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Packed ERs create longer wait times, nurse fatigue

Doctors worried for peak flu season
Posted at 1:58 PM, Oct 27, 2021

BALTIMORE (WMAR) — Emergency rooms are packed, busier so far this fall than they were at the peak of COVID-19 hospitalizations. It's causing a strain on hospital staff and increasing wait times.

"We have nowhere to put anyone," said Baltimore ER nurse Lena Sutch.

It's a mixture of COVID-19, RSV and the flu, which is only just beginning.

"Marylanders are back on the move and they are getting hurt and they are ill," said Dr. Ted Delbridge.

There are more patients during a nursing shortage that means longer wait times.

"Across the state, there are no inpatient beds in our hospitals. When we can’t move people out, we keep them in the ER and there’s no closing the doors to an ER so we can have 30-40 more patients in the waiting room," said Sutch.

When that happens, hospitals use the Maryland Institute for Emergency Medical Services Systems, or MIEMSS, to let EMS personnel know just how crowded they are.

A yellow alert means they are particularly busy. A red alert means they have no more in-patient beds.

"The hospitals are trying to message to the EMS clinicians that, if they have an option, to take a patient to a different facility. That might be in the patients best interest in terms of the timing and availability of care in the ED," said Delbridge, executive director of MIEMSS.

This September to mid-October was more than four times busier than the same time period in 2019 and 2020. Area hospitals were on yellow alert for 14,474 hours and red for 8,726, compared to 3,700 and 1,500, on average, in the falls of 2019 and 2020.

"We keep track of the number of respiratory illnesses the EMA systems encounters and it is higher right now that it typically is this time of year," said Delbridge.

This fall was also busier than the peak of COVID-19 hospitalizations in January of this year.

To help with the constant alerts, MIEMSS created a coordination center to transfer patients between hospitals.

"We can call them and say 'hey we have this really sick person. We don’t have anywhere to put them'. They know of all of the ICU beds throughout the state and they can help us place people and they’ve just recently started doing that this kids too because our pediatric numbers are going up," said Sutch, who is also the Maryland Emergency Nurses Association president.

Sutch said this is helpful, but more needs to be done because, with 2,600 nursing vacancies statewide, they are getting burnt out.

"They had compassion fatigue. There’s high rates of PTSD in the ER. High rates of workplace violence and it’s just getting dangerous not having enough nurses," said Sutch.

President of the Maryland Hospital Association Bob Atlas said the shortage is worse than it has been in some time. It's not just nurses, but other staff including respiratory therapists, and it has been exacerbated by the pandemic.

"It’s been a long haul, 600 days of fighting COVID and that strain has certainly started to show," said Atlas.

Atlas said hospitals are trying to fill vacancies by offering retention bonuses, increasing minimum wage or using travel nurses.

"That cost is considerable and has really risen to almost an unsustainable level," said Atlas.

Staffing has become such an issue that some hospital systems have again scaled backed on elective procedures. It's a step others may need to take as the flu season really picks up. During the week of October 16, flu activity was minimal. Peak flu season usually doesn't start until December.

Sutch said people can help by staying home if they are sick, wearing masks, and taking care of chronic issues.

"People who can generally go to an urgent care or try to follow up with a primary care doctor is really important because we can’t fix everything," said Sutch.

She said above all, understand they are doing their best.

"The best thing that people can do is just be patient with us," said Sutch.

Several universities have created expedited nursing programs to get students into the field.

Gov. Larry Hogan announced emergency legislation earlier this month to maximize the ability of state hospitals to increase their nursing workforce. This legislation would make permanent a number of the steps the governor has put in place temporarily.

They include:

  • Registered nurses or licensed practical nurses who hold a current active license in any other state or jurisdiction may render nursing care.
  • A request to all state nursing programs to once again allow the earliest graduation possible for qualified nursing students.

Maryland Department of Health Secretary sent a letter to the state’s hospital and nursing home leaders outlining additional flexibilities they may use:

  • State health officials encourage all hospital leaders to work with their local nursing programs to ensure that hospitals can use student nurses to the maximum extent feasible.
  • State health officials encourage all hospital leaders to actively recruit nursing staff from Nurse Licensure Compact states to increase the supply of nursing personnel. The compact allows nurses to have one license but the ability to practice in multiple states.
  • Certified Nursing Assistants. Nursing students may perform the tasks of Certified Nursing Assistants with supervision.
  • Physician assistant students may practice without a license.
  • A physician may delegate to unlicensed individual aspects of care that are necessary for emergency COVID-19 treatment as determined by their clinical judgment.