Should You Go to the ER for That? How to Decide Medical Options as Covid Strains Hospitals

The Four Percent


With emergency rooms and ICUs across the country overloaded, a trip to the hospital can mean greater pandemic-related risks. According to the Covid Tracking Project, more than 132,000 people are in hospital with Covid-19, with the majority of states reporting record hospitalizations. That affects not just emergency departments but staffing and space throughout entire hospitals, which usually isolate Covid patients to prevent infection.

That is complicating the decision to go to the emergency room. Here’s what doctors and other medical authorities advise.

When are urgent-care clinics the best option?

If you aren’t experiencing heart attack or stroke symptoms, some lesser emergencies may be easier addressed outside the ER, said Andra Blomkalns, chair of the emergency medicine department at Stanford University. This is critical if hospitals in your area are near capacity. “If you have a sprained ankle, it’s probably not the time to go to the hospital,” she said. Many urgent-care clinics also post waiting times and can do sutures, X-rays and other diagnostic testing.

Remember that your gut reaction can be misleading. Research shows that people can’t always judge whether they are experiencing a health emergency, said Charleen Hsuan, professor of health policy and administration at Pennsylvania State University, adding, “in general, patients aren’t necessarily good at telling when something is a real emergency or not.”

Which area of the hospital poses the most risk to non-Covid patients?

As Covid patients pour in, separating them from ER arrivals with non-Covid-related emergencies is getting more difficult, said Sarah Nafziger, vice president for clinical support services at the University of Alabama at Birmingham Hospital. Many hospitals, including Dr. Nafziger’s, have created separate entrances and waiting areas, but such measures help only so much amid the onslaught of patients. “They don’t come in wearing a label: ‘I have Covid’ or ‘I don’t,’ ” she said.

If you can choose among ERs and have more than minutes to spare, what can you do before heading to a hospital?

If your doctor has admitting rights at a particular hospital, call to see whether you should come in and inquire about crowds, said Eugene Litvak, president of the Institute for Healthcare Optimization, a nonprofit in Newton, Mass. Many hospitals post ER waiting times online or can estimate them over the phone. Also, consider the size of the hospital, especially if you end up needing intensive care. “Larger hospitals have better resources and typically smaller hospitals have much fewer ICU beds that are critical nowadays,” he said.

What should you learn before going to a hospital for surgery?

In general, you should get a sense of current staffing levels as well as resources after surgery. Pre-pandemic research shows that a nurse-to-patient ratio of 1:5 or 1:4 can result in better care for the patient, said Mr. Litvak, who is also an adjunct professor at the Harvard T.H. Chan School of Public Health. Covid patients are clustered in hospitals and staying longer, so they are drawing resources from other departments, he said, but nursing staff can’t move back and forth, tending to Covid and non-Covid patients. You might ask your doctor whether surgeries are scheduled evenly throughout the week or concentrated on certain days, which can limit space in recovery areas on some days, he said.

A hospital’s website might also alert patients to any pandemic-related changes to procedures, Dr. Hsuan said. She warned that quality ratings for hospitals haven’t been updated to reflect operations during the pandemic.

How can you ensure the best care amid reports of doctors and staff being stretched thin?

Beyond tracking hospital-occupancy rates, there is no way to tell if a particular medical provider feels overworked. Hospitals don’t release information on when they rotate staff to provide time off between shifts. “To some degree you have to have some faith in the system,” Dr. Blomkalns said. “Physicians are used to staying up nights, studying hard and being challenged on the job—and this is what we all trained to do.”

What can you do once at the hospital?

Social distancing, masks and hand-washing are critical. Most hospitals don’t allow cloth masks and will ask patients to wear surgical ones during their stay. According to Dr. Nafziger, while some health-care workers have been vaccinated, the shots haven’t yet had an effect on the hospital population overall. “It doesn’t mean that hospitals are any safer right this minute,” she said.

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