Scary time for Worcester hospitals: patient numbers soaring in ER presents challenges

WORCESTER — Emergency rooms statewide are bursting at the seams, with record numbers of patients. It's a situation that is creating challenges to provide safe and effective care.

The state of affairs is so bad at Massachusetts General Hospital in Boston that last week hospital officials said overcrowding reached a “full-blown crisis.”

In Worcester, officials aren’t using that choice of words, but one hospital leader said it’s the worst he’s experienced in decades.

That opinion comes from Dr. Eric Dickson, president and CEO at UMass Memorial Health. Dickson has been associated with UMass for 30 years and said overcrowding in the health system’s emergency rooms in Worcester is at a level he’s never seen before.

“The scariest part is we’re managing today, but there is no clear end in sight,” said Dickson.

All-time record at St. Vincent Hospital

Dr. Adam Darnobid, chief of emergency medicine at St. Vincent Hospital, didn’t say the situation falls in the crisis realm. However, he reported the hospital set a one-day record last week in its emergency room when it received 180 patients.

“We’re doing a decent job,” said Darnobid of meeting the challenge. “We’re seeing more patients for sure.”

The increase in respiratory illness cases, including COVID-19, influenza and respiratory syncytial virus, is contributing to higher patient numbers, according to Darnobid.

More to the story

Dickson echoed that development to explain what’s happening at UMass, but it’s not the whole story at the largest health care system in Central Massachusetts.

A shortage of hospital beds isn't the problem, said Dickson. It's a lack of coordination statewide and regionally in how best to manage them.

The primary culprit, said Dickson, is a shortage of staff at skilled nursing facilities, rehabilitation centers and nursing homes. When hospitals are ready to discharge patients to those facilities to receive a lower level of care, they don't have the necessary staff to care for them. As a result, patients are backing up into UMass emergency rooms in Worcester.

"I’ve never seen it this bad, and I have the numbers to show that,” said Dickson.

According to Dickson, the "daily census" at UMass is up 35%, compared to pre-COVID years. What that means, according to Dickson, is the number of patients that occupy beds. Currently, 850 patients are admitted among the two campuses in Worcester, Memorial and University, but there are only 750 beds.

The 100-bed gap means some patients are placed in hallways, some go to the post-anesthesia cardiac unit and others into a “surge area.”

As a last resort, the emergency room is the final stop in the surge area progression, said Dickson. That's when “boarding” happens, when patients are stuck in the emergency room for days or weeks at a time, waiting for a bed to open up.

Overcrowding can turn deadly, because as the only Level 1 Trauma Center in Central Massachusetts, UMass may not have room to admit a patient suffering with critical illness.

"If you can't take patients at that center, it can be the difference between life an death in a time of sensitive illnesses," said Dickson.

'We need to coordinate resources'

The solution, as Dickson sees it, is better coordination of health care resources across the state and region. If one hospital reaches patient capacity, then there needs to be a system to identify where a patient ready for discharge can be sent to receive the appropriate level of care.

“We need to coordinate resources. We’re not doing it now, and it needs to happen,” said Dickson.

Another key, said Dickson, is to increase staffing at lower-level points of care, like skilled nursing facilities, so situations like boarding can be minimized. He believes the state needs to explore ways to send more money to these facilities so they can hire more employees or bring in temporary travel staff. The problem with travel nurses is they are 40% more expensive than full-time staff, according to Dickson.

More than respiratory illnesses

At St. Vincent, where the one-day record was set in the emergency department, Darnobid noted the increase in respiratory illnesses wasn't the only factor. The recent string of frigid weather places the area's underserved populations in a tough spot that required more medical attention. There were also normal situations faced in the ER, like strokes and heart attacks.

Since last week’s record day, Darnobid said the hospital’s ER is averaging a tick above its normal daily average of 150 patients. To meet increased patient demand, St. Vincent staff from other departments can pitch in, said Darnobid. The hospital also has an existing relationship with Reliant Medical Group for patient referrals.

Don't be fooled by numbers

St. Vincent is getting its share of respiratory illness cases, with a total of 200 patients from the start of this year through Thursday. The breakdown includes 105 with flu, 75 with COVID-19 and 20 RSV cases.

Darnobid believes those numbers don't give a true picture of how much illness is in the community, because the level of testing for COVID-19 pales in comparison to the pandemic months.

“The numbers are likely much higher,” he said, and cautioned that people are still getting sick from COVID. The state Department of Public Health's weekly dashboard shows a declining number of COVID infections.

● 112 confirmed COVID-19 cases in Worcester, compared to 156 in last week’s report

● 4,353 confirmed and probable COVID-19 infections statwide, compared to last week’s report of 5,834

● Deaths from COVID-19 dropped statewide: 39 confirmed and probable in this week’s report, compared to 48 last week.

Meanwhile, acute respiratory disease accounts for 13.8% of emergency department visits statewide, according to this week’s state report: 2.4% related to COVID-19, 2% to influenza and .3% to RSV.

Vaccination is the best way to protect oneself against COVID-19, influenza and RSV, said Darnobid: "You have to get the vaccination. It’s incredibly important.”

It might be important, but the vaccination rate for the latest COVID-19 booster is low: 10% in Central Massachusetts and 18% statewide. Dr. Michael Hirsh, Worcester’s medical director, shared those percentages this week with the city’s Board of Health.

Contact Henry Schwan at henry.schwan@telegram.com. Follow him on X: @henrytelegram.

This article originally appeared on Telegram & Gazette: Emergency rooms at Worcester hospitals run record numbers