One Valley doctor says she’s never seen the ER so busy
Download mp3 (11.88 MB)Emergency rooms were often overwhelmed during the pandemic. As the case numbers of COVID-19 surged in our community, more people would crowd ERs seeking care.
But now, one Valley emergency medicine doctor says she’s never seen her department so busy. We are in the height of respiratory virus season but, she says, there’s more leading to the uptick than that.
Dr. Kara Geren is with Valleywise Health’s hospital — the county’s safety net hospital — and she joined The Show to talk more about it.
LAUREN GILGER: Good morning, Dr. Geren.
DR. KARA GEREN: Good morning Lauren. Thank you for having me.
GILGER: Thank you for coming on. So begin with what you're seeing right now you're seeing, you know, you say the busiest it's ever been in the emergency department there.
GEREN: Yeah, by what I mean is we have more patients in the emergency department than I've ever seen. I've been at Valleywise for 13 years and for that time, have practiced almost exclusively at Valleywise. So that's where my experience comes from. But the sheer quantity of patients in the emergency department, it's nothing I've ever seen before. And there's a lot of reasons for that and I'm happy to go into that.
GILGER: Yeah. So I mean, busier than you saw during the pandemic is quite something, I mean, tell us what could be behind this obviously respiratory virus season is something. Is that contributing?
GEREN: Absolutely. It is definitely contributing. There's a lot, lot and lot of influenza A going around. There's some COVID going around and although not nearly as much of RSV going around, there is still some of that as well, but it's much more multifactorial than that. A lot of the patients coming in with respiratory illnesses right now are discharged in comparison. All of this, in comparison to COVID. When we were at the height of COVID, there were a large number of patients, but the big difference was the patients we had were much sicker. I wouldn't say that that's what we're seeing right now. I think it's more the sheer quantity of patients that we're seeing. So you're right, certainly respiratory illnesses. But part of our struggles at Valleywise specifically, and I can't speak to other hospitals but I know other hospitals experiences as well in the Valley, is boarding of patients in the emergency department. And what I mean by that, but what I mean by that, it's kind of a holding pattern. So we've determined a patient needs to come into the hospital, they need to be admitted to the hospital, but there is simply not an inpatient bed for them or they need to go to another facility for whatever reason, whether it's specialty care or that's where their care has been has occurred and past and they need that specific doctor or care. So they need to be transferred to another facility. And rather than receiving inpatient care in the appropriate location, they are instead in the emergency department. And this has been a problem for many, many years. We are just very lucky at Valleywise that it has not been as bad of a problem until it is now. I'll give you an example of the other day. We technically have 31 or 32 areas that are curtained off with stretchers and we had more than that more like 33 or 34 patients awaiting in patient beds.
GILGER: Wow. So this is patients laying on gurneys basically in corridors and hallways, things like that.
GEREN: Yeah, so these are patients that are in a specific bed. We try and make people who are boarding in the emergency department as comfortable as possible. They are getting the care they need as an inpatient, but they are physically in the emergency department. So we put them in hospital beds and they are getting the routine medications and they're getting the same treatment they would receive in an inpatient bed. But physically in the emergency department. And if you have all these people waiting, that really limits where you can see emergency department patients. So we're seeing patients in the hallway, we're seeing patients in chairs, patients who are uncomfortable and here for emergency care are getting a lot of their care in chairs because we simply do not have a lot of room.
GILGER: Wow. So, I mean, what are the outcomes like for patients then? I can't imagine it's better. I mean, is this a problem when it comes to patient care?
GEREN: Yes, it's a huge problem for patient care. Studies are mixed but we do believe that there is at least an association between increased short term mortality and boarding in the emergency department. There are so many factors that go into that. There's at least an association and many studies show that there's probably stronger than just an association and in terms of patient care, you know, I unfortunately, like many things you have to be flexible. So I was sitting in an area where I normally don't sit in order to try and help patient care the other day, and I overheard a patient complain that it took them three hours to get Tylenol and I very much empathize with that patient. But I also got very frustrated at that statement because I'm, you know, we are trying the best we can. But this is a broken system, not our health care system, like not Valleywise, the entire system is broken. This is a nationwide problem that is multifactorial. Our American College of Emergency Medicine Physicians group, which is the national group had a meeting in September of 2023 and came up with a list of causes or, or contributing factors and what could be done about it. So, we are just a microcosm of the big problem.
GILGER: Talk a little bit about the root of that problem in the health care system in general. Like what's causing the backup? Is this a ripple effect?
GEREN: Yes, absolutely it is a ripple effect. There's a lot of them that I don't understand as a physician, you know, in terms of payment, transparency, you get paid for certain things but not other certain things. So there's a lot of that, that I don't understand, but I can tell you on a kind of what has been identified and that what I see on a regular basis, I would say are probably four big things. One is mental health, there's not a lot of outpatient resources. So people seek emergency care also, as medicine has become more complicated, psychiatric patients don't just have psychiatric problems. They also have complicated medical problems and our system is not built to be able to deal with that. We have lots of operational barriers getting patients discharged. For instance, if they need a skilled nursing facility or a long-term care facility and those are full or their insurance has not said that that's acceptable for them to go to. That takes time. There's a huge workforce problem. As we know, people are leaving health care, physicians, nurses, staff techs, radiology techs, they're leaving health care in droves after COVID during COVID and after COVID. There's a lot of, a lot of reasons for that, overworked, the staffing ratios are going up. The amount of violence and verbal abuse in the emergency department is something that we have never seen before. I have multiple colleagues that are out because of injuries caused by patients. It's only getting worse and social determinants of health. For instance, in my microcosm yesterday, I had a patient who did not have a home and did not want to leave the emergency department because it was warm and cozy and they were had food. And it was not a good feeling to say, I'm sorry, you have to leave. We need this spot for someone else.
GILGER: Yeah, man. What's the effect on your own work? Your staff? I mean, this must be taxing.
GEREN: It's exhausting. It's as I mentioned, you know, just hearing someone we're doing the best we can and to hear someone complain is sad and we, we try our best. We empathize, but it's also frustrating because we're doing the best we can. The good thing is since COVID, I think systems have realized they have to be aggressive about it. I know that nursing staff is getting paid more than they used to. So that's great. But long term, that's not a good solution. We know that there's gonna be we're gonna have a shortage of millions of nurses. We know that that's an issue all the way down to nursing, admissions and nursing colleges.
GILGER: Unfortunately, we'll have to leave it there. That is Dr. Kara Geren, Emergency medicine doctor with Valleywise Health joining us. Dr. Geren, thank you so much for coming on and for your insights here. I really appreciate you taking the time.
GEREN: Thank you so much for letting me talk about what's going on.
