COVID creates ERs stuck with patients. No beds in the hospital...admission impossible.
Jim Snitz is seeing this problem first hand as an ER resident in Atlanta's Grady Hospital!
Latest sign of hospitals’ COVID crisis: Patients kept waiting in ERs for beds By JOE MAHR and LISA SCHENCKER, Chicago Tribune CHICAGO TRIBUNE | JAN 07, 2022 AT 5:00 AM Illinois hospitals running short on inpatient beds are increasingly housing patients in their emergency rooms, creating a situation some doctors say threatens the quality of care. As of Sunday night, the most recent state data available, Chicago hospitals had 239 people waiting in beds in ERs for space elsewhere in the hospital to open up — the highest level ever measured during the pandemic. An additional 220 people were waiting in ERs in hospitals in suburban Cook County, and with more still in the regions covering DuPage and Kane counties (50), Lake and McHenry counties (39) and Will and Kankakee (27).
The situation is one more sign of the unprecedented strain placed on the Chicago area’s health care system by a COVID-19 case surge that public health officials hope peaks this month. But at the moment, there’s no indication in state data that the curve is about to bend.
“We have not seen a reprieve,” said Yolanda Penny, director of nursing services at St. Bernard Hospital and Health Care Center on the city’s South Side. Patients and ambulances continue to stream into the ER at St. Bernard, which like many hospitals in the area is short on staff and bursting with patients. Yolanda Penny, director of nursing, and Dr. George Dengler talk to a patient in a hallway where multiple patients sit in beds awaiting available rooms on Jan. 5, 2022, in the emergency department at St. Bernard Hospital in Englewood. (Brian Cassella / Chicago Tribune) The Tribune has previously reported how this fifth pandemic surge came at a perilous time for Illinois hospitals, as they struggled with fewer workers trying to care for more people. The vast majority of those patients weren’t seeking treatment for COVID-19 and were often sicker from delaying needed care earlier in the pandemic. In mid-December, an already strong surge fueled by the virus’s delta variant became supercharged with the arrival of the more infectious omicron. Although the new variant is considered milder, the sheer number of infections has sent COVID-19 hospitalizations to record levels, most of them involving unvaccinated residents.
The growth in COVID-19 patients can have a cascading effect: Emergency rooms keep getting new patients, but no beds are available in the other hospital wings for those who need to be admitted. So admitted patients are “boarded” in ERs, waiting for space to open. That can mean longer waits and less room for others arriving at ERs. Though boarded patients still receive care from doctors and nurses while waiting in the ER, it might not be exactly the same type or level of care they’d receive elsewhere in the hospital. The practice of boarding also took place before the pandemic, but not nearly to the same extent, doctors say. Some doctors say boarding, while not ideal, does not harm patients. But others, including the American College of Emergency Physicians, point to research that suggests the opposite.
“Taking care of a patient for a few hours in a critical situation is just so different than taking care of a patient for three days who’s admitted to the hospital,” said Dr. Joshua Miksanek, a fellow with the group and medical director of the emergency department at SIH Herrin Hospital in southern Illinois. “It’s a different type of medicine.” Boarding patients in ERs is a “quality of care concern and a safety concern,” said Dr. Russell Fiorella, system chief medical officer and vice president of medical affairs for Sinai Chicago. ERs can be hectic places where patients with behavioral health problems often first land — not the type of environment a sick patient wants to stay in for an extended period of time. Sinai Chicago, which runs Mount Sinai and Holy Cross hospitals, lately has been seeing, at times, about 10 to 20 boarders at once across its system. That level triggers an alert prompting doctors and nurses to try to make more room in the hospitals, such as by more swiftly discharging patients who are ready to go home or grouping other patients together. The Illinois Department of Public Health doesn’t publish boarder data online, unlike other hospital metrics. But IDPH did provide the Tribune data it had collected through Sunday night, and that data shows the number of boarders had grown across the state to a high of 719. The weekly average, which adjusts for the ups and downs of each day’s figures, also had reached a new high at 630.
IDPH’s data did not provide numbers for individual hospitals, in keeping with the agency’s long-standing practice during the pandemic. Federal officials do publish data on hospitals, but the latest data is from the week ending Dec. 30. Of 24 Chicago hospitals reporting data on their intensive care units, which treat the sickest patients, five said they were nearly or completely full: Roseland, Mount Sinai, Holy Cross, St. Bernard and South Shore. Several others reported less than 20% of ICU beds available, a state metric signaling a stressed facility. It’s unclear how well the data is vetted, with some busy hospitals showing zero ICU patients, a near impossibility. It’s not unusual, even in non-pandemic times, for some hospital ERs to fill sooner than others, with hospitals in low-income neighborhoods trying to provide care with fewer resources.
