REPORT: ERs Are Now Swamped with Seriously Sick Patients — But Many Don't Even Have CV

An ambulance crew weaves a gurney through the halls of Sparrow's Emergency Department. Overcrowding has forced the staff to triage patients, putting some in the waiting rooms, and treating others on stretchers
and chairs in the halls.

Source: Health News Florida

Published: October 26, 2021

By: Kate Wells

Patients who couldn't see a doctor earlier in the pandemic or were too afraid to go to a hospital have finally become too sick to stay away. Many ERs now struggle to cope with an onslaught of need.

Inside the emergency department at Sparrow Hospital in Lansing, Mich., staff members are struggling to care for patients who are showing up much sicker than they've ever seen.

Tiffani Dusang, the emergency room's nursing director, practically vibrates with pent-up anxiety, looking at all the patients lying on a long line of stretchers pushed up against the beige walls of the hospital's hallways. "It's hard to watch," she says in her warm Texan twang.

But there's nothing she can do. The ER's 72 rooms are already filled.

"I always feel very, very bad when I walk down the hallway and see that people are in pain or needing to sleep or needing quiet. But they have to be in the hallway with, as you can see, 10 or 15 people walking by every minute."

It's a stark contrast to where this emergency department — and thousands others — were at the start of the coronavirus pandemic. Except for initial hot spots like New York City, many ERs across the U.S. were often eerily empty in the spring of 2020. Terrified of contracting COVID-19, people who were sick with other things did their best to stay away from hospitals. Visits to emergency departments dropped to half their normal levels, according to the Epic Health Research Network, and didn't fully rebound until the summer of 2021.

But now, they're too full. Even in parts of the country where COVID-19 isn't overwhelming the health system, patients are showing up to the ER sicker than they were before the pandemic, their diseases more advanced and in need of more complicated care.

Months of treatment delays have exacerbated chronic conditions and worsened symptoms. Doctors and nurses say the severity of illness ranges widely and includes abdominal pain, respiratory problems, blood clots, heart conditions and suicide attempts, among others.

Tiffani Dusang is the director of of emergency and forensic nursing at Sparrow Hospital in Lansing, MI. As overworked nurses leave, she struggles to staff every shift, and works hard to keep remaining nurses
from burning out. - Lester Graham/Michigan Radio

But there's nowhere to put them all. Emergency departments are ideally meant to be brief ports in a storm, with patients staying just long enough to be sent home with instructions to follow up with their primary care physician or being sufficiently stabilized to be transferred "upstairs" to inpatient units or the intensive care unit.

Except now, those long-term care floors are full too, with a mix of COVID-19 and non-COVID-19 patients. That means people coming to the ER are being warehoused for hours, even days, forcing ER staff to perform long-term care roles they weren't trained to do.

At Sparrow, space is a valuable commodity in the ER: A separate section of the hospital was turned into an overflow unit. Stretchers stack up in halls. The hospital has even brought in a row of brown reclining chairs, lined up against a wall, for patients who aren't sick enough for a stretcher but are too sick to stay in the main waiting room. Still, some of the patients in the brown recliners are hooked up to IVs, while others talk quietly with medical specialists who sit across from them holding clipboards, perched on wheeled stools.

There is no privacy, as Alejos Perrientoz just learned. He came to the ER this particular morning because his arm has been tingling and painful for over a week now. He can no longer hold a cup of coffee. A nurse gave him a full physical exam in the brown recliner, which made him self-conscious about having his shirt lifted up in front of strangers. "I felt a little uncomfortable," he whispers. "But I have no choice, you know? I'm in the hallway. There's no rooms."

"We could have done the physical in the parking lot," he adds, managing a laugh.

On the other side of the ER, beyond a warren of identical-looking hallways and heavy double doors that can be opened only with an employee badge, is Sparrow's ambulance bay. Seventy to 100 ambulances pull in each day. "It's a lot," Dusang says, watching emergency medical service teams wheel their patients over to the triage nurse. "It's the highest I've ever seen in my career."

About three times a week, the ER arrives at a point where it just can't take any more patients, she explains. Then it sends out the alert for ambulances to divert patients to other hospitals. But that's a risky move because Sparrow is one of the only hospitals in this part of the state that's equipped to handle severe traumas. Dusang says it feels like "waving the white flag."

"But you have to do it when you feel unsafe," she says, meaning so crowded that the staff can't provide patients with adequate care. "So although it won't [entirely] keep ambulances from coming in, at least it gives them that awareness that, 'Oh, you know, the ED's in trouble.'"

Even patients who arrive by ambulance are not guaranteed a room: One nurse is running triage here, screening for those who absolutely need a bed and those who can be put in the waiting area.

"I hate that we even have to make that determination," Dusang says. Lately they've been pulling out some of the patients who are already in the ER's rooms, when others arrive who are even more critically ill. "No one likes to take someone out of the privacy of their room and say, 'We're going to put you in a hallway because we need to get care to someone else.' "

The number of ER patients is mostly back to normal, but patients are so much sicker

This isn't just happening at Sparrow.

"We are hearing from members in every part of the country," says Dr. Lisa Moreno, president of the American Academy of Emergency Medicine (AAEM). "The Midwest, the South, the Northeast, the West ... they are seeing this exact same phenomenon."

Although the number of ER visits returned to pre-coronavirus levels this past summer, admission rates, from the ER to the hospital's inpatient floors, are still almost 20% higher. That's according to the most recent analysis by the Epic Health Research Network, which pulls data from more than 120 million patients across the country.

"It's an early indicator that what's happening in the ED is that we're seeing more acute cases than we were pre-pandemic," says Caleb Cox, a data scientist at Epic.

Continue reading at: Health.wusf.usf.edu

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