PLATTSBURGH – Local hospital officials say a confluence of factors has led to crowding and increased wait times at emergency departments.
But they emphasized they still want people to seek care if they need it.
“We want to get people the care that they need and that they deserve and that they want, but to accomplish that in a setting of some constrained resources, sometimes those people who can wait may have to wait a bit,” University of Vermont Health Network Chief Medical Officer Dr. David Clauss told the Press-Republican.
“We would just ask for people's patience.”
Towards the start of the pandemic in early 2020, people were afraid to come to the emergency room, said Gail Bjelko, a registered nurse and the director of the University of Vermont Health Network, Champlain Valley Physicians Hospital Emergency Department.
Clauss said emergency department use cut in half for a while; Dr. Ashley Weisman, Elizabethtown Community Hospital’s director of emergency medicine, recalled only seeing eight to 10 patients over a 24-hour period.
That’s a sharp contrast to the current crowding, a problem the administrators said is also occurring nationally.
Clauss, who has a background in emergency medicine, said people tend to assume ER crowding can be attributed to individuals seeking out emergency care when they do not need it, but data show that’s not actually the case.
The least urgent cases always tend to make up a relatively low percentage, he said.
“The increases are increases in people who legitimately really should be in the emergency department.”
Those who delayed care toward the beginning of the pandemic are now presenting with more advanced or more serious conditions.
That challenge has coupled with the region’s older population and a bounceback to pre-COVID emergency department volumes, Clauss said.
But the crowding itself is really more of an outflow problem than an in-flow problem, he continued, pointing to tremendous strains on inpatient capacity.
Those can be attributed to staffing challenges for the North Country’s health care workforce — which have been exacerbated by the pandemic, New York State’s COVID vaccine mandate and the growing traveling nurse industry — in conjunction with full inpatient beds.
Long-term care facilities, also suffering from limited staffing, have been unable to take in patients no longer in need of acute care in the hospital.
As a result, admitted patients are taking up many of the CVPH emergency room’s 29 beds.
Further complicating the bed availability issue is a huge influx in families seeking out COVID tests that return results more quickly than at testing sites, Bjelko said.
Throughout September and early October, the hospital has seen double the number of persons under investigation for COVID-19 on a daily basis compared with preceding months.
Anyone who comes to the ER with COVID-related symptoms gets a rapid swab to test for the coronavirus, with results coming back in about an hour and a half.
Symptomatic patients have to go to private rooms, of which there are 23 in CVPH’s emergency department.
“We're finding that we don't have enough private space to accommodate all the patients who are coming in with symptoms,” Bjelko said.
As a result, patients who are symptomatic but appear stable are being sent to their cars after their swabs to await the results. If their tests come back negative, staff can then place them in a semi-private room, Bjelko said.
“But … if the patient comes back positive, it could take hours before they get a private room.”
MAKING A 'TREATMENT' CAKE
Also contributing to wait times is the focus on setting patients up for successful treatment plans at home, a response to the challenges in hospital capacity and a process that takes time.
Weisman described how she asks many more questions about how patients get around, who does their grocery shopping, what transportation they have and whether they have internet access.
Each shift, she picks up a new contact or a new way of doing something, piecemealing together plans for how patients can continue their treatment after they leave the ER.
“The solution that includes a safe home plan is so custom that it just definitely takes more time upfront,” Weisman said.
“It’s like making a cake where the recipe and the availability of ingredients changes every single case.”
Weisman clarified that having to wait at the emergency room does not mean you were wrong to come or should “get out of here."
Both she and Bjelko pointed to how triage nurses are well-trained to prioritize ER patients, and follow a standardized process to get a sense of whether a patient needs more tests and can be safely monitored in the waiting room area.
“If something happens, if your status changes in the waiting room, you’re a 10-step walk to an emergency department bed and immediate care, not a 35-minute drive,” Weisman said.
Crowding at the region’s larger hospitals like CVPH and UVM Medical Center in Burlington creates a significant ripple effect that impacts the smaller facilities who depend on them for higher levels of care, Clauss said.
Weisman said every delay in the process — COVID testing, decrease in staff, longer patient stays — at those hospitals means fewer patients from small towns like Elizabethtown and Ticonderoga get in.
“I’ve had days where I’ve called CVPH, UVM, Porter, Alice Hyde, Adirondack Medical Center, Canton-Potsdam, Glens Falls and Albany to try and transfer a patient, all unsuccessfully, and kept the patient overnight in observation status in our ER to try and come up with a plan in the morning,” she added.
“That has not been an uncommon scenario over the last couple of weeks.”
CVPH Chief Medical Officer Dr. Lisa Mark has said a three-week elective surgery pause implemented at the Plattsburgh hospital was, in part, aimed at helping put the facility in a better position to meet the needs of the community it serves after it began limiting transfers from regional hospitals earlier this month.
WHEN TO COME
Bjelko asked the community for patience as the ER navigates this difficult time, and spoke to the commitment of the staff.
“They’re doing what they can to support the community and to support their patients," she said. "Sometimes it doesn’t seem like enough, but they’re working hard for sure.”
Bjelko advised those with non-emergency and non life-threatening problems to first contact their primary care providers or go to an urgent care facility.
She also urged individuals simply seeking COVID swabs to go to a testing site. CVPH offers testing by doctor’s order at 23 Hammond Lane in Plattsburgh, and you can find a testing site near you anywhere in New York State by visiting tinyurl.com/uaa2tmcc.
The officials stressed that any life- or limb-threatening conditions should prompt an ER visit. Clauss gave as examples: significant injury, chest pain or shortness of breath, or new neurologic symptoms.
As an emergency medicine doctor, Weisman views her department as the safety net. She said it’s very hard to know exactly when is the right time to go to the ER, a challenge even physicians face.
“If you feel you need to come to the ER for whatever reason, whatever is going on, you feel like you’re at a point where you need some immediate help to solve a problem, come to the emergency room."
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