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Peak flu? Not yet, emergency doctors say

As the flu keeps hitting emergency rooms and inpatient stays, hospitals that have reached capacity are using ambulance diversions.

Susan Morse, Senior Editor

It's unknown if this year's early flu season has peaked, but physicians interviewed at hospital emergency departments in Syracuse, New York, said they've yet to see a slow-down.

The New York State Department of Health weekly flu report confirms what emergency room doctors are feeling: Compared to other years, the number of patients hospitalized with the flu this season is higher, according to Jeremy Joslin, MD, an emergency room physician and medical director of the downtown campus adult emergency department for Upstate University Hospital.

[Also: Spotlight on flu season: Where hospitals are slammed hardest]

"We've definitely been over capacity," Joslin said. 

The flu is creating capacity issues for hospitals in the city and nationwide as the Centers for Disease Control and Prevention has deemed the influenza virus widespread. 

"I don't know if it's worse, but it's January; last year it was March," Hospital Executive Director Ron Lagoe said of this year's flu season.

More than 30 children have died from this year's flu strain, H3N2.

[Also: Hospitals will feel human and financial toll from severe flu season]

When patients come into the ER, they can either go in two directions: home or upstairs to inpatient care, Lagoe said. 

"When it's upstairs and it gets completely full, there's no place to go," Lagoe said. "We have three good-sized hospitals, they use ambulance diversions." 

The Hospital Executive Council is the joint planning organization for the three major hospitals in Syracuse. Among its duties is coordinating the diversion system for the hospitals using software that links the emergency departments. 

From January 1-21, the hospitals reported 117.7 hours of ambulance diversion, compared to 13.6 hours in 2017 and 35.1 in 2016.

St. Joseph's Hospital Health Center still accepts the ambulances when the patient has chosen the hospital for transport, said Max Berube, MD, director of the Emergency Department. 

"We still accommodated 2.8 transports per hour during the hours we were on diversion," Berube said. "I'm a big proponent of no diversion at all." 

The hospitals and city have numerous urgent care centers and physician offices to handle patients during the day.

The emergency department physicians interviewed said volume has been heavy throughout the day, but increases at night. 

"The emergency department, at least in smaller metro areas (such as) Syracuse, are the only health services open 24/7 and are hooked up to the inpatient beds," Lagoe said. "The bottom line is throughput. Hospitals are about acute episodic care. It's great when everything is moving, but doesn't work so great when (it's not)."

In addition to volume, there is an issue of length of stay due to an ongoing issue of delays in transferring patients who are difficult to place in long-term care, Lagoe said. 

"When you're already full and get 7 percent more visits, it's a problem," he said, referring to the 7.4 percent jump in ED visits between January 2016 and January 2018 . 

However, between January 2017 and January 2018, emergency department utilization actually decreased slightly, from 12,965 ED visits last year through Jan. 21, to 12,468 visits through the same  period this year for all three hospitals. In 2016, there were 11,609 visits through Jan. 21.

"No, we're not drowning in patients," Joslin said. "We're seeing people who are appropriate to be there." 

Upstate University Hospital has more trauma beds than the other hospitals. Of the three, it had the highest diversion hours in January: 72, compared to 4 for St. Joseph's and 41.7 for Crouse Hospital.

"I think all hospitals and providers understand the delicate balance of capacity," said Joslin, who also serves as medical director for the hospital's transfer center. "Any time there's a surge of patients, it does off-balance that line you want to walk with capacity. I think it understandably makes operations more difficult."

This year's more virulent strain of flu has tipped the balance toward inpatient care for patients with an underlying chronic condition, Joslin said. 

The flu can be hard to differentiate from other serious illnesses such as bronchitis or pneumonia, until a test can be administered, Berube said.

St. Joseph's has made weekly adjustments to its staffing levels, and for the last few weeks, has asked staff to come in early or leave late.

As far as the cost to the ER, Berube said, "My personal opinion, it's the cost of doing business."

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com

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