that people think that they have an emergency when they do not. When I was in the Air Force, I gave patients a questionnaire about their reason for being in the ER. Many of them said that they were there because they had a real emergency. When we reviewed their charts, we found that 20% of them did have a real emergency. The other 80% did not. They thought they did. They had no medical training so there was no way that they could tell the difference. It was appropriate for them to be in the ER since they did not know any better. The result of all of this is that it is very difficult to predict how many patients will actually show up in an ER. For that reason, it makes staffing difficult to predict. In addition, certain times of the day are busier than others. Staffing must be aimed at guessing how much staff to have when it gets busy. That is not as predictable as one might expect. For all these reasons, ER's in this country often have long waits. There is no one reason why that is so. That is why there is no one fix for it either. The flexibility that I had in the Air Force is not present in civilian hospitals. Therefore, waits are common to see and hard to correct.

Nanticoke plans golf tournament The 22nd annual Nanticoke Health Services Golf Tournament is Friday, Sept. 5 at the Seaford Golf and Country Club. The day will consist of practice, lunch, 18-holes of golf, dinner and door prizes. A full field of participants is expected with a noon shotgun start and scramble format. The tournament's goal is to raise over $35,000 for Nanticoke Memorial Hospital. Proceeds will be used for the hospital's charity endowment prescription fund, a special indigent fund for patients in need of assistance with their prescriptions. Teams of four players will compete for various donated prizes. During the course of the day, golfers will have chances to test their skills by competing in contests for Longest Drive, Closest-To-The-Pin, Hit-The-Green and a Hole-In-One. All participants will have the opportunity to putt through a three-step qualifying round. Following dinner, three people will putt for $2,500 each. Entry fees are $150 per player and $600 for a foursome. Sponsorships packages are available. Anyone interested in individual reservations or sponsorship opportunities should contact the Nanticoke Health Services Development office at 302-629-6611, extension 2404 or email

Depression support The Mental health Association in Delaware will be sponsoring a Depression Support Group in Laurel on the second and fourth Thursdays of each month. The meetings begin at 7 p.m. The MHA encourages anyone dealing with a depressive disorder to attend. Register in advance by calling 1-800-287-6423. Peer support groups sponsored by Mental Health Association of Delaware are not intended to replace professional mental health treatment. MHA does not publish support group locations; locations are provided with registration.

Oncology symposium The Sixth Annual Seaside Oncology Symposium will take place Saturday, Oct. 11, at the Boardwalk Plaza Hotel in Rehoboth Beach. The Tunnell Cancer Center and the Medical Society of Delaware sponsor this annual, half-day symposium to update participants on the diagnosis and management of cancer. It is designed for physicians, nurses and other healthcare professionals. The conference, which begins at 7:30 a.m. and ends with lunch at 1 p.m., is planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint-sponsorship of the Medical Society of Delaware and Beebe Medical Center. The Seaside Oncology Symposium is supported by unrestricted educational grants from various pharmaceutical companies and programs. Details regarding this year's topics and speakers will be available soon. Hotel reservations may be made directly with the Boardwalk Plaza at 800-332-3224.

MS Society plans bike event The Delaware Chapter of the National Multiple Sclerosis Society needs volunteers to help organize and run the 2008 Bike MS: NRG Energy Indian River Power Plant Bike to the Bay. Participants cycle 45 miles, 75 or 150 miles from Dover to Rehoboth and back over two days to raise money for multiple sclerosis. Taking place on Sept. 27 and 28, the annual fundraiser attracts more than 1,600 cyclists who ride across Kent and Sussex counties over two days. To ensure a safe and enjoyable event, each of these miles needs to be monitored by support-and-gear vehicles and bike mechanics. Rest stops are set up every 10 to 12 miles and stocked with beverages, fruit and high-energy bars. More than 200 volunteers are needed to register cyclists; set up rest stops and man them throughout the ride weekend; monitor the route; clean up; hand out rider numbers, t-shirts, goodies and information packets; load and unload the equipment truck; prepare and serve breakfast, lunch and dinner; distribute information packets; direct traffic; and provide logistical and clerical support. To volunteer, contact Volunteer Coordinator Jenna Wagner at 302-655-5610, or email

