The following post in no way represents the opinions, policies or strategies of my employer. Nor does it necessarily represent the opinions or feelings of my colleagues.
The US is currently experiencing quite a bad influenza season.
Healthcare services and drug supplies are being stretched to the limit in the United States as the authorities warn this year’s flu season is severe.
Official figures indicate that influenza is now “widespread” in 41 states, with high numbers of cases reported in New York, where state governor Andrew Cuomo has declared a public health emergency.
Robert Glatter, an emergency doctor at New York’s Lenox Hill Hospital, said the facility was opening extra work spaces to take care of the influx of patients.
He said medics were almost as worried about the situation as they had been during the swine flu outbreak of H1N1 in 2009.
The severity of this year’s flu is of particular concern, he said, adding many patients are elderly and suffer from severe aches, chills, cough, fevers, dizziness, nausea, vomiting and diarrhoea.
The situation has been compounded with simultaneous spikes in people presenting with pertussis and norovirus, and has placed significant extra demand on hospital wards, and in particular, their emergency departments.
In Australia the influenza season is yet to hit. But looking at the US experience, we should be preparing for a busy one.
I have been working as a nurse in the emergency department for many years now. During the winter season, we see a large increase in demand for hospital in-patient services from our community.
Typically, this quickly overloads our hospital bed capacity. With the hospital full, patients presenting to the emergency department (ED) that require admission have no-where to be sent, and must remain in the ED until a bed becomes available. Sometimes for many days.
This inability to access in-patient beds is known as access block. It leads to a situation known as emergency department overcrowding.
With no-where to place these admitted patients, and a vital need to keep treating new arrivals, inevitably patients are moved into our corridors and other non-clinical areas.
There are now many studies that show these patients, and indeed all patients cared for within this overcrowded environment, are at a significantly increased risk of morbidity and mortality (that is, an increased risk of poorer health outcomes or even death).
An overcrowded, high-stressed emergency department needing to care for its usual workload and the additional workload of patients waiting to access the hospital, quickly becomes demoralised, exhausted and at increased risk of medical errors & accidents.
Perhaps you have visited our department and experienced this situation yourself over the last few years. Perhaps you might experience it during the impending flu season.
We need to prepare for this winter surge in demand for our services now. Once you start reading about overcrowded emergency departments in the newspapers this winter, it is way too late.
The hospital must have a robust and effective strategy for maintaining a flow of patients in and out of our emergency departments so that they can continue to provide quality critical care.
One possible strategy (and there are others) is to move admitted patients up to the corridors outside the ward they are expected to be admitted to. This is by no means a perfect solution, and it is not appropriate in all cases. But what it does do is spread this extra workload evenly throughout the hospital rather then attempting to contain it within the limited space of the ED.
Instead of one area (the ED) having 10–20 admitted patients crowded into their corridors, each ward area can care for an additional 2 or 3 patients. Wards will not like this, but access block is a all-of-hospital problem that requires a shared response.
Patients on their correct specialty ward, with less overcrowding will receive better care, in a safer environment.
I ask you to consider all this and to ensure that our healthcare leaders are developing and implementing strategies such as these now, so that we are ready to meet any demands that the flu-season may bring safely and efficiently.
It is your health system.