Eight hour waiting time. Patients leave before they are seen. Massachusetts hospital emergency departments are on the brink.


The Boston Globe

Janet Cook, 69, at her home in Norfolk. Cook waited in a wheelchair for nearly eight hours in the emergency department in early October before an inpatient bed opened. Erin Clark/The Boston Globe

The emergency department at Massachusetts General Hospital was so crowded on a Friday night last month that Janet Cook waited nearly eight hours in a wheelchair in a crowded hallway before an inpatient bed opened. This was after the 69-year-old Norfolk resident had writhed in pain for nearly two hours before receiving medication.

“The hallways were filled with patients on stretchers and the nurses were telling you, ‘We’re sorry, we don’t have beds,'” Cook said, who was diagnosed with bowel obstruction. “The lady in front of me had a broken vertebra in her neck and there were people calling for help. It was like a war zone.

Cook’s recent experience at Mass General is not isolated. While Massachusetts hospital emergency departments have weathered influxes of sick patients throughout the pandemic and in years past, doctors say what they are seeing now is unprecedented. Staffing shortages are at their worst — about 19,000 positions go unfilled, according to a report released earlier this week by the Massachusetts Health & Hospital Association — and ERs continue to see a flood of desperately ill patients who have delayed care during the pandemic. An early start to the flu and respiratory virus season and a steady stream of COVID-19 hospitalizations further strained the system.

Not only have patient wait times increased, but doctors cite an even more alarming statistic: a rising tide of ER patients giving up and leaving before even seeing a doctor. A recent national study revealed that the rate at which people leave hospital waiting rooms before receiving care has almost doubled, from 1% to around 2%. between 2017 and the end of 2021, expose themselves to even more serious illnesses.

To better understand the toll that overcrowded ERs have on patients, The Globe asked readers to share their recent experiences. Some spoke of waiting for hours in pain. A recently retired doctor suffered a stroke in September and had to wait 20 hours in the emergency room before a bed became available. She spent most of her time on a stretcher, meters from a row of patients with antibiotic-resistant infections.

Several people who sought treatment at other hospitals described instances where they heard intimate details about the medical histories and symptoms of other patients, as exhausted doctors and nurses tried to deal with people in crowded waiting rooms.

“Most caregivers say this is the worst they’ve ever seen,” said Steve Walsh, president of the Massachusetts Health & Hospital Association. “There is huge concern about the fragility of the system.”

Dr. Alexander Janke, emergency physician at VA Ann Arbor Healthcare System/University of Michigan, studied hospital overcrowding across the country and said it felt like the levees had broken in the nation’s healthcare system.

“It’s not like we’re on the brink. It’s like we’re on the edge of the abyss,” he said.

Janke and her colleagues studied emergency department boarding — detaining patients admitted to emergency departments, often in hallways, while waiting for an inpatient bed — across the country between January 2020 and December 2021.

They found that when a hospital was more than 85% full, emergency department boarding times often exceeded the national standard of four hours. (Across Massachusetts, hospital beds are 94% occupied, according to the latest state data.)

Health experts say boarding longer than four hours creates patient safety concerns, such as a higher risk of medical errors as overwhelmed doctors and nurses rush among patients to provide care.

The researchers also found that when hospital occupancy exceeded this 85% mark, the median boarding time was 6.58 hours, compared to 2.42 hours at other times.

While emergency departments have periodically struggled over the years with overcrowding, the crisis now goes far beyond that, Janke said. And the situation continues to deteriorate.

“This is unprecedented in my career,” said Dr. Michael VanRooyen, head of corporate emergency medicine at Mass General Brigham, who has worked in emergency medicine for 30 years.

Hospitals cannot free up enough emergency department beds because many places patients are being sent to, such as nursing homes, are also flooded.

Janke puts it this way: “We are all at risk of a serious car accident, and you want the system ready for you. And it’s not ready for you right now.

Janke and his colleagues also found that among the worst performing hospitals, about 10% of ER patients left before a medical evaluation at the end of 2021, compared to 4.3% at the start of 2017.

At Mass General Brigham, the state’s largest health care system, an average of 6% of patients needing emergency care from July through October left unseen, three times the level that was setting off the alarms.

“We’ve never seen averages, to this degree, of 6%,” VanRooyen said, adding that he’s seen spikes above 10% over the same period.

VanRooyen is concerned because, he said, people who go out before receiving care don’t necessarily leave because they are less sick.

“There’s been pretty strong evidence that shows people who leave unseen are just as sick as those who come into hospital.”

Other Massachusetts health systems declined to share data on the percentage of their patients who left before being seen.

Yolette, a Randolph mother, said she saw patients repeatedly leave the emergency department waiting room in mid-September when she rushed her teenage son to South Shore Hospital because he had trouble breathing. She asked that her last name not be used to protect her family’s privacy.

“It was so busy, and people kept coming in, and this head nurse was making announcements, saying it would be eight hours before you were seen,” Yolette said. “And every time she made that announcement, people got up and left.”

She said they waited about three hours before her son was finally treated with oxygen, steroids and intravenous fluids. He has since recovered.

Yolette was worried about the delay in care, but she said what prompted her to write a stern letter to the hospital was concern for patient privacy. During her hours of waiting, she said she inadvertently heard intimate details about symptoms and test results from other patients, as doctors were forced to treat many in the waiting room.

In a statement, South Shore Hospital said the “extremely high” emergency department volumes they and so many other health care systems face are challenging.

“While we respect privacy at all times, we are also aware of the importance of initiating care as quickly as possible when visiting a patient, and this may include the need to communicate with a patient and /or a patient’s family in a lobby or waiting room,” he said.

The Baker administration on Tuesday increased the alarm level it uses to track the number of staffed hospital beds available, marking an important signal to hospitals that overcrowding was getting worse. The action requires weekly regional meetings of hospital leaders to develop strategies to address overcrowding and also consider voluntarily reducing elective and elective procedures and surgeries.

But with no immediate relief in sight, VanRooyen said more patients could spend all of their time in the ER being treated in a hospital hallway, or having blood and intravenous fluids drawn started in a waiting room chair.

The hope is that these “crazy accommodations” can stave off VanRooyen’s worst nightmare: someone in desperate need of emergency care goes away and deteriorates.

“There’s a very real risk,” he said, “of missing a surgical issue, a heart issue, a heart attack.”

Globe staff’s Jessica Bartlett contributed to this story.



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