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ERs Are Swamped With Seriously Ill Patients, Although Many Don’t Have Covid
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An ambulance crew weaves a gurney through the halls of the emergency department
at Sparrow Hospital in Lansing, Michigan. Overcrowding has forced staff members
to triage patients, putting some in the waiting rooms, and treating others on
stretchers and chairs in the halls. (Lester Graham / Michigan Radio)


ERS ARE SWAMPED WITH SERIOUSLY ILL PATIENTS, ALTHOUGH MANY DON’T HAVE COVID

By Kate Wells, Michigan Radio October 29, 2021

Republish This Story

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

This story is part of a partnership that includes Michigan Radio, NPR and KHN.
It can be republished for free.

Tiffani Dusang, the ER’s nursing director, practically vibrates with pent-up
anxiety, looking at patients lying on a long line of stretchers pushed up
against the beige walls of the hospital hallways. “It’s hard to watch,” she said
in a warm Texas 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,” Dusang
said.

The scene is a stark contrast to where this emergency department — and thousands
of others — were at the start of the pandemic. Except for initial hot spots like
New York City, in spring 2020 many ERs across the country were often eerily
empty. Terrified of contracting covid-19, people who were sick with other things
did their best to stay away from hospitals. Visits to emergency rooms dropped to
half their typical levels, according to the Epic Health Research Network, and
didn’t fully rebound until this summer.

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But now, they’re too full. Even in parts of the country where covid isn’t
overwhelming the health system, patients are showing up to the ER sicker than
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 other conditions.

But they can hardly be accommodated. Emergency departments, ideally, are meant
to be brief ports in a storm, with patients staying just long enough to be sent
home with instructions to follow up with primary care physicians, or
sufficiently stabilized to be transferred “upstairs” to inpatient or intensive
care units.

Except now those long-term care floors are full too, with a mix of covid and
non-covid patients. People coming to the ER get warehoused for hours, even days,
forcing ER staffers 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. A row
of brown reclining chairs lines a wall, intended for patients who aren’t sick
enough for a stretcher but are too sick to stay in the main waiting room.

Forget privacy, Alejos Perrientoz learned when he arrived. He came to the ER
because his arm had been tingling and painful for over a week. He couldn’t hold
a cup of coffee. A nurse gave him a full physical exam in a brown recliner,
which made him self-conscious about having his shirt lifted in front of
strangers. “I felt a little uncomfortable,” he whispered. “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 added, managing a
laugh.

Even patients who arrive by ambulance are not guaranteed a room: One nurse runs
triage, screening 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 said. Lately,
staff members have been pulling out some patients already in the ER’s rooms when
others arrive who are 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.'”

A medical student from the College of Osteopathic Medicine at Michigan State
University consults with a patient in the hallway of Sparrow Hospital’s
emergency department in Lansing, Michigan.(Lester Graham / Michigan Radio)

ER Patients Have Grown Sicker

“We are hearing from members in every part of the country,” said Dr. Lisa
Moreno, president of the American Academy of Emergency Medicine. “The Midwest,
the South, the Northeast, the West … they are seeing this exact same
phenomenon.”

Although the number of ER visits returned to pre-covid levels this 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,” said Caleb Cox, a data scientist at
Epic.

Less acute cases, such as people with health issues like rashes or
conjunctivitis, still aren’t going to the ER as much as they used to. Instead,
they may be opting for an urgent care center or their primary care doctor, Cox
explained. Meanwhile, there has been an increase in people coming to the ER with
more serious conditions, like strokes and heart attacks.

So, even though the total number of patients coming to ERs is about the same as
before the pandemic, “that’s absolutely going to feel like [if I’m an ER doctor
or nurse] I’m seeing more patients and I’m seeing more acute patients,” Cox
said.

Moreno, the AAEM president, works at an emergency department in New Orleans. She
said the level of illness, and the inability to admit patients quickly and move
them to beds upstairs, has created a level of chaos she described as “not even
humane.”

At the beginning of a recent shift, she heard a patient crying nearby and went
to investigate. It was a paraplegic man who’d recently had surgery for colon
cancer. His large post-operative wound was sealed with a device called a wound
vac, which pulls fluid from the wound into a drainage tube attached to a
portable vacuum pump.

But the wound vac had malfunctioned, which is why he had come to the ER.
Staffers were so busy, however, that by the time Moreno came in, the fluid from
his wound was leaking everywhere.

“When I went in, the bed was covered,” she recalled. “I mean, he was lying in a
puddle of secretions from this wound. And he was crying, because he said to me,
‘I’m paralyzed. I can’t move to get away from all these secretions, and I know
I’m going to end up getting an infection. I know I’m going to end up getting an
ulcer. I’ve been laying in this for, like, eight or nine hours.'”

