Low Volumes in EDs Sound the Alarm

May 20, 2020 9:21 AM | Sally Winkelman (Administrator)

WACEP President’s Message, May 2020
Ryan Thompson, MD, FACEP

Across the state, ED patient volumes remain significantly decreased, with some EDs seeing half or even a third of their usual volumes. While the initial decrease in volume was seen as something of a relief for some – who doesn’t love an easier overnight? – the persistent downturn has led to mounting concerns.

The first concern is, of course, for our patients. In the early days of the COVID outbreak, I was routinely having patients apologize to me for being in the ED for non-COVID related problems, even when they clearly needed to be seen for emergency care. They were worried that they were pulling me away from other people who might need my care, or that they would be “wasting” healthcare resources. While this concern for their neighbors is admirable, it is clearly ill-advised in the case of severe symptoms requiring ED evaluation, such as chest pain or abdominal pain.

Another cohort of patients avoiding the ED were people who were simply afraid that they would be exposed to COVID while in the hospital. I saw more than a few patients walk into the ED, look around at the isolation procedures in the waiting room and staff in their masks and face shields, and turn right around and walk back out. While this might seem like a reasonable fear, the fact is that we deal with highly infectious diseases in the ED all the time and are experts at preventing cross-contamination of patients.

This decrease in patients seeking ED care is doubly concerning when you consider the lack of outpatient care available right now. These patients aren’t seeking alternative care – they aren’t seeking care at all. This has led to a rash of delayed presentations and worse outcomes. Anecdotally, I’ve seen more ruptured appendices and perforated ulcers in the last 2 months than I normally would in a year.

Another major concern caused by low volumes is a significant drop-off in revenue for some groups. Small groups and rural hospitals run on thin margins as it is, and a sustained drop in volume could lead to corporate takeovers and hospital closings. While some government aid is available, it’s nowhere near enough to cover the losses. Compounding the problem is the significant amount of planning and sweat equity that went into preparing our EDs for COVID, often completely unfunded. Even for hospital employees and those employed by large groups, EPs across the state are seeing pay cuts and hours cut – an unneeded additional stressor in these already stressful times.

In order to try to reassure patients that Wisconsin’s EDs and hospitals are safe and have more than enough bandwidth to care for both COVID and non-COVID patients alike, WACEP has partnered with the Wisconsin Hospital Association. A new PSA will be hitting the airwaves soon across Wisconsin, reminding people that Wisconsin EDs are safe, well-equipped, and ready to care for them when they need us.