COVID-19 strains emergency departments, prompting ambulance diversions

As a result of the most recent spike in COVID-19 cases that have strained area hospitals, some patients were experiencing longer wait times at emergency departments.

The pressure on its facilities prompted hospital officials to enact mitigation measures to preserve capacity for emergencies. Those included, in some cases, boarding patients within the emergency department, turning away patient transfers and diverting ambulances to other hospitals.

The spread of the highly transmissible omicron variant has caused record new cases across the state, driving total COVID-19 hospitalizations statewide to surpass 1,000 total patients this month.

In the past two weeks, new cases and hospitalizations have been on the decline. As of this past Wednesday, 794 patients were hospitalized with COVID-19, according to the Iowa Department of Public Health’s weekly coronavirus report.

Among those, 109 were in intensive-care units and 51 were on a ventilator.

But in the midst of a spike in COVID-19 positivity rates — reaching more than 25 percent some weeks in Linn and Johnson counties — hospital officials reported seeing similar increases in patients arriving at their emergency departments.

Wait times increased with onset of omicron

UnityPoint Health-St. Luke’s Hospital’s 34-room emergency department saw patient volumes that were 20 percent higher than average during the spread of delta variant and the onset of omicron, said Dr. Ryan Sundermann, St. Luke’s medical director.

Providers expanded volume in the emergency department by placing beds and chairs in the hallways to treat patients, and worked to expedite the triage process, Sundermann said. However, high patient volumes within the hospital created a “trickle up” disruption that made it difficult to move patients from the emergency department into inpatient beds.

“When the hospital is full, it’s difficult to move patients into the hospital, which keeps our beds full,” he said.

At times, St. Luke’s had to board patients in the emergency department and they typically wait two to four hours for an inpatient bed.

Mercy Medical Center in Cedar Rapids also saw a gradual increase in emergency department traffic over the past six months, officials said, but the number of patients has returned to pre-pandemic levels in recent weeks.

At peak times during busy days, officials said some individuals may have waited up to several hours before seeing a provider. But they pointed to major staffing shortages as the main driver to those wait times.

Before COVID-19 two years ago, wait times typically were 20 minutes.

"As we’ve stated many times this past year, nationwide hospital staffing shortages are also a reality here in Cedar Rapids,“ Mercy Medical officials wrote in a statement. ”The increase in ER wait times that individuals may have experienced during the COVID pandemic have largely been related to staffing.“

The emergency department at Mercy in Iowa City — which touted its 10-minute wait time before the pandemic — has not experienced significant changes in patient volumes in the past year, said Dr. Josh Eastvold, the hospital’s emergency department medical director.

Eastvold said door-to-provider times — the time a patient spends from arrival to seeing a health care provider — has remained stable at 25 minutes, and less than 10 minutes for Level 1 emergent cases. Hospital data shows the average time between arrival and triage for 2021 was 10.5 minutes.

At University of Iowa Hospitals and Clinics, the emergency department saw a slight decline in patient visits in 2020, dipping below 2016 levels, hospital officials told the Board of Regents this past April. However, severity of patient conditions remained high, according to hospital leadership.

In the two years since COVID-19 arrived in the state, officials say the emergency department has seen “an increase in higher acuity cases.”

“While our overall number of patient visits to the emergency room may not be significantly increased, we are seeing a higher number of patients who need to be admitted to the hospital than we did before,” Dr. Theresa Brennan, UIHC chief medical officer, said in an email to The Gazette.

In addition to patients arriving at the emergency department needing inpatient admission, the system also has seen increased requests to transfer patients from other hospitals because of a high patient census across Iowa. Those two factors has “led to sicker patients in our ER and our hospital in general,” Brennan said.

Ambulances diverted, patient transfers turned away

As patient volumes increased, some hospitals have diverted ambulances in an effort to preserve capacity and resources. Ambulance diversion is a practice of temporarily redirecting ambulances to other hospitals to alleviate emergency department crowding.

Area Ambulance Service, the emergency medical services provider for the Cedar Rapids area, has had its ambulances diverted roughly 15 times throughout the two-year pandemic, CEO Keith Rippy said.

Diversions rarely last very long, most of the timelasting for just a few hours, Rippy said. Ambulances are notified well ahead of time and patient care is not affected, he added.

“We’ve seen, over the course of the pandemic, some incidents in which we were diverted, but I wouldn’t call it significant,” Rippy said.

Mercy Medical officials confirmed the hospital had been on diversion status previously in the pandemic, but not in recent months.

St. Luke’s has made it a policy to never go on diversion status, Sundermann said. However, high patient numbers has meant the hospitals have had to turn away requests from other hospitals to transfer their patients — a trend in the latest surge that has impacted the state’s smallest hospitals the most.

Critical access hospitals, such as those in Anamosa and Independence, have smaller capacity and don’t have specialty providers who can take care of more complex patient cases. These facilities typically transfer patients who need that higher level of care to hospitals such as St. Luke’s, but have been unable to do so in the midst of the most recent surge.

Sundermann, who also sees patients at smaller UnityPoint Health-affiliated hospitals in the region, recalled the effort to transfer a patient to another hospital. He called health systems in cities such as Kansas City, Omaha and Madison looking for an open bed, but was turned away from every single one.

“The small hospitals in surrounding communities are really suffering,” he said.

To help preserve their capacity, local hospital officials continue to emphasize the importance of getting the COVID-19 vaccines and booster shots if they qualify.

To alleviate potential emergency department crowding, Sundermann also encouraged individuals with no symptoms or mild symptoms of COVID-19 to seek out coronavirus testing elsewhere, if possible. However, he emphasized emergency medical providers will be available to anyone in need.

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