A rise in patients awaiting long-term care beds is crowding Vermont’s ERs - vtdigger.org
On Friday, the University of Vermont Medical Center in Burlington issued a warning to Vermonters: Don't visit our emergency department if you can avoid it.
Instead, it advised people with relatively minor issues to seek treatment at doctor's offices or urgent care centers rather than visit the hospital's overcrowded emergency room.
Stephen Leffler, president of the medical center, said the overcrowding was caused by a "perfect storm" of several health care trends condensed into a single day: More than 100 patients sought care on Friday, but the facility had only 53 staffed beds.
"It's back to normal-busy now and we're managing OK, but Friday was particularly stressful and difficult," he said on Tuesday.
The challenges are not over. Leffler and other hospital officials across the state said they've faced a longer trend of overcrowding in emergency departments — and even inpatient care generally — in recent months, on top of the strain hospitals have experienced since the beginning of the Covid-19 pandemic in early 2020.
State statistics back that up. Data from the Agency of Human Services shows that the total number of open intensive care and medical/surgical beds statewide has declined in the past week, down to only 45 beds for the week of Oct. 10, compared to between 60 and 70 through most of the summer.
The agency data also illustrates one of the reasons for the squeeze: The number of patients in hospitals who are waiting to be discharged to subacute beds, such as long-term care or rehab centers, has increased, meaning that there are fewer beds for new patients coming in.
There are also about 32 patients each week seeking mental health treatment that can't get into an inpatient psychiatric facility, according to the agency data.
Anywhere from 20% to 35% of inpatient beds statewide are occupied by patients who need a lower level of care, said Devon Green, vice president of government relations at the Vermont Association of Hospitals and Health Systems, a trade organization for hospitals.
"They no longer need to be hospitalized, but they can't be sent home, and we are having difficulty placing those patients," she said.
Like hospitals, long-term care facilities have struggled to hire and retain nursing staff during the pandemic. For example, last week, UVM Home Health and Hospice ended 24/7 medical care for its residents due to staffing problems.
Ryan Sexton, an emergency medicine physician at Northeastern Vermont Regional Hospital in St. Johnsbury, said he's also recently observed that patients seeking emergency care have a "higher acuity" of care, meaning that people are coming in with more severe illness due to delaying preventive care during the pandemic.
Sexton said the regional system is so overwhelmed some days that smaller, nearby emergency departments can't accept more critically ill patients, like trauma patients or those who have suffered heart attacks.
Instead, those patients are sent as far away as coastal New Hampshire, forcing ambulance crews to travel hours out of their way and inconveniencing patients and their families.
"When you have to take a local ambulance and transfer a patient not an hour away but three hours away … that really impacts your EMS response and the ability to provide 911 response to a community," Sexton said.
Patients visiting the St. Johnsbury emergency department also must wait longer to get admitted, since the patients already in the ER are waiting for an inpatient bed, he said.
Leffler said UVM Medical Center, a "tertiary care" hospital that accepts more complicated medical cases, has been taking patients from outside its normal area because so many other tertiary care hospitals are filling up.
"We are doing our very best to accept everyone we possibly can," he said. "But when our ER is completely full, that also is more difficult. We still always take people with acute emergencies, like traumas or heart attacks or strokes, but it may make us delay taking someone with a less urgent problem."
He said that people with serious medical issues should still go to the emergency department, but those with minor medical issues should start by calling their primary care doctor or a local urgent care center. The medical center has a checklist to help people decide where to start.
The Vermont Department of Health has also reported a rise in Covid hospitalizations in the past few weeks. Sexton said he has further seen a rise in all respiratory diseases, as Vermonters take off their masks and return to normal activities.
Leffler said the hospital has noticed an uptick in Covid patients, but he doesn't believe it's driving the current issue. About half of the medical center's patients with Covid are visiting the hospital for different reasons and test positive while they're there.
UVM Medical Center is working with other facilities to try to improve mental health access and long-term care availability, Leffler said. "We have to make sure we have an adequate workforce," he said.
Green said the hospital association was hoping for legislators to work on therapeutic alternatives to mental health facilities and to support mobile mental health crisis teams. It also opposed a federal government proposal to cut reimbursement for home health services, which Green said would "compound" the problem.
Legislators are aware of the issue, she said. "It's just, it's a very large and intractable problem in a variety of sectors of the health care system."
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