Beebe to hold Fun Fest The Beebe Medical Center Auxiliary will hold the 8th annual Fun Fest at Winswept Stables on John J. Williams Highway (Rt. 24), in Lewes, on Saturday, Sept. 27, from 10 a.m. to 3 p.m. The event is open to the public and a great place to bring the entire family. Proceeds generated at this annual event will be used to support the programs at Beebe Medical Center. Numerous games, including two obstacle courses, a train ride, and a moon bounce, will be featured. There also will be face painting. Winswept Stables' petting zoo and pony rides will be part of the day's activities. Members of the Winswept Stables Pony Club will give riding demonstrations throughout the day. Refreshments, including hot dogs, hamburgers and homemade baked goods from Auxiliary members, as well as pumpkins and chrysanthemums, will be available for purchase. Members of the Beebe Medical Center Auxiliary and of the Junior ROTC at Cape Henlopen High School will be volunteering at the event.

McElroy promoted at Nanticoke Nanticoke Health Services announces the promotion of Ms. Janan McElroy, RN, CPUR to director of Case Management. In her new position, she will play a vital role in bringing the most appropriate, cost effective care to the patients of Nanticoke Memorial Hospital. McElroy has over 33 years experience in the health care field, focusing on Case Management during the last 10 years. She began as an LPN at Nanticoke in 1977. McElroy was one of the first LPNs to work in Nanticoke's Intensive Care Unit, progressed to ICU staff nurse and then to charge nurse. By 1993, McElroy was working as Nanticoke's first Home Health staff nurse. She quickly advanced within Home Health to patient care coordinator and then to agency coordinator. Between 1998 and 2007, McElroy worked as outpatient case manager, pediatric/ICU case manager, was promoted to hospitalist Case Manager and then to PCU/ICI case manager. McElroy received a registered nursing degree from Delaware Technical & Community College, is an active ACLS instructor, a CPR instructor and is working towards achieving accreditation in Case Management.

Nanticoke welcomes associate Nanticoke Health Services welcomes Steven A. Rose, RN, MN, to the position of vice president of Operations. In this position, Rose will be responsible for a variety of professional and support services. Rose has over 34 years experience in the health care field including nursing, hospital administration and serving as Pennsylvania's Medical State Area Command Executive Officer of the Army National Guard. He holds a master's degree in nursing from Pennsylvania State University and acquired a post-master's certificate in hospital administration from Villanova University.

Nanticoke appoints board members Nanticoke Health Services announces four new members that will serve on the board of directors for Nanticoke Health Services: Kevin E. Carson, D.Ed.; David E. Crouse, CWA; Greg Johnson; and Patricia Gane Olekszyk. Dr. Kevin Carson has served as the superintendent for the Woodbridge School District since Aug. 1998. Before that, he served as assistant superintendent for one year. Dr. Carson came to Woodbridge from Sussex Tech, where he was assistant superintendent for nine years. He received his undergraduate degree from Wesley College in Business Administration, master's degree in Personnel Management from Central Michigan University and doctorate of education from Temple University. Dr. Carson resides in Bridgeville. David Crouse is a senior vice president and senior financial consultant for PNC Investments in the Lewes office. Crouse joined PNC Investments in July 1993 and has over 20 years of experience. He earned a bachelor's degree in Business Administration from Longwood University in Farmville, Va. Crouse holds the Chartered Wealth Advisor designation from the Estate & Wealth Strategies Institute at Michigan State University. Greg Johnson is the president of CAP Management, providing administrative, accounting and management services to its wholly owned subsidiaries: The Car Store, Delmarva Motors Acceptance Corporation, Atlantic Financial Credit Services, Cash Advance Plus, Premier Company, Wye River Foods and Affordable Used Cars. Johnson has been in the insurance industry for over 20 years, is a Certified Insurance Counselor, is on the board of directors for Delaware National Bank and is a member of the Nanticoke Rotary Club. Patricia Olekszyk, along with her husband, Dr. Joseph P. Olekszyk, and son, Michael Olekszyk, has been a resident of Seaford for 18 years. Mrs. Olekszyk, co-owner of Nanticoke Ear, Nose and Throat Associates in Seaford, earned a bachelor's degree in Accounting and has taken MBA program graduate courses from St. Joseph's University in Philadelphia, Pa. Olekszyk handled accounts receivable for 70 physicians at the Philadelphia College of Osteopathic Medicine and was practice manager for Practice Management Associates, a physician billing service. Olekszyk served as a member of the Nanticoke Health Services Auxiliary for 17 years. During that time, she also served as president.