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TriCityPopulationGrowthComparedtoEmergencyDepartmentAccommodations

ScottB
,
BrowerJ

ABSTRACT:

TriCityMedicalCenterhasbeeninservicefor65yearsandhaswitnessedmassive
amountsofgrowthinCarlsbad,Oceanside,andVistacommunities.TriCityMedicalCenterisa
districtrunhospitalanditdependsondistrictmoneyandvotersforthemajorityofthe
nonpatientfinancials.Asthepopulationgrows,thehospitalneedstomakeaccommodationsfor
it.Theemergencydepartmentisavitalsectionsofthehospitalthatneedstoworkeffectivelyand
successfullytomaintaingoodemergencymedicalresponse.Myresearchtopicinvolved
populationgrowthandhowitmaymanipulatethewaitingroomtimesintheemergency
department.Populationgrowthwascomparedtoemergencydepartmentactivitylogsfrom2012
to2014.TheaveragepopulationfromthethreecitiesofCarlsbad,Oceanside,andVistawere
comparedtothenumberofemergencydepartmentpatientsandaveragewaittimerecordedfor
thatyear.Thedatawasthencomparedandpercentagegrowthofpopulation,emergency
departmentpatientnumbers,andaveragewaittimewascompared.

INTRODUCTION:

TriCityMedicalCenterwascreatedinthe1950sasamodernlocalhospitaltoserve
andnurturethegrowthofruralcommunitiesinnorthernSanDiego.ThethreecitiesofCarlsbad,
Vista,andOceansideconstructedaregionalhospitaltoserveatacrossroadofthethree
communities.TriCityHospitalDistrictwasestablishedbythevotersofthesethreecitieswho

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approvedabondforlandpurchaseandconstructioncosts.TheearlyestablishmentsofTriCity
openedin1961staffedby42physicians(TriCity,2014).Growthwasimmediatelyneededdue
toservingsuchalargeareawith49,019inhabitants.In1960,theTriCitycommunitywas
startingtodevelopCarlsbadhad9,253residents,Vistahad14,795residents,andOceansidehad
24,971residents.Comparingthelargestofthethreecities,Oceanside,overthecourseoffour
decadesdisplaysthesignificantgrowthoccurring.Withthebasebeing24,971in1960,thenext
10yearsalmostdoublethepopulationto40,494in1970.Thecolossalgrowthoccurredfrom
19701980,withapopulationof76,698in1970thepopulationroseto128,498people.Asof
2015,Oceansidehasapopulationof167,086people,whichisa660%increaseover55years.
CarlsbadisthesmallestcitycomparedtoVistaandOceansidewithabasepopulationof9,253in
1960.Overthenextdecadethepopulationgrewfrom9,253residentsto14,844residents.The
largestgrowthcanbeobservedfrom19801990thepopulationin1980was35,490andthe
populationin1990was63,126.ThecurrentpopulationinCarlsbadis105,328people,thisisa
1130%increaseover55yearsthelargestoutofthethree.TriCityMedicalCentercurrentlyhas
397bedswithover500physicians.Evenwithamediumsizedhospital,thesurrounding
populationissignificantlylargerthanthehospitalroomscanaccommodate.IntheUnitedStates,
thereisarequired30patientbedsrequiredforevery10,000peoplethatliveinaspecificarea
(Kaiser).
RoundingtheTriCityMedicalCenterEmergencyDepartment,atrendcanbespotted.
Theemergencydepartmentwaitingroomisoverflowingwithpatientsseekingmedicalattention.
Emergencymedicineoutcomescanbeverydependentontimeandmedicalattention.Thereare
notpatientsrequiringemergencymedicinewaitingroom,butstillinneedofmedicalattention.

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TheregionTriCityMedicalcenterservesover3millionresidents(AtlasMedicare,2014)with
lessthan35bedsintheemergencydepartment.Withambulanceservicesclaimingpriority,the
waitingroombecomesaswampymessduetotheoverflowofpatients.Theaveragetimespentin
theemergencydepartmentandhospitalwas4.7daysin2014(AtlasMedicare,2014),compared
tothenationalaveragewhichisalso4.7days.ThenationalaveragewaittimeintheE.Ris24
minutes,theaverageforCaliforniais26minutes(ProPublica,2015),theobservationsprove
verydifferentwaittimesatTriCity.Somepatientshavingtowaitfiveto7hourstobe
administeredtotheemergencydepartmentanditcausesmuchangerwithsomepatientsleaving
withouttreatment.TriCitystatesthatthebusiesttimesfortheemergencydepartmentarefrom
10am10pm,congestedwaitingroomsareconsistentlyseen.