The nurse in charge of his care told Moreno she simply hadn’t had time to help
this patient yet. “She said, ‘I’ve had so many patients to take care of, and so
many critical patients. I started [an IV] drip on this person. This person is on
a cardiac monitor. I just didn’t have time to get in there.'”

“This is not humane care,” Moreno said. “This is horrible care.”

But it’s what can happen when emergency department staffers don’t have the
resources they need to deal with the onslaught of competing demands.

“All the nurses and doctors had the highest level of intent to do the right
thing for the person,” Moreno said. “But because of the high acuity of … a large
number of patients, the staffing ratio of nurse to patient, even the staffing
ratio of doctor to patient, this guy did not get the care that he deserved to
get, just as a human being.”

The instance of unintended neglect that Moreno saw is extreme, and not the
experience of most patients who arrive at ERs these days. But the problem is not
new: Even before the pandemic, ER overcrowding had been a “widespread problem
and a source of patient harm, according to a recent commentary in NEJM Catalyst
Innovations in Care Delivery.

“ED crowding is not an issue of inconvenience,” the authors wrote. “There is
incontrovertible evidence that ED crowding leads to significant patient harm,
including morbidity and mortality related to consequential delays of treatment
for both high- and low-acuity patients.”

And already-overwhelmed staffers are burning out.

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

Burnout Feeds Staffing Shortages, and Vice Versa

Every morning, Tiffani Dusang wakes up and checks her Sparrow email with one
singular hope: that she will not see yet another nurse resignation letter in her
inbox.

“I cannot tell you how many of them [the nurses] tell me they went home crying”
after their shifts, she said.

Despite Dusang’s best efforts to support her staffers, they’re leaving too fast
to be replaced, either to take higher-paying gigs as a travel nurse, to try a
less-stressful type of nursing, or simply walking away from the profession
entirely.

Kelly Spitz has been an emergency department nurse at Sparrow for 10 years. But,
lately, she has also fantasized about leaving. “It has crossed my mind several
times,” she said, and yet she continues to come back. “Because I have a team
here. And I love what I do.” But then she started to cry. The issue is not the
hard work, or even the stress. She struggles with not being able to give her
patients the kind of care and attention she wants to give them, and that they
need and deserve, she said.

She often thinks about a patient whose test results revealed terminal cancer,
she said. Spitz spent all day working the phones, hustling case managers, trying
to get hospice care set up in the man’s home. He was going to die, and she just
didn’t want him to have to die in the hospital, where only one visitor was
allowed. She wanted to get him home, and back with his family.

Finally, after many hours, they found an ambulance to take him home.

Three days later, the man’s family members called Spitz: He had died surrounded
by family. They were calling to thank her.

“I felt like I did my job there, because I got him home,” she said. But that’s a
rare feeling these days. “I just hope it gets better. I hope it gets better
soon.”

Around 4 p.m. at Sparrow Hospital as one shift approached its end, Dusang faced
a new crisis: The overnight shift was more short-staffed than usual.

“Can we get two inpatient nurses?” she asked, hoping to borrow two nurses from
one of the hospital floors upstairs.

“Already tried,” replied nurse Troy Latunski.

Without more staff, it’s going to be hard to care for new patients who come in
overnight — from car crashes to seizures or other emergencies.

But Latunski had a plan: He would go home, snatch a few hours of sleep and
return at 11 p.m. to work the overnight shift in the ER’s overflow unit. That
meant he would be largely caring for eight patients, alone. On just a few short
hours of sleep. But lately that seemed to be their only, and best, option.

Dusang considered for a moment, took a deep breath and nodded. “OK,” she said.

“Go home. Get some sleep. Thank you,” she added, shooting Latunski a grateful
smile. And then she pivoted, because another nurse was approaching with an
urgent question. On to the next crisis.

This story is part of a partnership that includes Michigan Radio, NPR and KHN.




