Emory Report
October 15, 2007
Volume 60, Number 7

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October 15, 2007
Clock is ticking on Grady’s ‘golden hour’

Grady doctor Katherine Heilpern is Ada Lee and Pete Correll Professor and Chair of the Department of Emergency Medicine at Emory School of Medicine.

On any given day at Grady Memorial Hospital, the Emergency Department treats 350 people with acute illnesses and injuries; 575 ill, admitted patients receive life-saving care in the intensive care units and nursing units; ten patients with life-threatening trauma are resuscitated and taken to the operating room or admitted; one patient with major burns is admitted to the Burn Unit; the Grady EMS Call Center receives 270 calls from the City of Atlanta and sends paramedics and an ambulance to the scene nearly 200 times a day; ten babies are delivered; and the Georgia Poison Center fields 300 calls about poisonings or overdoses from throughout the state.

Remarkably, this is all in a single day’s work. Multiply this by 365 and you can appreciate the staggering volume of ill and injured patients cared for each year.

Take me to Grady
In this metro region of 5 million people it is, I think, easy to rest easy when Grady’s lights are on and the doors are open. Grady is the “safety net” for Atlanta and much of North Georgia — a Level 1 Trauma Center with 24-hour-a-day capacity, and the will and welcoming arms of a gentle giant — here to serve the health care needs of all our citizens and visitors. Level 1 Trauma Center designation is a major milestone.

We — the faculty physicians and residents of the Emory and Morehouse Schools of Medicine who provide the medical staffing at Grady under contract with the Fulton-DeKalb Hospital Authority — specialize in the “golden hour,” resuscitating the injured in the first precious 60 minutes after a major trauma. That hour can literally mean the difference between life and death. It also means the hospital has substantial expertise and capacity in emergency care delivery, trauma, neurosurgery, orthopedics and disaster readiness, every hour of every day. To those hurtling along our streets, this should lend great comfort. We created a bumper sticker several years ago, and it hangs in my office still: “If I’m injured in a crash, take me to Grady.”

Did you know that if Grady were to close its doors, the nearest Level 1 Trauma Centers lie 85 miles south in Macon or 115 miles north in Chattanooga? How would you feel if you or a loved one had to be transported to those centers for a car crash incurred within the metro Atlanta region? Think about the golden hour.

A patient tsunami
In addition to the emergency and trauma care, the Grady Health System is nationally renowned for superlative care in sickle cell disease, stroke, HIV/AIDS, neonatal care, burns and poisonings.

It also serves our local citizens in its safety net role as it wraps its arms around the disenfranchised. They turn to Grady for help because it’s “their” hospital, or because they have been turned away by everyone else: the under-insured who can’t make a cash co-pay, the homeless, victims of interpersonal violence too frightened to speak, the resource-poor with chronic mental illness, diabetes, hypertension, congestive heart failure, addiction and asthma. Where might these individuals find acute medical care, refuge, a referral, or hope, in a community without Grady?

The 225,000 urgent and emergent annual patient visits will have to be absorbed by area clinics, hospitals and emergency departments. Ironically, my emergency department colleagues throughout the region tell me their emergency departments and hospitals are full now. The wave of patients displaced by a shuttered Grady Health System has been appropriately described as a “tsunami.” So I ask you, how will area hospitals, clinics and urgent care facilities deal with this surge in patients when we have no surge capacity now?
Furthermore, an additional 750,000 routine outpatient visits per year will require redistribution, and routine medical care will be delayed. If substantial co-pays are required, many of these patients will forego care.

Closure of the Grady pharmacy will lead to increased problems with patients receiving routine medications. If a prescription is obtained, even generic medications may be unaffordable at local chain pharmacies. This is a vicious cycle, driving blood sugar and blood pressures up, leading to more emergency department visits and increasingly complicated, expensive resuscitations and outcomes.

More than 30,000 patients are hospitalized at Grady each year. If Grady closes its doors, people will still get asthma attacks, cancer, heart failure, heart attacks, pneumonia, strokes and kidney infections. Premature babies will be born and require neonatal intensive care. People will still fall off ladders, drink and drive, get in fights, and crash their cars. All will need to be admitted and cared for at other metro Atlanta hospitals and the region will need to absorb an additional 1 million outpatient visits per year. At present, and much to my dismay, the metro region has demonstrated neither the capacity nor the will to prepare for the potential tsunami of this volume of displaced, and predominantly resource-poor group of patients.

The radio station that plays in all our heads is WIFM: what’s in it for me? No matter where you live in the metro region, closure of Grady Hospital will affect each and every one of us as we seek care for ourselves and our families. It will mean longer waits for you in area emergency departments, delays in routine visits to your physicians, longer wait times in the ER before your inpatient bed becomes available, and delays in elective surgery and procedures. In the City of Atlanta, you might call 911 and suffer long delays before you’re routed to the EMS dispatcher.

Prescription for cure
Public hospitals around the country are in crisis, and in some cities, finances have forced the closure of these venerable institutions. Let’s not for one moment rest on the belief that Atlanta is safe; each of these cities is now reeling from the consequences of public hospital closures.

It is not surprising that Grady is in a fiscal crisis. The county funding has been flat for more than 10 years, while health care costs and the metro population have skyrocketed. What is surprising is that a good solution has been on the table for several months, and no one has adopted the recommendation: Grady needs to revamp its governance structure, followed by the identification of new and more sustainable funding models. This was clearly articulated by the Metro Atlanta Chamber of Commerce Greater Grady Task Force and is the most sensible, viable option to ensure Grady’s survival.

The clock is ticking and money is running out. So, rest easy for several more weeks as the lights stay on and the doors are open, but by my estimate, we’ve already squandered 55 minutes of our golden hour. The future of our city hangs in the balance. I know we can do better than this.