UnityPoint Well being-St Luke’s Hospital staff collect for a walk-through of the emergency division, which features a new screening shed, outdoors the emergency entrance on the hospital in Cedar Rapids in April 2020. (Liz Martin/The Gazette)
Because of the latest spike in COVID-19 circumstances which have strained space hospitals, some sufferers have been experiencing longer wait instances at emergency departments.
The stress on its services prompted hospital officers to enact mitigation measures to protect capability for emergencies. These included, in some circumstances, boarding sufferers throughout the emergency division, turning away affected person transfers and diverting ambulances to different hospitals.
The unfold of the extremely transmissible omicron variant has brought on report new circumstances throughout the state, driving complete COVID-19 hospitalizations statewide to surpass 1,000 complete sufferers this month.
Prior to now two weeks, new circumstances and hospitalizations have been on the decline. As of this previous Wednesday, 794 sufferers have been hospitalized with COVID-19, in keeping with the Iowa Division of Public Well being’s weekly coronavirus report.
Amongst these, 109 have been in intensive-care items and 51 have been on a ventilator.
However within the midst of a spike in COVID-19 positivity charges — reaching greater than 25 % some weeks in Linn and Johnson counties — hospital officers reported seeing comparable will increase in sufferers arriving at their emergency departments.
Dr. Ryan Sundermann, UnityPoint Well being-St. Luke’s Hospital medical director. (Photograph courtesy of St. Luke’s.)
Wait instances elevated with onset of omicron
UnityPoint Well being-St. Luke’s Hospital’s 34-room emergency division noticed affected person volumes that have been 20 % increased than common throughout the unfold of delta variant and the onset of omicron, mentioned Dr. Ryan Sundermann, St. Luke’s medical director.
Suppliers expanded quantity within the emergency division by inserting beds and chairs within the hallways to deal with sufferers, and labored to expedite the triage course of, Sundermann mentioned. Nevertheless, excessive affected person volumes throughout the hospital created a “trickle up” disruption that made it tough to maneuver sufferers from the emergency division into inpatient beds.
“When the hospital is full, it’s tough to maneuver sufferers into the hospital, which retains our beds full,” he mentioned.
At instances, St. Luke’s needed to board sufferers within the emergency division they usually usually wait two to 4 hours for an inpatient mattress.
Mercy Medical Heart in Cedar Rapids additionally noticed a gradual improve in emergency division site visitors over the previous six months, officers mentioned, however the variety of sufferers has returned to pre-pandemic ranges in current weeks.
At peak instances throughout busy days, officers mentioned some people might have waited as much as a number of hours earlier than seeing a supplier. However they pointed to main staffing shortages as the primary driver to these wait instances.
Earlier than COVID-19 two years in the past, wait instances usually have been 20 minutes.
“As we’ve said many instances this previous yr, nationwide hospital staffing shortages are additionally a actuality right here in Cedar Rapids,“ Mercy Medical officers wrote in a press release. ”The rise in ER wait instances that people might have skilled throughout the COVID pandemic have largely been associated to staffing.“
The emergency division at Mercy in Iowa Metropolis — which touted its 10-minute wait time earlier than the pandemic — has not skilled important adjustments in affected person volumes up to now yr, mentioned Dr. Josh Eastvold, the hospital’s emergency division medical director.
Eastvold mentioned door-to-provider instances — the time a affected person spends from arrival to seeing a well being care supplier — has remained steady at 25 minutes, and fewer than 10 minutes for Stage 1 emergent circumstances. Hospital knowledge reveals the common time between arrival and triage for 2021 was 10.5 minutes.
Dr. Theresa Brennan, College of Iowa Hospitals and Clinics
At College of Iowa Hospitals and Clinics, the emergency division noticed a slight decline in affected person visits in 2020, dipping beneath 2016 ranges, hospital officers told the Board of Regents this past April. Nevertheless, severity of affected person situations remained excessive, in keeping with hospital management.
Within the two years since COVID-19 arrived within the state, officers say the emergency division has seen “a rise in increased acuity circumstances.”
“Whereas our general variety of affected person visits to the emergency room will not be considerably elevated, we’re seeing a better variety of sufferers who should be admitted to the hospital than we did earlier than,” Dr. Theresa Brennan, UIHC chief medical officer, mentioned in an e-mail to The Gazette.
Along with sufferers arriving on the emergency division needing inpatient admission, the system additionally has seen elevated requests to switch sufferers from different hospitals due to a excessive affected person census throughout Iowa. These two elements has “led to sicker sufferers in our ER and our hospital usually,” Brennan mentioned.
Ambulances diverted, affected person transfers turned away
As affected person volumes elevated, some hospitals have diverted ambulances in an effort to protect capability and sources. Ambulance diversion is a observe of quickly redirecting ambulances to different hospitals to alleviate emergency division crowding.
Space Ambulance Service, the emergency medical providers supplier for the Cedar Rapids space, has had its ambulances diverted roughly 15 instances all through the two-year pandemic, CEO Keith Rippy mentioned.
Diversions hardly ever final very lengthy, many of the timelasting for just some hours, Rippy mentioned. Ambulances are notified nicely forward of time and affected person care will not be affected, he added.
“We’ve seen, over the course of the pandemic, some incidents during which we have been diverted, however I wouldn’t name it important,” Rippy mentioned.
Mercy Medical officers confirmed the hospital had been on diversion standing beforehand within the pandemic, however not in current months.
St. Luke’s has made it a coverage to by no means go on diversion standing, Sundermann mentioned. Nevertheless, excessive affected person numbers has meant the hospitals have needed to flip away requests from different hospitals to switch their sufferers — a development within the newest surge that has impacted the state’s smallest hospitals probably the most.
Important entry hospitals, corresponding to these in Anamosa and Independence, have smaller capability and don’t have specialty suppliers who can maintain extra complicated affected person circumstances. These services usually switch sufferers who want that increased stage of care to hospitals corresponding to St. Luke’s, however have been unable to take action within the midst of the latest surge.
Sundermann, who additionally sees sufferers at smaller UnityPoint Well being-affiliated hospitals within the area, recalled the hassle to switch a affected person to a different hospital. He referred to as well being programs in cities corresponding to Kansas Metropolis, Omaha and Madison on the lookout for an open mattress, however was turned away from each single one.
“The small hospitals in surrounding communities are actually struggling,” he mentioned.
To assist protect their capability, native hospital officers proceed to emphasise the significance of getting the COVID-19 vaccines and booster photographs in the event that they qualify.
To alleviate potential emergency division crowding, Sundermann additionally inspired people with no signs or gentle signs of COVID-19 to hunt out coronavirus testing elsewhere, if attainable. Nevertheless, he emphasised emergency medical suppliers will probably be accessible to anybody in want.
Feedback: (319) 398-8469; michaela.ramm@thegazette.com
