Jan. 26--Officials at Santa Clara County's public hospital are considering the removal of protective glass that rings the registration desk of the emergency department -- despite concerns from some staffers about decreased security.
With a growing patient load at Valley Medical Center's emergency room, clerks say they worry for their safety, and the hospital's former security chief offers a strong admonishment.
"From incidents I can recall, if glass hadn't been there, there would have been injuries to staff," said Mark Mooring, a court-qualified expert on health care security who has consulted for more than 60 hospitals. "Those individuals, seeing a ready path over the counter, would have taken it."
But a committee of hospital staff and consultants says the higher volume of patients is a reason to make the change. The consultants, who are charged with increasing efficiencies in county operations, are weighing whether the security glass hinders patient flow and whether it is "customer-friendly." A final decision is months away.
VMC is not unique in its potentially explosive waiting room, where frustrated patients often scream, curse and bang their fists -- or occasionally worse. Other local hospitals feature floor-to-ceiling glass barriers in their registration and triage areas; some even require walk-in patients and visitors to pass through metal detectors.
Gwen Anderson, an emergency department clerk at VMC for 16 years,
said she saw enough incidents before the glass was installed in 2003 to know it's needed.
An extensive study following years of employee complaints prompted installation of the impact-resistant glass around the registration area.
"People come in, they're angry about not having a job, they're angry about losing their insurance and losing their home," she said. "And a lot of them are having to come here for the first time."
Heavier workload
Indeed, the San Jose hospital's emergency patient load is almost double what it was just four years ago. As the provider of last resort, VMC must treat any patients who come through the doors, regardless of ability to pay. Today, 300 people each day seek emergency care in the 24-bed department -- and thanks in part to the county's financial straits, no additional staff has been hired to accommodate the influx.
Thus, moving patients as quickly as possible through the emergency department is a central priority. In 2007, county supervisors looking to cut costs approved a $20 million contract with Deloitte Consulting to work with staff on recommending efficiencies.
"There's no benefit for our patients to have the glass; that's not what it was put up there for," said nurse manager Andrea Brollini. While she said she understands the clerks' concerns, "as far as a customer service-oriented approach, I think it does make us seem a little standoffish."
Brollini said the barrier slows down patient processing and hinders health assessments. For instance, when evaluating a person's skin color to determine dehydration levels, "It's always green, because the glass has a green hue."
The security officer in the waiting room offers protection for staff, Brollini added.
But some employees, still incensed after arriving at work several months ago to find the hospital had cut several openings in the glass so staffers could easily place armbands on patients, note with irony that the glass in front of the security officer -- who wears a bulletproof vest -- was left intact.
"Now that it's open, we feel exposed and vulnerable," said Anthony Aranda, who registers patients, checks insurance and verifies billing information. "Almost daily, we have to call the security officer to calm someone down."
Violent incidents
Clerks, physicians and nurses with similar concerns prompted former security chief Mooring to review emergency department incidents when he worked at the hospital. Mooring, employed at VMC from 1998 to 2006 before becoming a consultant in Southern California, said some patients tried to rip doors off their hinges; others had to be subdued with pepper spray or wrestled to the ground.
Mooring's recommendation to install the glass came after visits to hospitals throughout California and a review of industry standards. Both Good Samaritan Hospital and Regional Medical Center in San Jose feature solid glass barriers that stretch to the ceiling; Stanford University Medical Center and San Francisco General Hospital have metal detectors.
As part of their own review into how county hospitals handle a crush of patients safely and efficiently, VMC staff will soon head to Arrowhead Regional Medical Center in San Bernardino County, one of California's highest-volume emergency rooms. Officials there told the Mercury News the department has an outdoor concrete wall, metal detectors and security glass.
Possible liability
Mooring said if hospital administrators remove the glass, that decision must be based on a new security analysis determining the barrier is no longer needed to keep employees safe, rather than because of cost issues or patient flow. Otherwise, he said, the county could be subject to liability and state fines.
Arthur Slauer, of the International Association of Health Care Safety and Security, agreed. "Once you build it and then you take it down, if anything happens, people are going to jump into that fray like you wouldn't believe," said Slauer, a former Kaiser Permanente security manager. "All it takes is one incident, and I guarantee there's going to be a problem."
