Rhode Islanders urged to seek care in right setting to prevent hospital overcrowding

Health

PROVIDENCE, R.I. (WPRI) — State health officials and hospital workers held a news conference Wednesday to pass along a message to the public: “right place, right care.”

Dr. Nicole Alexander-Scott, director of the R.I. Department of Health, got together with representatives from Rhode Island’s two major hospital groups to stress that emergency room overcrowding is a real problem right now in health care facilities around the state and the country.

“I can tell you that we’re seeing overall occupancy numbers like 93% of capacity and 98% of capacity, and ICU utilization is at or near 100% capacity,” Alexander-Scott said.

Dr. Stephen Traub, an attending emergency medicine physician, said at this time of year, Rhode Island Hospital normally has 60 to 80 beds open for patients, but some days the hospital is down to a dozen beds or less.

“Our hospital has 47 emergency room beds, and many times over the last few months, we’ve had 60, 70, 80, 90 patients waiting, trying to be cared for in our emergency department of 47 beds,” said Dr. Paari Gopalakrishnan, interim President and CEO of Kent Hospital.

Gopalakrishnan said to address the problem, Kent has put up a military-grade tent in the parking lot to add 10 more beds.

“But the challenge is still the same. It’s staffing,” Gopalakrishnan added.

“I’m here with our colleagues because this is a public health concern, and it could become a patient safety concern,” Alexander-Scott said. “But we have an opportunity to do something about it, and that’s why we’re here to educate you today.”

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Alexander-Scott said there are a number of reasons for the overcrowding, including hospitals seeing a shortage in clinical staff, in part because of burnout after almost two years of pandemic response.

“Our heroes who have been health care workers on the front lines can only take but so much,” she said. “Burnout is a normal part of this process and we have to be able to support them.”

“What happens is this requires many facilities to reduce the number of available beds because of the staffing that they have available to provide care with those beds and to use emergency departments to then board those admitted patients that are less staffed,” she continued.

Another factor that’s been discussed for years, according to Alexander-Scott, is the ongoing behavioral health crisis “which involves patients with some very complex needs.”

She and others emphasized that many health issues can be treated “quickly and effectively” by primary care providers or within urgent care facilities. These types of issues include, but are not limited to:

  • Less severe cases of the flu
  • Back pain
  • Minor cuts
  • Sore throats
  • Low-grade fevers
  • Most cases of norovirus, or stomach flu

“If you go to the emergency room for these non-urgent but important health issues, patients will experience long wait times in the emergency departments, and patients may end up paying much more than they otherwise needed to,” Alexander-Scott explained.

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Doctors say there are several things Rhode Islanders can do to help the state get through the winter:

  1. Get vaccinated against COVID-19 and influenza, and a COVID-19 booster when eligible
  2. If unscheduled care is needed, call primary care physician or urgent care
  3. Keep regularly scheduled doctors appointments to keep health problems from worsening
  4. If emergency medical care is needed, the emergency departments within Rhode Island are open

In an effort to educate the public and help prevent further overcrowding in hospitals, emergency departments and intensive care units, the Health Department has set up an online resource guide with a list of primary care providers and urgent care centers that area available throughout Rhode Island.

“It’s critical that we get the word out now before the holidays and before the height of our respiratory viral season,” Alexander-Scott said. “It’s flu, it’s COVID, it’s RSV … they are all out there, we’re familiar with them. There are ways to handle them by getting seen and taken care of in the right place to get the right care.”

In addition to the state dealing with high transmission of COVID-19, Alexander-Scott said Rhode Island is seeing flu rates “considerably higher” than normally seen this time of year.

In a separate news conference Tuesday, Alexander-Scott elaborated on how the state is seeing flu numbers not usually seen “until January.”

In addition to the COVID vaccine, doctors suggest getting a flu shot as soon as possible and only using emergency departments for emergency situations.

There are reasons to seek immediate emergency care, which include:

  • Significant trouble breathing
  • Persistent chest pain or chest pressure
  • New weakness in an arm, leg or face
  • New difficulty speaking or confusion
  • Inability to wake or stay awake
  • Pale, gray or blue-colored skin, lips or nail beds, depending on skin tone

“If you’re not sure if you need emergency care, pick up the phone,” Alexander-Scott added. “That’s a helpful way to get started. Call your primary care doctor or call an urgent care center.”

Doctors also wanted to remind anyone coming in for care to be kind to hospital staff.

“We realize that your waits are long, and we realize that you will be frustrated, but ask that you remember that we’re on your team, and we’re here to take care of you,” Traub said.

An interagency team across the Executive Office of Health and Human Services (EOHHS) is working to develop and implement strategies to address the challenges hospitals are facing. They include:

  • Emergency regulations to assist with increasing the workforce and pre-hospital transportation availability
  • Partnerships with urgent care centers to explore developing capacity to expand emergency treatment options
  • Development of step-down capacity for behavioral health care and increased treatment initiation within emergency room settings
  • Provision of staffing supports, including direct care workforce recruitment and retention initiatives for home and community-based services
  • Planning for mobile crisis response for behavioral health and increased behavioral health system capacity through Certified Community Behavioral Health Clinics

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Alexander-Scott was asked, given the status of hospital emergency departments within the state, if they’ve considered reopening one of the state’s field hospitals. She said it “certainly has been a part of the considerations,” but noted that much of what’s occurring in emergency departments is not just specific to COVID.

“It’s connected to delayed care, it’s connected to the staffing crisis nationally, and it’s connected to the behavioral health crisis which we have described,” she explained. “If we had the opportunity to have some of those issues be cared for with that type of hospital setting, we would, but we are limited to the alternate hospital site really focusing on COVID. And that, as you can hear, is not the primary leading issue of our concerns.”

Alexander-Scott and other doctors at the news conference were also asked if the vaccine mandate for health care workers worsened the staffing crisis.

“It’s a contributing factor that is small in the grand scheme of things,” Alexander-Scott said, noting that Rhode Island is at 98% compliance with the state’s vaccination policy.

Copyright 2021 Nexstar Media Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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