Emergency Department Demands Amidst COVID
Although emergency department visits have been steadily increasing over the past decade (HCUP), COVID-19 has caused a sudden and significant overall drop in ED patient volume, by 42%, according to the CDC.
But not in COVID hotspots. They’ve been inundated. And emergency medicine providers on the frontlines may not get relief any time soon, especially with the impending threat of flu season.
Unfortunately, we cannot predict where the next cluster of cases will emerge, and this uneven distribution of demand for emergency medicine services has put added pressure on health leaders.
Understanding the Drop in Emergency Department Visits Outside of COVID Hot Spots
With emergency department cases cut by nearly half during the early months of COVID, where have all the patients gone? Several theories for the decline in visits have been proposed, among them (JAMA):
- COVID-19 precautions curbed transmission of other infections. Measures such as hand washing, face masks, social distancing, decontamination, and closures cut down on the spread of infectious diseases.
- People stayed home, resulting in less vehicular traffic, and fewer collisions and injuries.
- Hospitals, surgical centers, and physician offices put a hold on procedures, surgeries, and tests, reducing the numbers of emergency department visits due to sepsis, pain, nausea, etc.
- Facilities offered virtual healthcare, deferring less urgent patient encounters to reduce patient risk of exposure to COVID-19.
- Patients who have historically relied on emergency departments for issues such as sprains, back pain, respiratory infections, or other self-limited conditions stayed home to avoid exposure to COVID.
- People avoided emergency visits to stay out of the way, assuming the ED was being repurposed only for COVID treatment.
- People who lost health insurance during the spike in unemployment avoided emergency treatment for financial reasons.
Anticipating Emergency Department Needs in COVID Hot Spots
Emergency medicine providers are stretched thin in COVID outbreak zones. What are some of the sudden demands in these hot spots? Emergency department providers and leaders at a New York facility in the midst of the COVID crisis faced the following challenges and implemented significant changes with no time to spare (NEJM):
- Staff experienced a sudden drop in patients, but with much higher acuity.
- Facility had to double the ICU capacity, using their PACU, outpatient surgery sites, and other locations.
- Leadership redeployed physicians and advanced practice providers from other departments to the ED to help.
- Many members of the medical staff felt trepidation, having never worked in an outbreak setting (or emergency department for those redeployed) before.
- Providers requested and received additional training and preparation.
- Virtual health services increased exponentially, including an urgent care platform and post-discharge follow-up telemedicine visits.
Further, according to JAMA, providers on the frontlines report concerns about:
- Caring for increasing numbers of acutely ill patients who can deteriorate rapidly
- Worrying about their team members who may become critically ill or die from COVID-19
- Fearing they will catch the virus themselves or transmit it to their family members
- Having enough ventilators and crucial medical equipment for their patients
- Having adequate access to personal protective equipment
- Working in unfamiliar clinical roles
- Taking on increasing workloads
- Having access to mental health services for anxiety, depression, and distress
What Emergency Department Providers Say About Preparing for COVID
We recently surveyed emergency medicine professionals who have been on the frontlines of COVID to gain insight into what they believe facilities can learn from the outbreak. Here are some of their suggestions:
Dealing with the Uneven Distribution of Demand
Emergency departments look vastly different all across the nation at this time. If anything, the only similarity is that they’re operating at the extremes, from desert to battle zone. So how can leaders be prepared to make rapid, strategic decisions so their emergency departments are appropriately staffed in any situation?
The locum tenens arrangement was made for situations like these. Partnering with an experienced, trusted locums staffing agency can provide leaders with rapid solutions for emergency department talent needs.
- Locums emergency medicine providers can be hired quickly and easily
- Locums commitments are designed for the short-term and can be renewed as needed
- A trusted locums agency will ensure providers are fully vetted, credentialed, experienced, and qualified
- Locums doctors and APPs are accustomed to working flexible hours and schedules
- Electronic health records and virtual healthcare platforms come easily for locums providers, many of whom are digital natives or are otherwise used to learning new systems
We’re Here to Help
With forethought and strategic planning, emergency medicine leaders can be fully prepared to face whatever this pandemic brings.