Avoiding the Emergency Room? Waiting Could Be Worse

Posted May 1, 2020 by UVM Health Network

Illness and injuries happen. During the COVID-19 pandemic, University of Vermont Health Network providers have found a concerning trend: people are delaying the care they need. Out of concern for coronavirus infection and reserving care for critically ill patients, people are deferring care and smaller health concerns are growing into larger ones.

“The disasters of delaying care are more real than viral exposure at this time,” says Amanda Young, MD, Medical Director of Hospital Based Services and Emergency Medicine at Porter Medical Center. “During this pandemic, I have seen ruptured appendices, advanced heart damage due to the delay in coming in for a heart attack, skin infections that need surgery, bowel infections that have invaded the bloodstream, and even an infected ingrown toe nail that was in jeopardy of amputation. These are the things that keep me up at night.”

At Elizabethtown Community Hospital, the emergency department is finding the same reluctance from patients in need of care. “We are very concerned about community health, and to respond we have put processes in place to minimize potential risk of exposure – and any small risk far outweighs the risk of delaying care for these medical conditions,” says David W. Clauss, MD, head of the Emergency Department at Elizabethtown Community Hospital and its Ticonderoga Campus.

We know our communities are concerned about safely coming back to the hospitals. Emergency departments and urgent care facilities across the network have made the following changes:

Screening

• 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.

Masking and Personal Protective Equipment (PPE)

• All employees are required to wear masks, including the front desk staff that perform patient screening upon arrival.
• All patients 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.

Physical Distancing

• 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 that are ill are placed in separate, negative pressure rooms (prevents airborne cross contamination from room to room) that are cleaned according to current CDC guidelines.

Dr. Young understands the concerns the community may feel about entering a hospital at this time, but assures that the environment is safe and exposure risks are low. “Masks and commitment to hand hygiene have helped my own concerns about potential exposure at work. In some ways, the emergency room might be safer than common public spaces thanks to mandatory masking and hand hygiene practices.”

At the UVM Medical Center, COVID-19 enhancements are in place to separate patients and further minimize risk and exposure. “We created four new respiratory triage rooms and a separate waiting area for patients with COVID symptoms, and built two new negative pressure wards specifically to accommodate COVID patients,” says Ramsey Herrington, MD, Division Chief of Emergency Medicine, UVM Medical Center.

The patient experience has changed to reduce exposure risk. Across the network, patient-provider visits will feel different due to masked interactions, closed door consultations, and limited face-to-face encounters. These changes are in effect not only in urgent care and emergency department settings, but in primary and specialty care settings as well. Expanded eHealth video visits and telehealth appointments are available across the network to allow secure, video conferencing appointments between patients and providers. This service has improved continuity of care while maintaining access to care for patients across Vermont and northern New York. To learn more about this care option, visit www.uvmhealth.org/COVIDvideo.

“Anyone with an injury or concerning symptoms should feel very comfortable that we have a full range of care available and that we have altered our processes to minimize any potential risk of exposure,” says Dr. Clauss. “People should not hesitate to come into the emergency department or urgent care, especially for symptoms that concern them.”