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ER or UC volumes reduced due to COVID


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Just putting feelers out there for the different regions of the US. I work EM in Northeast Florida in a large volume ER in an urban setting. Normally very busy.  In the last 3 weeks we have never been slower. Director has slashed Doc and APP hours, it's actually looking pretty grim for us. This said, we are seeing COVID every day and all the problems associated with that. I spoke to a few friends of mine at other ERs in this area and they are reporting the same, people are generally staying away.

 

How are things in your neck of the woods concerning overall volume?  

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I don't work there but i spoke extensively with an RN at the level 3 hospital and ED in our county, population ~30,000 in New Mexico, it is very slow. She stated she had only seen 1 patient that day. She described it as "a weird social experiment where you realize you've been running your ass trying to help people and now with the the threat of contracting covid they really take care of most of this stuff themselves".

Our only local covid testing available is at that location. A tent has been set up outside. To give you a gauge, I believe we've only had ~4 positive cases in our county so far. Only 1 covid-19 related death in the whole state thus far. Apparently ~70% of our local population is adhering to social distancing and stay at home policies.

The hospital union filed a complaint against this said medical center for refusing to enter into negotiations in regards to the covid outbreak. The system has been bending and was basically already broken. If and when it does hit, it would/will be very, very messy.

So here it feels like, "The calm before the storm."

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I am a paramedic/firefighter in south florida. We are doing our best to not transport individuals to the ER who really don't need to be there. We always try to do this, however, we are taking a bit of a harder stance now. I'm sure that is one reason why the volume of patients is decreasing. 

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My solo coverage sites have taken a hit, but percentage wise doesn’t seem to be nearly as much as big centers. The local level one has been a ghost town. My census dropped from 8-12 to about 5-8. Same stupid coming in for the same stupid stuff again and again. Can’t take a hint.

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At a local Urgent Care here in Oklahoma. Start my shift at 9am. Here it is 1pm and first patient of the day rolls in. 

We've only had 1 positive coronavirus patient so far here, but I'm with the others who've posted. Seems like the calm before the storm. I thinkost people are avoiding us because they are concerned about exposure. 

I had to make a run for some groceries the other day and NO ONE seemed to understand the concept of social distancing. People literally brushed past me on aisles and even had one guy try to shake my hand. Hello people, it's called a pandemic for a reason!

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CAH in western Indiana: 1st week volume was about 50% of normal.  Now it's about 75--80% of normal.  We have seen many of the trivial complaints decline, but we have enough older and chronically ill patients that our census seems to have a minimum of the 75-80% based on their needs.  Our inpatient unit has 8 rooms.  They had been double occupancy, now they're single occupancy.  When I left on Thursday, all rooms were full, only 1 with a COVID-19 case.  The hospital has stopped all elective procedures, outpatient PT, etc.  Those folks are losing hours - though some are picking up hours at the screening desk where all comers: patients, family, deliveries, fire/EMS/police are screened before they're allowed in the building.

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Thanks, kind of like I thought.

I would be curious to hear from anyone in one of the hot spots: NYC, New Orleans, CT, or the big cities in CA. 

The evening news is showing images of long entrance lines, crowds, and even a bit of chaos. Even in my city they are kind of giving the impression that we are really busy. I'm not implying some sort of conspiracy, just how the imagery doesn't match reality.  

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Family med walk in in Western Washington has dropped, and we've gone to 100% telemedicine visits.  For a 4-7 PM walk-in shift, I'd typically get 10 people, now we're not hardly getting any.  My hours are sort of cut, but not really, as I am picking up more hours for a sick provider at another practice.

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Thanks, kind of like I thought.
I would be curious to hear from anyone in one of the hot spots: NYC, New Orleans, CT, or the big cities in CA. 
The evening news is showing images of long entrance lines, crowds, and even a bit of chaos. Even in my city they are kind of giving the impression that we are really busy. I'm not implying some sort of conspiracy, just how the imagery doesn't match reality.  

CT here; our volume has been way down. Main ED typically had 95-110 patients on the board all winter long during the day; lately it’s been been 30-40. COVID numbers definitely growing, but everyone else has been staying away.


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Central Florida small semi-rural/suburban ER. It’s been weird. Census is/was way down. Yesterday, I was pretty slammed for most of the day, then ghost town. For now, they are scrambling and our shifts are changing rapidly, they are reduced from 12-11 hours right now, but they expect us to leave a bit earlier and reflect that on our times. Some people are afraid, others still coming in for stupid crap. One of my favorite nurses is also a medic on fire/rescue, and they are nearly forcing people without true emergencies to stay away. Typical protocols are out the window and changing rapidly.

Uptick in ortho injuries and lacerations, domestic violence. People are sometimes coming in even sicker than they normally would be due to fear.

I expect it to get crazy and overwhelming here in the next 2-3 weeks. On my way home from work, I see people not taking this seriously at all.

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Some trends I am seeing in NYC: 

1) Folks not taking this seriously and some still goes out living their normal lives/dinning/gatherings
2) As COVID cases increases and mandating to stay home as risk of going to a clinic/hospital catching the infection > your primary complaint (ortho injuries, GI complaints, even chest pain as people are so scared to go into hospital!!)
3) ER/UC volume greatly reduced for a short while with less trauma/cardiac emergencies
4) ER/UC volume will rebound with exceedingly number of patients with COVID symptoms and from there a seed is planted in a given hospital for many more to come..
5) ER/ICU overload with the same COVID patients on vents and now with less PPEs
5) Here we are now

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2 hours ago, kang1208 said:

Some trends I am seeing in NYC: 
3) ER/UC volume greatly reduced for a short while with less trauma/cardiac emergencies

There's the COVID cure!  Heart attacks and trauma prevent COVID cases!  I would be curious to know why out of the blue there would be fewer perceived cardiac cases, not just in your setting but elsewhere, since many are saying that their volume has decreased which by default would include cardiac cases.  Less physical exertion thus less cardiac workload since folks are not at work?  There are so many potential case studies out of this mess.

Unfortunately while listening to the traffic reports this morning, COVID does not appear to decrease traffic accidents, even though there should be fewer vehicles on the roadway.

Edited by GetMeOuttaThisMess
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47 minutes ago, GetMeOuttaThisMess said:

There's the COVID cure!  Heart attacks and trauma prevent COVID cases!  I would be curious to know why out of the blue there would be fewer perceived cardiac cases, not just in your setting but elsewhere, since many are saying that their volume has decreased which by default would include cardiac cases.  Less physical exertion thus less cardiac workload since folks are not at work?  There are so many potential case studies out of this mess.

Unfortunately while listening to the traffic reports this morning, COVID does not appear to decrease traffic accidents, even though there should be fewer vehicles on the roadway.

Perhaps it is a combination of having less physical exertion or workload since people not going to work/working from home and even if they have chest pain they plan to ride it out and not seek care at this time. 

As for the traffic accidents, people are now driving very uninhibited due to the lack of traffic, and that's just stupidity in my opinion. 

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On 3/28/2020 at 11:36 AM, GetMeOuttaThisMess said:

I take this to show what we've known for decades.  What most people consider medical "emergencies" aren't in fact medical emergencies, otherwise they'd still be coming in.

Yep...I find it really interesting.  I'm guessing it'll go back to the normal way of things once all this clears up, despite a more robust telemedicine system.

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Volumes way down. Admissions WAY down. We have closed several of our hospital medicine services, literally 50% patient census. And this after all elective surgeries have been cancelled.

The calm before the shit storm.

Edited by greenmood
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