Crowded Emergency Departments & Staffing Crisis in Healthcare
In the United States, the Emergency Department's reputation and rank is the infamous canary in the coal mine, as it is a picture of not just one distinct ED or hospital group, but of an overall health system bursting at the seams.4
Jam-packed ED’s are an extensive challenge and a potential cause of patient injury.
Before the Covid-19 pandemic, emergency department (ED) appointments had grown greater than 60% since 1997 to ~146 million,1 with ~46 visits per 100 people in 2016.
The ED tally has not come back to earlier quantities following a noteworthy shrinkage in patient numbers through the initial Covid-19 pandemic wave.2
The pandemic has strengthened elements connected with over-cramming and amplified ED overall wait times for patients.3
DISCLAIMER: Dr. Dalawari shares interesting and relevant medical-legal news in the press. He also shares case verdicts & settlements from the public record. He has no professional or personal relationship to the cases.
Emergency Department, Medical Malpractice, Great Resignation, Physicians, Healthcare Workers, Overcrowding, Staffing Shortages, Covid-19 Pandemic, Stress, Burnout, Wait Times.
At a glance
In the United States, ED reputation and rank is the infamous canary in the coal mine, as it is a picture of not just one distinct ED or hospital group, but of an overall health system bursting at the seams.4
Discussion: (use sub-titles for these bullet points)
- Emergency Department Overcrowding
- Resignation, Retirement & Transfers
- Increasing Competition and Turnover
- The Impact on Patient Access to Care
- The Impact on Patient Safety and Quality
- The Final Word for a Dire Situation
Conclusion: The current trend is not viable for any healthcare group. The fiscal strain is only one component impacting the overcrowding of the Emergency Departments and chronic staffing shortages. Physician groups and hospital administrators must deal with the potential and real threat of increased medical malpractice suits brought against them by patients who may have been adversely impacted by these developments.
Staff Resignation, Retirement & Transfers
Another trend is the resignation, retirement, and transferring of health care workers out of the current medical system in the United States due to burnout, stress, motivation, family & personal reasons, fear of infection, and lifestyle choices.
The U.S. Bureau of Statistics states that ~4.3 million Americans, or 2.9% of the labor force, left their occupations in August 2021.5 Approximately 1 in 5 healthcare personnel have resigned since February 2020, with 31% of the remaining workers having deliberated quitting.5
Close to 80% of medical workplaces have been impacted by the country-wide healthcare personnel exit.5 Healthcare organizations are remunerating ~$24 billion more annually for medical staff costs when compared to costs prior to the Covid-19 pandemic.5
Emergency Department Overcrowding
A challenge with congestion in ED’s commences when a patient initially arrives and usually lingers countless hours to visit a healthcare practitioner. Then the patient can be returned to the ED while an exam area is rendered accessible for a medical assessment. The wait continues for a physician while the patient potentially arrived with a grave medical quandary necessitating pressing consideration. The lengthy waiting time may trigger a health dilemma which may intensify into a situation more critical for the patient.6
Overcrowding in ED’s causes physicians and nurses to hop from patient to the next in order to stay even with the need and response. This scenario initiates the health care personnel to become more frazzled, exhausted, and careless which can lead to a higher chance of medical neglect. Some potential harmful situations which may occur encompass not detecting a patient’s health status, failure to establish a medical condition, advising or managing the incorrect prescription, or harming the patient throughout a surgical procedure.6 ED medical malpractice patterns affiliated with overcrowding incorporate:6
• “Surgical errors.”
• “Patients who are left waiting too long while their medical conditions worsen.”
• “Failure of the medical staff to diagnose the medical condition of the patient.”
• “Misdiagnosis of the medical condition of the patient.”
• “Doctors or nurses causing medical errors.”
The Great Resignation
The resignation of healthcare workers across the United States could be considered an epidemic in the pandemic. Some may call it an epidemic due to the unpredictable pattern being exhibited by healthcare professionals.
The closing of businesses, massive layoffs, the shifting of work to online, and the unavailability of family support (i.e. child care) have exacerbated the Covid-19 situation for the economy and the people who work in the medical industry.
In a recent survey, hospitals described that augmented time periods and obligations, along with other tensions instigated by the COVID-19 pandemic, has caused the medical workforce in being mentally drained, and on occasion suffering post-traumatic stress disorder.7
Health administrators stated that in 2020, medical personnel have laboured with more and extended shifts, accompanied with compulsory overtime. Moreover, a few have conveyed that tending to seriously unwell patients caused additional stress on staff who felt ill prepared, while juggling numerous medical and managerial duties to spread out the workload among the staff.7
Medical facilities surveyed in early 2021, testified that they were undergoing elevated attrition among hospital workers, giving rise to chronic recruitment difficulties. 38 hospitals reported that they were staring at a precarious employment shortages in early 2021, and the staff resignation rate was remarkably excessive among nurses. One large medical facility serving marginalized populations in Texas, stated its yearly average for the nurse hiring and firing rate, compounded from 2% in 2019, to a whopping 20% in the first year of the Covid-19 pandemic.7
The same survey polled hospitals administrators who stated a proliferation of a demand for nurses and other health professionals. Several health facilities recounted that staffing agencies were offering very high hourly rates of pay, so the salaries needed to attract health care workers for regular full-time employment was skyrocketing.7
One CEO conveyed, “The cost [for agency nurses] has gone from $60–$70 to $200 per hour now. To get them in here to help has become an impossibility.”7 These price increases have resulted in fiscal strain on hospitals for increased staffing costs, as well as covering the additional costs of testing and treating Covid-19 patients who may not have insurance or who have maxed out their health coverage.