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ERS ARE SWAMPED WITH SERIOUSLY ILL PATIENTS, ALTHOUGH MANY DON’T HAVE COVID

By Kate Wells, Michigan Radio October 29, 2021

<h1>ERs Are Swamped With Seriously Ill Patients, Although Many Don’t Have
Covid</h1> <span class="byline">Kate Wells, Michigan Radio</span> <p>Inside the
emergency department at Sparrow Hospital in Lansing, Michigan, staff members are
struggling to care for patients showing up much sicker than they’ve ever
seen.</p> <p>Tiffani Dusang, the ER’s nursing director, practically vibrates
with pent-up anxiety, looking at patients lying on a long line of stretchers
pushed up against the beige walls of the hospital hallways. “It’s hard to
watch,” she said in a warm Texas twang.</p> <p>But there’s nothing she can do.
The ER’s 72 rooms are already filled.</p> <p>“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,” Dusang said.</p> <p>The scene is a stark
contrast to where this emergency department — and thousands of others — were at
the start of the pandemic. Except for initial hot spots like New York City, in
spring 2020 many ERs across the country were often eerily empty. Terrified of
contracting covid-19, people who were sick with other things did their best to
stay away from hospitals. Visits to emergency rooms dropped to half their
typical levels, according to the <a href="https://ehrn.org/">Epic Health
Research Network</a>, and didn’t fully rebound until this summer.</p> <p>But
now, they’re too full. Even in parts of the country where covid isn’t
overwhelming the health system, patients are showing up to the ER sicker than
before the pandemic, their diseases more advanced and in need of more
complicated care.</p> <p>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 other conditions.</p> <p>But they
can hardly be accommodated. Emergency departments, ideally, are meant to be
brief ports in a storm, with patients staying just long enough to be sent home
with instructions to follow up with primary care physicians, or sufficiently
stabilized to be transferred “upstairs” to inpatient or intensive care
units.</p> <p>Except now those long-term care floors are full too, with a mix of
covid and non-covid patients. People coming to the ER get warehoused for hours,
even days, forcing ER staffers to perform long-term care roles they weren’t
trained to do.</p> <p>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. A row of brown reclining chairs lines a wall, intended for
patients who aren’t sick enough for a stretcher but are too sick to stay in the
main waiting room.</p> <p>Forget privacy, Alejos Perrientoz learned when he
arrived. He came to the ER because his arm had been tingling and painful for
over a week. He couldn’t hold a cup of coffee. A nurse gave him a full physical
exam in a brown recliner, which made him self-conscious about having his shirt
lifted in front of strangers. “I felt a little uncomfortable,” he whispered.
“But I have no choice, you know? I’m in the hallway. There’s no rooms.</p>
<p>“We could have done the physical in the parking lot,” he added, managing a
laugh.</p> <p>Even patients who arrive by ambulance are not guaranteed a room:
One nurse runs triage, screening those who absolutely need a bed, and those who
can be put in the waiting area.</p> <p>“I hate that we even have to make that
determination,” Dusang said. Lately, staff members have been pulling out some
patients already in the ER’s rooms when others arrive who are 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.'”</p> <p><strong>ER Patients Have Grown Sicker</strong></p> <p>“We are
hearing from members in every part of the country,” said Dr. Lisa Moreno,
president of the <a href="https://www.aaem.org/">American Academy of Emergency
Medicine</a>. “The Midwest, the South, the Northeast, the West … they are seeing
this exact same phenomenon.”</p> <p>Although the number of ER visits returned to
pre-covid levels this 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 <a href="https://ehrn.org/">Epic Health Research
Network</a>, which pulls data from more than 120 million patients across the
country.</p> <p>“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,” said Caleb Cox, a data
scientist at Epic.</p> <p>Less acute cases, such as people with health issues
like rashes or conjunctivitis, still aren’t going to the ER as much as they used
to. Instead, they may be opting for an urgent care center or their primary care
doctor, Cox explained. Meanwhile, there has been an increase in people coming to
the ER with more serious conditions, like strokes and heart attacks.</p> <p>So,
even though the total number of patients coming to ERs is about the same as
before the pandemic, “that’s absolutely going to feel like [if I’m an ER doctor
or nurse] I’m seeing more patients and I’m seeing more acute patients,” Cox
said.</p> <p>Moreno, the AAEM president, works at an emergency department in New
Orleans. She said the level of illness, and the inability to admit patients
quickly and move them to beds upstairs, has created a level of chaos she
described as “not even humane.”</p> <p>At the beginning of a recent shift, she
heard a patient crying nearby and went to investigate. It was a paraplegic man
who’d recently had surgery for colon cancer. His large post-operative wound was
sealed with a device called a wound vac, which pulls fluid from the wound into a
drainage tube attached to a portable vacuum pump.</p> <p>But the wound vac had
