PROVIDENCE, R.I. (WPRI) — Measures are being taken at the state level to address challenges Rhode Island hospitals are facing amid a so-called “quademic” of RSV, flu, COVID-19, and a behavioral health crisis.
“We are seeing long visit waits at the local emergency rooms. This is not new; we’ve seen that year after year, and we are back into it again,” Ana Novais, acting secretary of the R.I. Executive Office of Health and Human Services (EOHHS) said Thursday.
While viruses like influenza and COVID-19 are still circulating and putting a strain on the health care system, for weeks, hospitals across the country have been feeling the effects of a surge in RSV cases among pediatric patients.
Novais said hospitals are also facing additional challenges, including behavioral health needs for both pediatric and adult patients, emergency department overcrowding, and a national shortage of health care workers.
At a news conference with hospital and public health officials from across the state on Thursday, Novais said a team is working on several strategies to address these challenges.
“There is not a silver bullet solution. It’s complex,” Novais said.
One of those strategies includes a media campaign on seeking care in the right setting.
“Not every issue needs to be treated in the emergency departments. Many health issues can be treated quickly and effectively by a primary care provider, an urgent care facility, or in another community clinic,” said Dr. Philip Chan, Consultant Medical Director of the R.I. Department of Health.
Doctors note there are reasons to absolutely go to the emergency room, including if someone is showing any of these signs:
- Stopped breathing or turning blue
- Head injury with passing out, throwing up, or not behaving normally
- Injury to neck or spine
- Seizure that lasts 3 to 5 minutes
- Bleeding that cannot be stopped
- Severe allergic reaction
- New weakness in an arm, leg, or face
- New difficulty speaking or confusion
- Inability to wake or stay awake
- Suddenly not able to speak, see, walk, or move
“When people go to the emergency departments, the most serious health issues get seen first, so people with less serious health issues may experience longer wait times if you’re going to the emergency department,” Chan explained.
Dr. Laura Forman, Chief of Emergency Medicine at Kent Hospital, began her remarks Thursday by painting a picture of what an overcrowded emergency department looks like.
“Today, it looks like an 82-year-old grandfather forced to wait in the emergency department for two days while having a heart attack because there is not a bed in the cardiology wing,” Forman said.
“It looks like a 24-year-old woman having a miscarriage, sitting in a hallway in this emergency department, while staff desperately try to find a sick patient who can come out of her room so that she and her husband can have a private place to grieve,” she continued.
“It looks like a patient with depression that’s so severe he’s actively suicidal, forced to wait in the emergency department for three days for a psychiatric bed,” Forman said. “It’s a family and an ER doctor forced to choose between caring for a vomiting 7-year-old in the waiting room, elbow to elbow with other sick patients, or waiting in that waiting room until 2 in the morning when a bed opens up where the patient can be cared for.”
Forman conceded that hospital overcrowding is nothing new, but added that there is not a sudden influx of patients creating the problem.
“It’s just that there are more and more roadblocks for our patients, more obstacles,” Forman said, referring to getting patients admitted, transferred, or discharged.
The stressors of the pandemic have exacerbated overcrowding, according to Forman. Because of that, she said it’s no longer something endured by just a few who have no other access to health care.
“It impacts anybody in any emergency department in our state today, and it can no longer be ignored,” she added.
Forman said the state’s emergency departments are full of people with “preventable emergencies,” but added that hospitals don’t have enough resources to get patients out of the emergency department in a reasonable timeframe.
“Our emergency departments are full of people waiting for the next level of care, sometimes for days,” she said.
Dr. Linda Brown, a division director of pediatric emergency medicine at Hasbro Children’s Hospital, said what the facility is seeing now with the surge of RSV and other respiratory viruses is “clearly unprecedented.”
“The volumes that we’re seeing are significant,” Brown said. “The severity of illness that we’re seeing is actually quite significant as well.”
Brown said this has uncovered a pediatric capacity issue, in terms of inpatient and critical care beds, and it is compounded by the behavioral health crisis.
“We have pediatric patients that stay in our emergency departments for days boarding, in our hospital’s inpatient as well, boarding for psychiatric beds,” Brown added.
Brown noted that Hasbro has been over capacity for the past few weeks, and at some points, at 125% or more capacity.
“What I mean by that is actually every bed within the hospital has been used for a pediatric patient,” she explained. “Every bed in the ICU has been used, and we are using many of the beds that are within our emergency department to take care of patients that are actually already admitted to the hospital.”
