Pawtucket Times

Healthcare groups ask public to avoid ER unless necessary

- By BILL SEYMOUR Contributi­ng Writer

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.

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 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.

 ?? Photos: Michael Derr ?? A sign warns patients at Thundermis­t Health Center in Wakefield to expect over an hour wait for the facility’s convenient care services on Monday morning.
Photos: Michael Derr A sign warns patients at Thundermis­t Health Center in Wakefield to expect over an hour wait for the facility’s convenient care services on Monday morning.

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