The Impact on Patient Access to Care
Some patients are getting short-changed and suboptimal care during the Covid-19 pandemic crisis. Across many U.S. states, the volume of patients has engulfed hospitals, principally during waves of high infection rates of COVID-19. This brought about a dangerous trend where a patient’s health condition could deteriorate beyond acceptable wait times for access to care.
This may be especially true for cardiac and oncology patients where time waiting for surgery can make a huge difference in patient outcomes. Patients impacted by these delays should seek the help of a patient advocate or legal team to investigate the possibility of a medical malpractice lawsuit or a mediated resolution. There are licensed physicians who work in the frontlines of medical care, who are highly trained and can testify as expert witnesses in a court of law.
Between Feb 22-26, 2021, a healthcare survey revealed that 40 responding hospitals had over 90% inpatient occupancy, and 56 hospitals had over 90% of their ICU beds in use.7 One large city hospital, reported that “it would do only urgent surgeries and discharged patients to their homes for recovery because of a shortage of recovery areas in the hospital.”7
The downstream effects resulted in bottlenecks throughout emergency departments and inpatient units. For example, one medical facility reported, “that 13 of its 17 emergency treatment rooms were occupied by COVID-19 patients waiting to be admitted to the hospital.”7
The Impact on Patient Safety & Quality of Care
Several hospitals had to defer or cancel elective surgeries at numerous stages throughout the pandemic to retain the human and equipment capacity caused by COVID-19 waves of infection.7
One administrator, “attributed some emergency room deaths at their hospital to patients not following up on their prior care needs.”7
They also forecast, “that such widespread delayed care would result in higher hospitalization rates and a need for more complex hospital care in the future.”7
This scenario contributed to patients foregoing standard assessments and diagnostic testing, such as cancer screenings and cardiology tests, which may have brought about life-threatening disease going unrevealed.
A hospital executive described, “finding a sharp decline in cancer diagnoses during the pandemic, and that patients were not presenting for examination at the onset of symptoms.”7
Some patients could have a fear of getting infected with Covid-19 at a hospital, so they may choose to ignore their health changes, and wait it out at home not getting diagnosed or treated.
The quality of care has suffered as a consequence of exhausted and exiting physicians, nursing, and paramedical staff.
Many hospital managers in the Health and Human Services Office survey narrated, “that staffing shortages have forced them to assign substantially more patients per staff, …to cut its staff-to-patient ratio in half for some periods during the pandemic, to 1-to-12 from 1-to-6.”7
Diminished staff-to-patient ratios can bring about errors when less care is committed to each person suffering from a Covid-19 infection or related symptoms.
The Final Word for a Dire Situation
The healthcare workers over the past two years have been bullied by protesters, left mourning over the death of a family member or friend, or acquired the Covid-19 virus through transmission at work or home.
These reasons are not simple and should not be overlooked, but are often complex and impact a healthcare worker and perhaps their family.
The impact on healthcare workers could be financial, mental, physical, spiritual, or legal. The legal ramifications not only affect the medical workers but also the patients they serve in their duties as professionals.
The current trend is not viable for any healthcare group. The fiscal strain is only one component impacting the overcrowding of the Emergency Departments and chronic staffing shortages.
Physician groups and hospital administrators must deal with the potential and real threat of increased medical malpractice suits brought against them by patients who may have been adversely impacted by these developments.
No one can predict when the Covid-19 pandemic will end or if the great resignation will continue until the end of 2022 and into 2023.
The lessons learned from the Covid-19 pandemic will be studied by population health units, legal teams, and government officials for years to come.
The mental health dimension is another arena that has been vastly underreported with increased suicide rates, elevated depression rates, and a crisis an opioid addictions leading to overdose deaths.
DISCLAIMER:Dr. Dalawari shares interesting and relevant medical-legal news in the press. He also shares case verdicts & settlements from the public record. He has no professional or personal relationship to the cases.
References - Sub-Title (h3)
1. Centers for Disease Control and Prevention. National hospital ambulatory medical care survey: 2016 emergency department summary tables. https://www.cdc.gov/nchs/data/nhamcs/web_tables/2016_ed_web_tables.pdf. Accessed January 9, 2022.
2. National Syndromic Surveillance Program Community of Practice. Impact of the COVID-19 pandemic on emergency department visits - United States, January 1, 2019-May 30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69:699-704
3. Lucero A, Sokol K, Hyun J, Pan L, Labha J, Donn E, Kahwaji C, Miller G. Worsening of emergency department length of stay during the COVID-19 pandemic. J Am Coll Emerg Physicians Open. 2021 Jun 22;2(3):e12489. http://doi.org/10.1002/emp2.12489
4. Kelen GD, Wolfe R, D’Onofrio G, Mills AM, Diercks D, Stern SA, Wadman MC, Sokolove PE. Emergency department crowding: the canary in the health care system. NEJM Catalyst website. https://catalyst.nejm.org/doi/full/10.1056/CAT.21.0217
5. Finis N. Reversing the great resignation of 2021: insights for healthcare leaders. Kronos website. https://www.kronos.com/blogs/industry-insights/reversing-great-resignation-2021-insights-healthcare-leaders. Published November 10, 2021.
6. Fagel, BG. Overcrowded emergency departments leading to hospital malpractice and doctoral malpractice. HG.org. https://www.hg.org/legal-articles/overcrowded-emergency-departments-leading-to-hospital-malpractice-and-doctoral-malpractice-28845. Accessed January 9, 2022.
7. U.S. Department of Health and Human Services Office of Inspector General. Hospitals reported that the COVID-19 pandemic has significantly strained health care delivery results of a national pulse survey february 22–26, 2021. https://oig.hhs.gov/oei/reports/OEI-09-21-00140.pdf. Accessed January 19, 2022.