She said this has left Hasbro with little room to take care of patients coming in the door for emergency care, which has led to unprecedented wait times in emergency rooms. The hospital has had to triage patients, meaning the sickest and most urgent cases get seen first.
“We have had a little bit of a breather in the past few days, in that the RSV may have started to tick down a little bit, but I don’t think any of us are sort of claiming victory at this point,” Brown said, recognizing that flu and COVID-19 are also circulating.
Novais announced Thursday another new strategy to help with the staffing shortage: a temporary emergency regulation that will allow emergency medical services (EMS) professionals to work in hospitals and other health care facilities.
Additionally, she said the state will work to expedite the licensure process to ensure that all new health care workers are able to join the workforce in Rhode Island as quickly as possible.
On top of that, the state is also asking primary care doctors to help do what they can to keep emergency rooms below capacity, including making more same-day sick appointments available for patients, offering expanded and/or non-traditional office hours, and seeing patients who have non-urgent symptoms in the office or by telemedicine.
Chan acknowledged that outpatient health care providers are also very busy and certain requests, like retesting for COVID-19 or other respiratory viruses, are backing up the health care system to an extent.
“You don’t need to go back to get a negative to either go back to school or to go back to work. That’s not needed,” Chan said.
There are further measures being taken at the state level, including:
- DCYF is focusing on expediting discharges from Hasbro and Bradley Hospital, especially for children who can go home if supportive services can be made available.
- Daily weekday meetings with BHDDH and all hospitals, BH Link and three Community Mental Health Centers with stabilization units to identify openings to place clients.
- Building the infrastructure for Certified Community Behavioral Health Clinics, which officials expect to come online in fiscal year 2024.
- The Health Department’s PediPRN Program is available to pediatric providers to help diagnose, assess, and manage mild to moderate behavioral health issues in children.
- Sharing a Family Behavioral Health Crisis Plan that is available multiple languages, to help all families plan for behavioral health emergencies.
- Launching Mobile Response Stabilization Services, which is a mobile crisis service that can help prevent youth from having to go to or stay at the Emergency Department.
At the press event, state leaders highlighted an online resource for seeking care in the right setting, which has links to lists of primary care providers, urgent care centers, and health centers in Rhode Island, along with guidance on when and when not to go to the emergency room.
In addition to seeking care in the right place, health leaders again promoted the steps everyone can take to stay healthy and out of the hospital for non-behavioral health needs:
- Get your flu shot. Everyone older than six months of age should be vaccinated every year. For information on where to get a flu shot, visit health.ri.gov/flu.
- Be up to date on your COVID-19 vaccinations. For many people, that means getting a booster. For information on how to get vaccinated, visit C19vaccineRI.org.
- Cough or sneeze into your elbow.
- Wash your hands often with soap and water.
- Consistent with recommendations from the CDC, people who are at high risk of getting sick should wear masks when COVID-19 levels are “medium,” and everyone should consider wearing masks in crowded indoor settings when COVID-19 levels are “high.” (COVID-19 levels by county are posted here.)
- Clean and disinfect frequently touched surfaces at home, work, and school.
- Stay home if you are sick.
- Keep children home from daycare or school who have fever, especially with a cough, difficulty breathing or shortness of breath, congestion, runny nose, or sore throat, until they are fever-free for 24 hours without medications that reduce fever. Contact your pediatrician or health care provider if you believe your child needs medical care. Your provider can offer advice on whether your child needs to be evaluated in person, tested for COVID or flu, and the best location (doctor’s office, urgent care, emergency room) for care.
The Health Department also shared resources for staying on top of behavioral health needs, including:
- If you or someone you know is having thoughts of suicide or is experiencing a non-life-threatening mental health or substance use crisis, call 988.
- Contact Kids’ Link RI if it is needed. Kids’ Link RI is a behavioral health triage service and referral network. A program offered in collaboration with Gateway Healthcare, Lifespan, Hasbro Children’s Hospital and Bradley Hospital, Kids’ Link RI is available 24 hours a day, seven days a week to help triage children and youth in need of mental health services and refer them to treatment providers. To contact Kids’ Link RI, call 1-855-543-5465.
- Contact BH Link if it is needed. BH Link’s mission is to ensure all Rhode Islanders, 18 and over, experiencing mental health and substance use crises receive the appropriate services they need as quickly as possible in an environment that supports their recovery. To contact BH Link, call 401-414-LINK (5465).