Wednesday, July 15, 2020

Hospitals in Houston are overloaded Making Doctors hold more COVID-19 patients in Emergency Rooms

Hospital in Houston have been forced to treat hundreds of COVID-19 patients in their emergency rooms sometimes for several hours or multiple days as they scramble to open additional intensive care beds for the wave of seriously ill people streaming through their doors.

At the same time, the region’s 12 busiest hospitals are increasingly telling emergency responders that they cannot safely accept new patients, at a rate nearly three times that of a year ago, according to data reviewed by reporters.

The increase in ambulance diversions, coupled with the spike in patients being held indefinitely in emergency rooms, are the latest indicators that Houston hospitals are straining to keep up with a surge of new coronavirus patients.

A public hospital in Houston has being reported to have ran out of a medication to treat COVID-19 patients and that a spike in at-home deaths from cardiac arrest suggests that the death toll from the coronavirus may be higher than official statistics show.

Since Texas officials have not issued another stay-at-home order to slow the virus’s spread,  people have being hospitalized with COVID-19 in the region, including more than 1,000 in intensive care units, a record since the pandemic began.

Also, hospitals are still seeing a steady flow of patients in need of care as a result of car accidents, violent crime and heat-related medical emergencies.

Houston patients wait in Emergency Rooms for hours, days before being moved to hospital beds.

Officials in Houston are warning that the situation could become a replay of what happened in New York City in March and April, when thousands of people died as hospitals struggled to keep up with the surge of patients, but without the same level of government intervention to stem the tide.

Typically when people arrive at a hospital emergency department, they’re evaluated and treated by the medical staff. Those sick or injured enough to require hospitalization are then moved to other areas of the hospital for specialized care. But increasingly in Houston, particularly for patients suffering from COVID-19, there’s nowhere for them to go.

“Normally that patient would just go to an ICU bed, but because there are no beds available, they continue to board in the emergency room,” said Harris Health System president and CEO Esmaeil Porsa, who oversees the city’s two public safety-net hospitals. “It is not an optimal level of care. This is not something we would choose to do. The only reason this is happening is because we are being forced to do it.”

Although hospital leaders say they are working to provide high-quality care for patients being held in emergency rooms in part by bringing specialized medical staff and equipment to patients being treated there.

Studies done before the coronavirus pandemic show that the longer patients stay in  Emergency Rooms, the worse their outcomes.

Dr. Cedric Dark, an emergency physician at Baylor College of Medicine in Houston said "The problem is you can’t get them to where they need to be, and now it puts the Emergency Room doc in the position of having to function like the hospitalist or the intensive care doctor, and that’s not a role that we’re really supposed to be in.”

A daily status report prepared on Wednesday by the SouthEast Texas Regional Advisory Council, which coordinates the Houston region’s emergency medical response, showed multiple hospitals running out of immediately available nonsurgical ICU beds, including both of the city’s top-tier trauma centers, Ben Taub Hospital and Memorial Hermann’s flagship hospital in the Texas Medical Center.

As of Wednesday afternoon, about 145 patients were being held in emergency departments throughout the Memorial Hermann Health System, according to internal numbers provided separately by a Memorial Hermann physician and confirmed by a hospital executive.

Several other Houston area hospitals have reported holding multiple patients in their   Emergency Rooms, including four with more than a dozen.

Dr. Jamie McCarthy, an executive vice president at Memorial Hermann Health System and an emergency room physician, acknowledged that the coronavirus crisis has forced his teams to hold more patients in Emergency Rooms.

“All the hospitals are full,” McCarthy said. “All the hospitals in the city are boarding patients. We are expanding capacity, but we can’t turn those on immediately. It requires staffing. It requires nurses and doctors to come in.

And so, as we’ve continued to expand our inpatient capacity, we’re just keeping up with the volume that’s coming in.”

It’s not unusual for a small number of patients to be held in  Emergency  Rooms on busy days, especially during flu season, but three Houston ER physicians said they have never seen so many patients receiving prolonged care in emergency departments.

Although treating patients in the Emergency Room for more than a few hours is “not ideal,” McCarthy said, Memorial Hermann has worked to mitigate the impact on patients by sending intensive care doctors and other specialists to emergency departments, to ensure patients are receiving quality care regardless of where they’re located.

“We are adding more capacity, but we are absolutely stretched now, and if it keeps going this way, we’re going to run out of room. We’re going to look like New York,” McCarthy said, emphasizing the need for Houston residents to stay home and avoid crowds to slow the virus’s spread.

One of Houston’s largest hospital systems, HCA Healthcare, also has been caring for dozens of COVID-19 patients in its emergency departments.

In a statement, HCA spokeswoman Debra Burbridge said hospital officials have taken steps to reduce the impact on patients, including sending staff members who would normally be performing or assisting with elective surgeries  which have been suspended under an order by the governor  to treat patients with COVID-19.

Dr. Kusum Mathews, an assistant professor of critical care and emergency medicine at the Icahn School of Medicine at Mount Sinai in New York, said hospitals can take steps to reduce the risks of overcrowded   Emergency Rooms, including some of those described by Memorial Hermann and HCA officials.

Treating patients sickened by the virus “has outstripped every stretch of our imagination,” Mathews said. “We have had to put beds in hallways, double up patient rooms just to allow for offloading the emergency department to get more patients in.”

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While Houston’s top hospital executives have repeatedly said they can add hundreds of new intensive care beds to meet the demand, at least for the next couple of weeks, the number of patients being treated in emergency rooms demonstrates the difficulty of executing those plans in the midst of a rapidly growing crisis, officials say.

The logjam of patients being treated in  Emergency Rooms has also led to delayed emergency response times across the city, according to Houston Fire Department officials.

When hospitals get overloaded, they ask regional authorities to divert ambulances elsewhere.

Earlier coronavirus outbreaks inundated emergency rooms in New York City and Detroit, but lockdown orders in those cities led to fewer car accidents and a reduction in violent crime, freeing more space in Emergency Rooms for COVID patients.

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