Avoiding the Emergency Room? Waiting Could be Worse

Emergency medicine staff member wearing a mask and blue scrubs talking to a patient.

Posted April 9, 2021

University of Vermont Health Network providers and health systems across the United States have documented a concerning trend throughout the COVID-19 pandemic: Emergency Department (ED) visits are down.

According to the Centers for Disease Control and Prevention (CDC) emergency department visits declined 42 percent during the COVID pandemic, with the steepest declines in the Northeast. It’s not because people are healthier; in fact, patients are presenting with more serious conditions when they do come in. The conclusion? People are delaying the care they need.

“There is nothing more upsetting to an emergency provider than a devastating diagnosis for a patient who delayed their care out of fear of seeking care,” says Amanda Young, MD, medical director of hospital-based services and emergency medicine at UVM Health Network - Porter Medical Center. Over the past year, she has seen patients with advanced heart damage because they delayed coming in for a heart attack, bowel infections that have invaded the bloodstream and even an infected ingrown toenail that put the toe in jeopardy of amputation.

“More recently, I have seen two delayed cancer diagnoses for patients who were hesitant about investigating their symptoms, but time can make a difference,” Dr. Young says.

At UVM Health Network - Elizabethtown Community Hospital, the emergency department is finding the same reluctance from patients in need of care, says David W. Clauss, MD, head of the ED at Elizabethtown Community Hospital and its Ticonderoga Campus. He adds that experience has shown hospitals are safe.

“We were very concerned about community health, so we put processes in place to minimize potential risk of COVID-19 exposure. We now have the benefit of knowing that those infection control measures were, and are, effective in preventing the spread of COVID-19 infection within the healthcare setting,” says Dr. Clauss. “Any very small remaining risk is far outweighed by the risk of harm from delaying care for acute medical conditions.”

A recent study at Brigham and Women’s Hospital confirmed that the transmission of COVID-19 within health care settings was low due to infection control measures; it will likely become even lower in the months ahead.

“Now that healthcare workers have added a high rate of vaccination to ongoing infection control measures, I’m confident these events will be extremely rare going forward,” Dr. Clauss adds.

Alicia Guilford says she was “a little cautious” about going to the ED at the University of Vermont Medical Center when her 80-year-old father’s lung condition flared. Because he needed her assistance, she was permitted to accompany him.

“Once we got to the ED, it was clear they were doing what they needed to do to protect themselves and their patients,” says Guilford.

Infection prevention measures at the Medical Center include a re-configuration of the physical space: new respiratory triage rooms and a separate waiting area for patients with COVID symptoms have been created to separate patients and two new negative pressure wards were constructed specifically to accommodate COVID patients.

“This made us feel a lot better about going and made the subsequent trips less concerning,” adds Guilford. In the end, it was much better to have gone in to seek care than to suffer at home not knowing when he might find relief.”


Infection Prevention Measures

Emergency departments and urgent care facilities across the network are continuing with the following practices to keep patients, visitors and staff safe from infection:

  • All employees arriving for work are screened with health questions and a temperature check. Any employees that screen positively are sent home.
  • All arriving patients and visitors are screened at the front desk.
  • All employees are required to wear masks, including the front desk staff that perform patient screening upon arrival.
  • All patients and visitors are required to wear masks.
  • Scrubs are required for all employees to minimize infection transfer. Employees change into scrubs when they arrive at work and leave them for launder at the hospital.
  • All employees working with COVID-19 patients wear personal protective equipment.
  • Many front desk staff are separated from patients and visitors by clear plexi-glass partitions.
  • For most COVID-19 patients, registration is conducted by phone to minimize exposure.
  • Positive COVID-19 patients who are ill are placed in separate, negative pressure rooms (prevents airborne cross-contamination from room to room) that are cleaned according to CDC guidelines.
  • Improved ventilation systems in areas where care is provided to patients with known or suspected COVID-19 infection
  • Environmental Services staff have implemented proven, best-practice procedures for cleaning COVID-19 rooms.