Emergency rooms in Arizona hospitals are extremely busy. this is the reason
Emergency departments in Arizona are extremely busy, and while the rise in respiratory illnesses is part of the problem, health care providers say it’s not the only reason.
Some Arizona health experts say winter visitors, overburdened primary care doctors and a lack of insurance accountability are all part of the problem.
As a result, providers say patients regularly spend hours and even days in emergency departments waiting for an inpatient bed: a problem known as “patient boarding” that negatively impacts outcomes and patient safety, studies have shown.
“I’ve been here at Valleywise for 13 years and I’ve never seen it this busy,” said Dr. Cara Gerin, an emergency medicine physician at Valleywise Health Medical Center in Phoenix, who says she sees patients of all ages, not just one age group. He added: “There are many more patients waiting for beds than I have ever seen before… and some of them are due to respiratory diseases, but it is certainly not the only reason.”
State data shows that influenza, RSV (respiratory syncytial virus), and the virus that causes COVID-19 are now widespread, and influenza and RSV infections are at a higher than average level for this time of year.
Cold weather tends to bring in more patients who are homeless and have substance abuse and behavioral health problems because “things get worse if you have to be outside, and they get worse when it gets cold,” Gerin said. But multiple factors are likely at play, including a general workforce shortage in the health system.
“If something doesn’t work, go to the emergency department. If it gets worse, go to the emergency department,” Gerin said. “If the system doesn’t work, we’re the recipients.”
Before the COVID-19 pandemic, Valleywise Health Medical Center’s emergency department saw between 160 and 170 patients a day. Over the past few weeks, it has averaged 200 to 210 per day, with nearly 300 on peak days, Valleywise spokesman Michael Murphy wrote in an email.
“Our emergency department is 14% busier than we expected it to be so far in January, and that was also true in December,” said Mimi Kumler, CEO of Tucson Medical Center, which has the busiest emergency departments. Southern Arizona’s emergency department is one of the busiest in the state.
One factor is that snowbirds that may have stayed away during COVID-19 have now returned and their winter populations have increased dramatically, Kumler said.
Emergency room visits are also in place at Banner University Medical Center in Phoenix, said emergency room physician Dr. Munish Pao.
“January is classically our busiest month, but we were looking at our volumes compared to the last few years, and we were up 5 to 10% compared to previous years. January has been a really busy month,” Bao said. “We are busier than we were in January 2022 and 2023.”
Here are five things to know about emergency departments in Arizona:
Emergency departments say they are busier this month than they have been during the coronavirus (COVID-19) pandemic.
“We physically have more patients than we did during COVID, but the patients we had with COVID, especially at the beginning of the pandemic, were sicker,” Gerin said. “Now there are certainly patients, but the average patient is not sick.”
Gerin said she sees patients of all ages. The vast majority of people with COVID-19 and influenza are discharged from the emergency department without being admitted to hospital. But she said people in higher-risk groups, including older adults and people with compromised immune systems, are more likely to need a hospital bed.
The shortage of doctors is part of the problem
Gerin said she sees a “tremendous number” of people in Valleywise’s emergency department who couldn’t get immediate help from a primary care doctor, or didn’t have a primary care doctor at all.
“It’s fair to say from a workforce perspective, there is a physician shortage,” Tucson Medical Center spokeswoman Julia Strange said. “One of the reasons people end up in the emergency department is because they can’t get to a provider, or there isn’t a provider on call.”
There has been a recent issue with the availability of specialty doctors on call for emergency departments in southern Arizona, such as gynecologic surgeons and ear, nose and throat specialists, said Kumler, CEO of Tucson Medical Center. As a regional hospital, TMC gets emergency referrals from other hospitals that don’t have the subspecialties their patients need, she said.
Some providers say two government bills can help reduce quantities
One reason people end up in emergency departments is a systemic problem with health insurance liability that can lead to fewer doctors practicing in the community, Kumler said.
House Bill 2035, introduced by Rep. David Cook, R-Globe, mandates that health plans provide comprehensive information on claims denials and calls for streamlining the appeals process and reducing time wasted by health care workers seeking clarification.
Cook’s proposal also calls for reducing the timeframe for credentialing doctors and other health care providers to 45 calendar days, from the current 100 days, with retroactive payment for claims accumulated during the credentialing process, a news release from the Arizona Hospital and Healthcare Association said.
“I really think the only way to solve this problem is through policy change,” Kumler said of the surge in emergency departments. “If you’re an independent physician and you’re practicing in a market where payers aren’t regulated, you’re not going to be able to get paid for the work you do and walk away… Payer accountability is a really important change we can make.”
Another bill, House Bill 2990, was introduced by Rep. Alexander Kolodin, R-Scottsdale, and aims to fix delays in transferring patients between hospitals, which affects bed availability.
Arizona patients often face long wait times when transferred between hospitals, and Kumler said Kolodin’s bill would reduce those delays by allowing hospitals to manage their own transportation services or contract with local fire departments and districts.
The sickest patients will be seen first, so wait times in the emergency department may be long for patients with less serious illnesses
“If you’re not in critical health, you may have to wait,” Gerin said. “We won’t forget you. It takes us a long time to get done what we need to get done.”
Providers say it’s always helpful for patients to know when to go to the emergency room instead of urgent care or their primary care provider. Chest pain, shortness of breath, difficulty breathing, confusion, loss of speech or movement or a high temperature are all signs that a person should go to the emergency room, while a sore throat, runny nose and cough can usually be dealt with by a primary care physician. Or a virtual visit or urgent care.
Emergency department use has risen since coronavirus (COVID-19) nationwide
The real problem with crowded emergency rooms is that they lead to patients being boarded, something not limited to Arizona, Gerin said.
“It’s a problem in the national system that we see at the local level and we’re just trying to deal with it,” she said on January 9. “We’ve had someone here for 73 hours. It’s been almost three days. They’ve been sitting in the emergency department… Studies have shown that patients who stay in the emergency department instead of getting an inpatient bed, their mortality rates go up,” she said.
Emergency department numbers have surged across the country, U.S. Health and Human Services Secretary Xavier Becerra wrote in a Dec. 18 letter to U.S. Rep. Debbie Dingell, D-Mich.
“The problems of crowding and boarding in emergency departments are not new but have worsened significantly during and after the COVID-19 pandemic,” Becerra wrote. “This situation is far from ideal patient care and can exacerbate health inequalities, cause workforce burnout, and create risks to patient safety and public health.”
At one point on Jan. 8, 150 patients were being held in emergency departments waiting for an inpatient bed at Tucson hospitals, Kumler said.
“The emergency department can never say no. We never close our doors, we continue to expand to the extent that we can,” she said. “We have certainly adapted our systems to provide quality patient care in the emergency department but our preference, and the patient’s preference, is to be in the inpatient room.”
Connect with healthcare reporter Stephanie Ennis on Stephanie.Innes@gannett.com or 602-444-8369. Follow her on X, formerly Twitter: @Stephanie Ennis.