When a hospital decides its ER is too crowded, it can ask the state to go on bypass, which causes ambulances to be diverted to other hospitals until the space crunch eases. This bypass system was controversial before the pandemic — with some hospitals declaring a bypass so often IDPH investigated — and now the system has become even more stressed. IDPH, which regulates hospitals, has not provided recent bypass data sought by the Tribune. But an IDPH spokesperson said that, with so many hospitals overwhelmed, the agency has limited when hospitals can go on bypass to “extreme situations.” St. Bernard, for example, asked to go on bypass multiple times earlier this week, Penny said. But it wasn’t allowed.
“It is devastating because we do need that reprieve sometimes just for the staff and safety of the patients; however, we understand what’s going on in the city,” Penny said. “We can appreciate what’s going on with our neighbors, and our neighboring hospitals.” Penny said she didn’t have information on the number of boarders in the Englewood hospital’s ER this week but said there’s been an increase during the latest COVID-19 surge. Like many hospitals, St. Bernard is facing a staffing shortage, partly because staff members are sick with COVID-19 and partly because it’s lost nurses to staffing agencies that can offer higher-paying work. St. Bernard has asked the state for assistance and said it expected to receive additional staff Friday.
Chicago paramedics are hearing of wait times in Chicago ERs that stretch to 15 hours, said paramedic Anthony Snyder, who also directs EMS issues for Chicago Fire Fighters Union Local 2. St. Bernard’s ER wait times now exceed four hours, Penny said. Snyder said hospitals’ struggles affect paramedics too. In normal times, they can wheel a gurney into an ER and quickly get direction from a nurse on where to put the patient, allowing them to move on to another ambulance run. Now it can take 20 minutes until a nurse has time to talk with paramedics, Snyder said. Often, he added, the nurse directs them to move the patient into a wheelchair to wait for care. If the patient is too sick for that, paramedics must keep him or her on the gurney. In those situations, he said, it’s common to wait an hour, sometimes two, before paramedics can transfer the patient and respond to another call. Those delays add stress to an already overwhelmed EMS system, he said, with most paramedics now working three 24-hour shifts a week. “I think everybody’s struggling,” Snyder said of his peers. “It feels like everybody’s right at the limit.”
In southern Illinois last weekend, one patient with COVID-19 symptoms who arrived in a hospital ER had to be taken to a hospital in Champaign because no closer hospital could admit the patient, said Brad Robinson, EMS system coordinator for SIH Memorial Hospital of Carbondale. That three-hour drive meant an ambulance was unavailable for 911 calls or other transfers for six to seven hours.
When hospitals have “boarders and no available beds, that then affects the resources of the community with emergency services because they’re driving much longer distances to get people to tertiary care to where they can become an inpatient and actually be treated,” Robinson said.
So far, IDPH said, no Illinois hospital has begun to ration care, as has been seen in places ranging from New York City to Alaska during the worst surges. But where the latest surge first took hold in Illinois — the northwest corner — hospitals told the state even before Thanksgiving that they had started to ration supplies, from blood collection tubes to certain medicines.
In a Nov. 19 report to IDPH, the Rockford region’s liaison said some hospitals were reporting up to 10% more patients than available beds, with a severe shortage of staffers, even after the state temporarily sent supplemental workers to some places. Across the state, data shows that hospitals were able to open up more beds just before Christmas. But since then, the number of available beds has begun shrinking again. As of Wednesday night, the most recent data available, the state was averaging less than 300 ICU beds available, the lowest average on record and about half of what was available during the height of the fall 2020 surge. Hospitals are trying to make more room by suspending or slowing elective surgeries. They’re also redeploying workers, such as moving those who normally help with elective procedures to critical care. Still, extended ER waits and boarders have become a fact of life during this latest surge. “Boarding in the ERs is more or less a regular part of the process now,” said Dr. Laura Concannon, chief medical officer at Amita Health Saints Mary and Elizabeth Medical Center Chicago. Yet Concannon has an even bigger concern: that patients who are truly in need of emergency care, hearing about boarding and long ER wait times, will start avoiding hospitals again, as they did at the start of the pandemic. She and other doctors worry that patients will grow sicker at home and only arrive at the hospital when their situations have become dire. “That’s going to be worse for the community,” Concannon said. “If they feel like they need the care, they’re safer boarding here than being at home.” email@example.com firstname.lastname@example.org