MATERIALSANDMETHODS:

Patientsthatentertheemergencydepartmentcyclethroughmultiplestations

beforegettingadmittedtoanemergencydepartmentafirstnurseassessthepatient,thenthe
patientistriagedandregistered,andthenamedicalhistoryandexaminationisdonebefore
admissiontotheemergencydepartment.Onceatreatmentplanisdecidedbythephysician,the
physiciandecideswhetherthepatientneedstobeadmittedtothehospital,tobedischarged,or
needstoscheduleanoutpatientappointment.Recordsandstatisticsforemergencydepartment
visits,discharges,inpatients,observations,andpatientsleavingbeforebeingseenbyaphysician
arerecordeddailyandcompiledbiweekly.Admissiontotheemergencydepartmentisdecided

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basedonmedicalattentionneed,hospitalandemergencydepartmentcapacity,andemergency
departmentwaittime.
Dataiscollectedandcompiledbyunitsecretariesinordertoimproveanddevelop
procedurestoimproveemergencydepartmentvisitanddischargeefficiency.Dataisalsousedto
calculatetheamountofpatientsleavingwithoutseeingaphysician.Patientsseenbyaphysician
isusuallybecausethepatientdoesnotwaituntiltheyareseenandtheyleavetheemergency
department,notbecauseofphysiciansnotbeingpresenttoseepatients.Calculatingtheaverage
lengthofstayforpatientsleavingwithoutbeingseenisimportanttoassessingwaitingroom
times.Thedatabeingusedforthisarticleisthetotalnumberofadmitstotheemergency
departmentin2012,2013,2014.Thenumberofemergencydepartmentadmissionswillbe
comparedtothetotalpopulationgrowth.
Emergencydepartmentactivitylogswerecomparedwiththepopulationchartsdatafrom
Carlsbad,Oceanside,andVistaduring2012,2013,and2014.Populationcollectionwas
collectedthroughcensuses,samplesurveys,andobservationalstudies.Acensusisastudythat
collectsdatafromeverymemberofpopulationinaspecificarea.Samplesurveysaredata
collectionsfromasubsetpopulationtoestimatethepopulationandanobservationalstudyisa
studyusedtoassesscauseandeffectrelationshipsofpopulationinagivenarea.

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RESULTS:
Emergencydepartmentactivitylogsfrom2012,2013,and2014showasteady
increaseinpatientadmissionsoverthethreeyears.ThepopulationoftheTriCities(Carlsbad,
Oceanside,andVista)hasalsogrownalsosignificantly.
In2012,theTriCitieshaveacombinedpopulationof376,429(Carlsbad109,166,
Oceanside171,222,andVista96,040).Atotalof69,873patientswereseenin201257,352
(82%)ofthemwereemergencydepartmentpatients.Theemergencydepartmentpatients
experiencedanaveragewaittimeof4hoursand30minutes.Thecontrolyearconcludeswith
TriCityserving57,352patientswaitingapproximately4hoursand30minutesinapopulation
of376,429.
In2013,thedatarecordedforpopulationgrowthintheTriCityareagrewto380,695,a
1.13%raisefrom2012.ThepopulationoftheTriCityareagrewslightlyandthetotalnumber
ofpatientsseenatTriCityMedicalCenterdecreased,whilethenumberofemergency
departmentpatientsraises.69,652patientswereseenatduring2013(.32%decreasefrom
previousyear)and57,510(82%)ofthemwereemergencydepartmentpatients,a.28%increase
fromthepreviousyear.WhatIfoundtobeinterestingisthattheemergencydepartmentwait
timeactuallywentdown,whilethenumberofpatientswhenup.Nostructuralchangeswere
donetothehospitalandtherewerestill397hospitalbedsand31emergencydepartmentrooms.
Theaverageemergencydepartmentwaittimewas4hoursand15minutesduringtheyearof
2013.Evenwithanincreaseof158patients,theemergencydepartmentwaittimewascutby15
minutes.

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TriCitiespopulationaccumulatingin2014was384,936people,a1.11%growth.Even
withasmallerspikeinpopulationcomparedto2013,TriCityMedicalCenteradmitted73,339
patients(5.29%increase)totaladmissionstothehospitaland61,050(83%)emergency
departmentpatients.Theemergencydepartmentwaitingroomtimedidnotdecrease,butitgrew
from4hoursand15minutesto4hoursand37minutes,a1.08%increase.ThisiswhatI
projectedtohappenandIfinditinterestingthat2013hadalargepopulationgrowth,butalower
emergencydepartmentwaitingtime.
DISCUSSION:
Comparingtheactivitylogsandpopulationgrowthstatisticsfromthethreeyears
sidebyside,Inoticedthatthereisnodirectcorrelationbetweenpopulationgrowthand
emergencydepartmentwaittimes.Itisdefinitelyafactorofwaittimes,populationgrowthisnot
thesoleandcontrollingfactor.Hospitalprotocolchangesconstantlywithnewmanagement,state
andfederalregulations,budget,etc..Thereisnowaytopredicttheamountofhospitaladmitsa
yearwillhaveandnaturaldisasterswoulddestroyanypredictions.
Thecontrolyear(2012)hadapopulationof376,429(Carlsbad109,166,Oceanside
171,222,andVista96,04).Atotalof69,873hospitalpatients,57,352emergencydepartment
patients,withanaveragewaittimeof4hours30minutes.In2014,thecombinedTriCity
populationwas384,936with73,339hospitalpatientsand61,050emergencydepartment
patientsandawaittimeof4hoursand37minutes.A2.26%populationgrowthoverthethree
yearswitha6.45%increaseinemergencydepartmentpatientsanda2.59%waittimeincrease.

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ANALYSIS:

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