Health Care

Rethinking ED waiting rooms in response to COVID-19

Similar to Rush, Henry Ford gets patients who walk to the ED or take public transportation. Its ED volumes have been low, but Deledda said the system will roll out tents in parking lots if needed during the flu season.
Henry Ford set up tents in its parking lots to triage COVID-19 patients during the area’s pandemic peak in March and April. Tents were also used as waiting areas.
The tents were taken down recently as Michigan sees its COVID-19 cases drop, but they are ready to be deployed at any time, Deledda said.
A downside to the tents is the lack of appeal for patients. “Rolling past and seeing the hospital look like a refugee camp doesn’t exactly project a sense of, ‘It’s safe here,’ ” Deledda said.
In addition to using tents at some of its sites, Mount Sinai Health System in New York has added virtual technology to triage ED patients quickly. Similar to other urban hospitals, Mount Sinai gets patients who walk or take public transportation to its EDs.
Rather than a triage nurse assessing a patient, a clinician does it virtually, allowing tests and medications to be ordered before the patient is in a bed and sees the bedside physician, which improves ED throughput and length of stay.
“This changes (the patient’s) experience and maybe even their outcomes, but certainly their turnaround times,” said Dr. Brendan Carr, Mount Sinai’s chair of emergency medicine.
Similarly to other systems across the country, Mount Sinai is seeing lower ED volumes, hovering around 70% to 80% compared with pre-COVID levels. This is largely because COVID-19 cases are down significantly but also because people who can leave the city during summer months usually do and the business district is now much quieter, Carr said. Even so, he said, Mount Sinai is always prepared for a surge of cases.
Henry Ford leaders are thinking about how to handle a potential patient surge during flu season as well. A challenge will be the ability to quickly distinguish COVID-19 patients from those with flu so they aren’t mistakenly grouped together. The symptoms of both viruses are fairly similar. To combat that, Henry Ford would like to be able to rapidly test patients for both COVID-19 and the flu accurately. Right now, Henry Ford can test a patient for COVID-19 and get the results back within two hours.
“We have to be pretty spot-on when it comes to diagnosis before we think about (grouping) patients,” Deledda said. “We are going to have to concentrate on isolation practices.”
Health system leaders are hopeful that ED volumes won’t return to overcrowding levels thanks to the increased use of telehealth. About 4% of ED visits are considered non-urgent, according to the most recent data from the Centers for Disease Control and Prevention, but there is also research suggesting about 30% of ED visits from chronically ill patients are unnecessary, leading to $8.3 billion in additional costs for the industry.
Perhaps fewer people will view the ED as their first option, Casey said, because now “people have realized they want more on-demand care.”

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