What's your ED like during COVID-19?

[jtpas]

Curious as to what others are experiencing in their departments. While the quarantine is still largely in place, our census in the ED is down significantly, albeit with higher acuity. Patients that do show up are pretty sick. Some staffing changes to accommodate the lower volumes. We have a dedicated COVID zone, secondary/overflow COVID or PUIs, and our usual trauma zone. Our leadership team has done a great job redistributing staff and resources as necessary. Interested to hear from y'all

[ohiovolffemtp]

Rural critical access hospital.  Volumes dropped as low as 1/3 of normal, with only the medium to high acuity coming in.  Some folks calling 1st, including some that by reported symptoms should come in refusing to.  Volumes gradually creeping back towards normal, with the lower acuity gradually returning.  With 1 provider (doc during the day, PA at night) and 2 nurses, we've been pulling the staff from the screening desk to help when we get a bolus of patients.  Seeing about 1 PUI/day.  Expecting that to ramp up some over the next few weeks.  Hospital has done quite a bit of planning for surge, and a little bit of communicating what those plans are.

[DiggySRNA]

Lower volume but higher acuity. The ER is being used appropriately and I like this version. 

Tons of respiratory complaints (and the walky talkies all think they have COVID). We don't swab them in house, we send them to outpatient testing sites.

Patients with BS complaints get treated and street'd from the waiting room. 

Our PCU, ICU, OBS, and stroke floors have become our COVID and PUI floors.

Interesting finding though is that 80% of the chest pains, abd pain, STDs, and "wellness visits" have dramatically gone down. That should change once "the US reopens"......

 

Edited April 18, 2020 by Diggy

[sk732]

Rural ER here and the COVID referral site for our health region...I'm getting a bit creeped out actually by volume, or lack of it, at the moment...though not complaining, since it's a much needed break to be honest. We're starting to see people with things that have evolved over days now instead of minutes, and people with minor complaints are starting to slowly wander back in to see us.  Nursing homes are punting people to us even faster than they usually do.  We're set up with a hot/cold area and a flex zone for expansion and a separate resus area if we get a COVID code blue.  Our surgeons happily come in right now instead of having us hold patients, since they're not doing elective surgeries.  I'm expecting a wave soon, as a lot of people didn't take things too seriously over Easter, so I'm thinking my next rotation is going to start to suck again.

$0.02 Cdn 

SK

[dphy83]

As the hardest hit area and hospital by Covid in our metro area (one that includes a large, tertiary academic center) we are seeing primary respiratory complaints with overall decreased volumes. Average acuity is probably up considering we had a period where we ran out of inpatient vents a couple of weeks ago.

While it has been super nice to keep the nonemergent people out of the ED and having the ED function as it probably was originally envisioned, it is evident that we need all of those non emergent patients to survive. Volumes being down equals revenue being down (doesn't help that elective surgeries are on hold) so shifts and hours are being cut across the board. Forget extra shifts, we are all now working below our contracted hours. I guess the silver lining is that providers in our group are fortunate enough to not be furloughed. But for all of the excitement that comes with working in these hectic times we are getting hit hard where it counts.

Kind of eye opening that my utopian vision of the ED isn't financially sustainable.

[EMEDPA]

All 4 of my rural ER jobs are seeing lower volumes, but since we already work either solo or double coverage there in no talk about decreasing hours. The double coverage job is still too busy for single coverage as it is a retirement community and vacation destination so we still get trauma, strokes, CVAs, etc at nl rates.  I have more hrs this month than usual as they pulled residents from one of the facilities and gave all those shifts to PAs. 

[ohiovolffemtp]

17 hours ago, EMEDPA said:

All 4 of my rural ER jobs are seeing lower volumes, but since we already work either solo or double coverage there in no talk about decreasing hours. 

Exactly why I'm much safer at my current job doing solo overnight coverage at a CAH than my old job at a L3 trauma center working for one of the big 3 staffing co's.  Was a bit of a hard sell to my wife initially because it's out of town, but she's definitely agreeing now.  Plus, given lower patient count and having sufficient PPE, I'm probably safer too.

[EMEDPA]

2 hours ago, ohiovolffemtp said:

Exactly why I'm much safer at my current job doing solo overnight coverage at a CAH than my old job at a L3 trauma center working for one of the big 3 staffing co's.  Was a bit of a hard sell to my wife initially because it's out of town, but she's definitely agreeing now.  Plus, given lower patient count and having sufficient PPE, I'm probably safer too.

Agree- We have no PPE issues, in fact they issue each provider and nurse our own dual canister P-100 respirators. We have 17 open shifts in may and june so I can realistically work as much as I want, and I will probably work a ton. What else is there to do? All my vacation plans, concerts, and planned visits with friends are shot.

[Mayamom]

Are you ER providers wearing PPE for every patient?? Universal precautions??

[EMEDPA]

All of our pts are masked at triage, regardless of complaint. 

mask and gloves for everyone. I already wear glasses.

If ENT/resp issue that seems low risk I add N-95. for high risk covid poster children I wear gown, goggles, surgeon's cap, and dual canister p-100 filter. 

[DogLovingPA]

Our volumes are way down.  Hours being cut 20% and I can't pick up extra in UC, etc as their volumes are down too.   We prepared for a huge surge that (thankfully) never happened.  

[True Anomaly]

I do inner city level 1 trauma center exclusively.  Like many of you, I’ve seen a significant downturn in volume, but that’s starting to rise back up over the past week.  While hours across the board have definitely been cut- I’ve lost 3 shifts this month at least- with the rising volume, I was called yesterday and asked if I could come in for a few hours to help with volume.

We do have a tent outside where all patients other than sick EMS patients are routed through initially- if they “screen in” for COVID which is basically fever/cough/dyspnea/diarrhea/abd pain/vomiting they Stay in the tent, and a PA/NP screens them there with nursing.  Regarding COVID- if they aren’t actually struggling to breathe or have conversational dyspnea or hypoxic, then they’re discharged- we’re not at a point of being able to test the worried well or those with minor sx’s.  The sicker folks get rooms in the ED, and work up proceeds as normal.  

I’ve gone back and forth with how to handle the non emergent patients over this past month.  Due to low volumes, little revenue is being generated of course so I thought when I saw them up front it might be best to let them go to the back, let the docs pick them up and generate RVUs (I work for a group where the docs are purely RVU based and the PAs/NPs are hourly with no production bonus).  But doing so puts them at risk simply by being in the ED of getting COVID, and everyone agrees that while it sucks to not be generating income, from a patient safety perspective if they shouldn’t be in the ER then just discharge them as soon as you can.  So I’ve spent most of my shifts discharging the non emergent stuff from the waiting room or tent.  I’m really not seeing patients in the ED much, other than when I got to work recently and one of the docs had two critical patients who needed central lines so I was asked to do those.

We’re all wearing N95s the entire shift, no matter what type of patient we see.  One of my fellow PAs was able to find P100 respirators which I purchased for both myself and my wife (she’s an ER doc at another hospital), so I wear a P100 for every patient encounter.  For the higher risk patients, I’ll wear a face shield and gown as well.

I don’t mind people coming in for nonemergent stuff- that just comes with the territory, and I never let those folks linger around for too long anyway.  But what is the most frustrating part of this whole ordeal- besides being cut hours of course- is primary care clinics or specialists who are still referring people to the ER for things that truly don’t need to be in the ER.  I’ve gotten used to clinics using the ER as a faster way to get nonemergent testing done, but it still continues during this whole thing, and there is truly no higher risk place to get COVID than the ER.