Local healthcare providers are supporting state health leaders who are cautioning residents to avoid hospital emergency rooms unless necessary in an effort to curb overcrowding and the spread of disease as incidents of respiratory viruses increase.
“Emergency Departments are appropriate for strokes, severe bleeding, chest pain, breathing difficulties, head trauma, severe burns and other situations where every lost second could mean life, disability, or death,” said Anitra Galmore, South County Health’s chief nursing officer.
“South County Health encourages those experiencing symptoms of minor respiratory illness to call their primary care provider,” she said, or visit a nearby walk-in medical center.
With rising cases of several respiratory viruses currently circulating in Rhode Island and with the holidays coming, state health officials issued the caution last week. A primary care physician should be contacted before going to a hospital emergency department, they said.
All of this comes as The American Academy of Pediatrics and Children’s Hospital Association are calling on the Biden administration to declare an emergency to support a national response to an “alarming surge of pediatric respiratory illnesses, including respiratory syncytial virus (RSV) and influenza.”
RSV is described as a very common respiratory virus that usually causes mild, cold-like symptoms, according to the federal Centers for Disease Control and Prevention.
Most people recover within two weeks — but RSV can be serious, especially for the very young or very old and those with compromised immune systems.
Rhode Island and states throughout the region are currently seeing high rates of RSV, a common virus that can be serious for some higher-risk children and adults. Cases of RSV usually peak in Rhode Island in early January.
Flu is starting to circulate in Rhode Island as well, and hospitals are still treating patients with COVID-19. The ongoing behavioral health crisis and a national healthcare worker shortage are creating additional challenges for the hospitals in Rhode Island as cases of respiratory viruses rise.
Illnesses in ERs
Last February, The Journal of Personalized Medicine, as reported on the federal National Institutes of Health website, pointed to several other issues as a result of overcrowded hospital emergency departments.
It has been comprehensively demonstrated by various studies concerning the subject that hospital crowding also causes a delay in the diagnostic process and the start of treatment, triggering a vicious circle that feeds the overcrowding itself, the journal said.
In turn, overcrowding also has a negative impact on the triage process, with an increase in the number of patients who do not access triage, an increase in the triage time itself, and an increase in the length of stay (LOS), the journal said.
Triage is the prioritization of patient care based on the severity of injury, illness, prognosis and availability of resources to help the patient.
In addition, several studies and meta-analyses have also observed that ED overcrowding is associated with an increasing trend of leaving the ED before undergoing medical examination and treatment, it noted.
While hospital emergency departments in Rhode Island are experiencing significant crowding and prolonged waiting times, advice to go only if urgent care is needed is a double-edged sword for hospitals.
While it helps to alleviate overcrowding, reduce the unnecessary spread of disease and cut long waits that are the core of persistent criticism of ERs generally, the caution also taps hospitals’ bottom lines because ER visits have high price tags and are a strong revenue source.
They are often three times or more costly than a doctor’s office visit charge.
South County Hospital said it is not seeing the respiratory illness surge other hospitals are experiencing. Galmore did not, however, address crowding, boarding and prolonged wait times in her ER.
“South County Health is seeing less than a 10% increase in patients presenting to South County Hospital’s Emergency Department with respiratory illnesses when compared to the same period last year,” she said.
Crowding in ERs is also a concern because it can lead to a greater spread of illness to those waiting for service during prolonged stays in close quarters in a waiting room.
Gilmore said that South County Hospital, however, has attempted to address that concern with various improvements to over 13,000 square feet of waiting and evaluation areas. It included changes to treat and disinfect air flow in patient care and waiting areas.
In addition to South County Health recommending people strongly assess their need for ER care, Thundermist Health Center provides walk-in service and said its offices are ready to help their established patients and those without a primary care physician to call.
“It is important that we keep our emergency departments clear for people with emergencies. We encourage all Rhode Islanders to follow the guidance from the Rhode Island Department of Health regarding seeking care in appropriate settings,” said Amanda Barney, spokeswoman for Thundermist.
“We carefully monitor the slots available each day for care at Convenient Care. If we reach capacity for the day, we post a message on our social media sites,” she said.
Dr. David Chronley, a recently retired South County pediatrician for 44 years, advised that parents should call their child’s pediatrician first before rushing off to an ER.
Respiratory distress means there’s increased work to breathe. Called “belly breathing,” a retraction occurs by using chest muscles to get air in. A parent or caregiver should take a child to an urgent care center if their regular pediatrician cannot be reached.
At the urgent care — often less crowded than an ER — healthcare professionals will recognize if the child needs to be transferred to a hospital.
“ERs are so crowded, it’s dangerous for young kids and babies because of other illnesses present there,” he said. “It’s really a better deal if the regular doctor treats the kid because he or she knows the kid best,” he added.
State leaders highlighted health.ri.gov/rightplace. This page has links to lists of primary care providers, urgent care centers and health centers in Rhode Island as well as guidance on when to go to the emergency department.
State leaders also announced last week that a new, temporary health regulation will allow emergency medical services (EMS) personnel to work under the supervision of an on-site healthcare provider in a hospital or other licensed healthcare facility in Rhode Island.
This regulation is in response to the staffing shortage in emergency departments, which is contributing to the overcrowding challenges at facilities.