malfunctioned, which is why he had come to the ER. Staffers were so busy,
however, that by the time Moreno came in, the fluid from his wound was leaking
everywhere.</p> <p>“When I went in, the bed was covered,” she recalled. “I mean,
he was lying in a puddle of secretions from this wound. And he was crying,
because he said to me, ‘I’m paralyzed. I can’t move to get away from all these
secretions, and I know I’m going to end up getting an infection. I know I’m
going to end up getting an ulcer. I’ve been laying in this for, like, eight or
nine hours.'”</p> <p>The nurse in charge of his care told Moreno she simply
hadn’t had time to help this patient yet. “She said, ‘I’ve had so many patients
to take care of, and so many critical patients. I started [an IV] drip on this
person. This person is on a cardiac monitor. I just didn’t have time to get in
there.'”</p> <p>“This is not humane care,” Moreno said. “This is horrible
care.”</p> <p>But it’s what can happen when emergency department staffers don’t
have the resources they need to deal with the onslaught of competing
demands.</p> <p>“All the nurses and doctors had the highest level of intent to
do the right thing for the person,” Moreno said. “But because of the high acuity
of … a large number of patients, the staffing ratio of nurse to patient, even
the staffing ratio of doctor to patient, this guy did not get the care that he
deserved to get, just as a human being.”</p> <p>The instance of unintended
neglect that Moreno saw is extreme, and not the experience of most patients who
arrive at ERs these days. But the problem is not new: Even before the pandemic,
ER overcrowding had been a “widespread problem and a source of patient harm,
according to a <a
href="https://catalyst.nejm.org/doi/full/10.1056/CAT.21.0217">recent
commentary</a> in NEJM Catalyst Innovations in Care Delivery.</p> <p>“ED
crowding is not an issue of inconvenience,” the authors wrote. “There is
incontrovertible evidence that ED crowding leads to significant patient harm,
including morbidity and mortality related to consequential delays of treatment
for both high- and low-acuity patients.”</p> <p>And already-overwhelmed staffers
are burning out.</p> <p><strong>Burnout Feeds Staffing Shortages, and Vice
Versa</strong></p> <p>Every morning, Tiffani Dusang wakes up and checks her
Sparrow email with one singular hope: that she will not see yet another nurse
resignation letter in her inbox.</p> <p>“I cannot tell you how many of them [the
nurses] tell me they went home crying” after their shifts, she said.</p>
<p>Despite Dusang’s best efforts to support her staffers, they’re leaving too
fast to be replaced, either to take higher-paying gigs as a travel nurse, to try
a less-stressful type of nursing, or simply walking away from the profession
entirely.</p> <p>Kelly Spitz has been an emergency department nurse at Sparrow
for 10 years. But, lately, she has also fantasized about leaving. “It has
crossed my mind several times,” she said, and yet she continues to come back.
“Because I have a team here. And I love what I do.” But then she started to cry.
The issue is not the hard work, or even the stress. She struggles with not being
able to give her patients the kind of care and attention she wants to give them,
and that they need and deserve, she said.</p> <p>She often thinks about a
patient whose test results revealed terminal cancer, she said. Spitz spent all
day working the phones, hustling case managers, trying to get hospice care set
up in the man’s home. He was going to die, and she just didn’t want him to have
to die in the hospital, where only one visitor was allowed. She wanted to get
him home, and back with his family.</p> <p>Finally, after many hours, they found
an ambulance to take him home.</p> <p>Three days later, the man’s family members
called Spitz: He had died surrounded by family. They were calling to thank
her.</p> <p>“I felt like I did my job there, because I got him home,” she said.
But that’s a rare feeling these days. “I just hope it gets better. I hope it
gets better soon.”</p> <p>Around 4 p.m. at Sparrow Hospital as one shift
approached its end, Dusang faced a new crisis: The overnight shift was more
short-staffed than usual.</p> <p>“Can we get two inpatient nurses?” she asked,
hoping to borrow two nurses from one of the hospital floors upstairs.</p>
<p>“Already tried,” replied nurse Troy Latunski.</p> <p>Without more staff, it’s
going to be hard to care for new patients who come in overnight — from car
crashes to seizures or other emergencies.</p> <p>But Latunski had a plan: He
would go home, snatch a few hours of sleep and return at 11 p.m. to work the
overnight shift in the ER’s overflow unit. That meant he would be largely caring
for eight patients, alone. On just a few short hours of sleep. But lately that
seemed to be their only, and best, option.</p> <p>Dusang considered for a
moment, took a deep breath and nodded. “OK,” she said.</p> <p>“Go home. Get some
sleep. Thank you,” she added, shooting Latunski a grateful smile. And then she
pivoted, because another nurse was approaching with an urgent question. On to
the next crisis.</p> <p><em>This story is part of a partnership that includes <a
href="https://www.michiganradio.org/people/kate-wells">Michigan Radio</a>, <a
href="http://www.npr.org/sections/news/">NPR</a> and KHN.</em></p> Copy HTML

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