PROVIDENCE, R.I. (WPRI) – The owner of Rhode Island’s largest hospital says the surge of patients they’ve experienced in the wake of Memorial Hospital’s closure is “among the most pressing challenges facing our hospitals.”
Lifespan spokesman David Levesque said both Rhode Island Hospital and The Miriam have seen a dramatic increase in patient volume in the last year. The emergency department at Pawtucket’s Memorial Hospital was ordered to stop accepting patients late last year, and was permanently closed on Jan. 1.
Levesque made the comments after Eyewitness News analyzed five years of R.I. Department of Health data that reveal hospital diversions – when hospitals say they can’t accept all incoming ambulances – have drastically increased in 2018.
The data shows the total number of diversions at the state’s hospitals ballooned from 44 in 2014 to 322 by late last month. Total hours on diversion are also up, from 206 hours in 2014 to 1,343 so far this year – the equivalent of nearly 56 days. Diversions are also up from 2017, when the state’s hospitals diverted a combined 168 times for a total of 914 hours.
Hospitals go on diversion for a myriad of reasons, from overcrowding to equipment issues, but only certain patients are sent to other hospitals for care. Department of Health spokesperson Joseph Wendelken said those in critical need of care are never diverted.
“Someone who is in labor or someone who has an obstructed airway, for example – that patient will always get transported to the nearest hospital,” Wendelken explained. “Ultimately it’s a system to make sure that patients are getting care as quickly as possible.”
Wendelken said walk-ins and those driven to the hospital by a loved one would still be admitted when a hospital is on diversion, but certain patients being transported by emergency medical services (EMS) would be sent elsewhere.
There are also rules in place to ensure that multiple hospitals aren’t on diversion at the same time: in the northern part of the state, if three hospitals go on diversion at the same time, they’re all forced to open. The same is true if two hospitals go on diversion in the southern region of the state.
The data logged by the department shows Providence hospitals have seen the largest change in diversion numbers. Roger Williams Medical Center had five diversions last year, but 48 so far this year. Rhode Island Hospital had 21 in 2017 but 56 in 2018; The Miriam had 34 diversions in 2017 but 83 in 2018.
Providence Public Safety Commissioner Stephen Pare said the city’s EMS has been working with local emergency departments to ensure patients get timely care.
“Since Memorial Hospital closed, the demand on Miriam and RIH has caused some stress on the system,” Pare said in an email to Eyewitness News. “Our EMS work within the system and will bring critical patients to the appropriate emergency department.”
In addition to the number of diversions, the overall time hospitals spent diverting patients has also grown. Miriam’s total time on diversion so far this year is about 323 hours, compared to last year’s total of 172. Roger Williams went on diversion for six hours in 2017; this year it’s been on diversion for 244 hours.
It’s a trend that Linda McDonald, president of the United Nurses and Allied Professionals (UNAP) union, pins on the closure of Memorial Hospital.
“I absolutely think that Memorial closing has had an impact in the amount of diversions and the amount of patients that we’re seeing at some of the local Providence hospitals,” she said.
Wendelken said Memorial’s closure is likely impacting hospitals like Rhode Island and The Miriam, but he said other factors are contributing to the spike being seen statewide. South County Hospital in Wakefield, for example, had 23 diversions in 2017 and 42 this year. Kent Hospital in Warwick had nine diversions last year and 40 this year.
“We don’t see any clear patterns that point to any one specific cause,” he said. “One thing that we are seeing across the entire system, however, is an increased need for behavioral health care.”
Wendelken said about 15% of ER visits are related to behavioral issues like mental illness and substance use. He said the Department of Health has implemented a new census system to track patient volume and vacancies at both emergency departments and behavioral health centers.
“Using those number we’re going to be making sure that people are getting care in the most appropriate setting,” he said.
The Chief of Emergency Medicine at South County Hospital, Dr. Bill Sabina, said his facility has seen higher numbers of behavioral health patients, but also pointed to a trickle-down effect from other hospitals diverting, particularly those in Providence that have been impacted by Memorial.
McDonald, whose union has pushed for legislation that would cap the number of patients each nurse could care for at a given time, points to staffing as another issue.
“The issue is really how do we have enough staff and enough capacity that when these high-volume times come, that we have the capacity to take care of the patients in Rhode Island as they deserve,” she said.
Levesque countered that the decision to request EMS diversions is based on availability of patient beds, not staffing levels.
“We have made significant investments to expand the physical space of our emergency departments, add staff and equipment, and further streamline processes,” he said. “Our clinical and operational experts are working with frontline staff on both short- and long-term solutions specific to immediate patient volume issues.”