Year’s flu and cold season strains emergency rooms

JERRY WOLKOWITZ Riverview Medical Center Emergency Room nurse Phyllis Manna administers medication to a patient. Area emergency rooms are at capacity due to seasonal ailments and staffing cutbacks.

It seems like it’s everywhere and affecting everyone: the coughing, sneezing and chest rattling sounding like an old, worn concertina.

It’s winter, and with the cold weather comes cold and flu season.

Temperatures have been particularly mild up until now, and it has not been an exceptionally harsh season for influenza, but area emergency rooms have become increasingly swamped with patients suffering from various upper respiratory complaints.

So severe has the deluge of patients to area emergency rooms been, that some health-care providers acknowledge that it is affecting their ability to care for people.

"Every hospital in Monmouth County has been overloaded," noted Dr. Robert Sweeney, who is chairman of emergency medicine for Meridian Health System.

Meridian owns and operates Riverview Medical Center, Red Bank; Jersey Shore Medical Center, Neptune; and Medical Center of Ocean County, Toms River. All three facilities, Sweeney said, are experiencing the same sort of problem.

Emergency department physicians are seeing a great deal of pneumonia, bronchitis and other complaints, including viral illnesses, especially among the very young, the very old, and those with compromised immune systems due to chronic conditions. Doctors, according to Sweeney, are also seeing a particularly stubborn strain of bronchiolitis, a respiratory malady found primarily in infants.

These ailments are certainly not uncommon for doctors to see from December to March, and the number of people suffering from them is higher than last year, though occurrences of influenza remain constant. But, Sweeney contended, there are other factors involved that are affecting the the emergency rooms’ abilities to treat these complaints.

In the era of managed care, health maintenance organizations have been stressing, and to some extent getting, a greater say in what is seen as appropriate care and what they are willing to pay for it. They often encourage that care be done on an outpatient basis.

Also, advances in technology and medical breakthroughs are allowing for more procedures to be done on an outpatient basis, and for shorter hospital stays.

In response, Sweeney noted, hospitals have downsized inpatient facilities, resulting in fewer beds.

Patients, feeling increasingly frustrated by long waits in the waiting room of their primary care providers (that’s HMO-speak for family doctor), are opting for emergency departments. Additionally, some physicians, according to Sweeney, are advising their patients to go to the hospital instead of coming into the office.

With more sick people and fewer beds, hospitals are sometimes having difficulty finding inpatient space. There have been instances where patients have had to stay in emergency rooms for up to two to three days, said Dr. Russell Harris, spokesman for the American College of Emergency Physicians and chairman of the emergency department of Our Lady of Lourdes Hospital, Camden.

"The current hospital environment is incredibly challenging," Harris said, "and it continues to grow."

Riverview Medical Center’s emergency department treated 33,000 cases in 2001. The medical center has begun a renovation project that will, among other things, expand, upgrade, and renovate the emergency department.

Harris also noted that New Jersey’s reimbursements for Medicaid patients are the lowest in the United States, and more and more doctors are refusing to take patients who rely on the government program. These patients, along with those who have no insurance, are forced into the emergency rooms, further straining the system.

"It’s not uncommon everywhere for hospitals to run out of beds," said Dr. Kieai J. Fukuda, chief of epidemiology, influenza branch, for the U.S. Centers for Disease Control, Atlanta.

Fukuda pointed to a 1998 study focusing on Los Angeles which supported the concerns raised by Sweeney.

One of the most pressing issues facing health-care facilities is the chronic, systemic shortage of nurses.

"In order to put patients in beds you need the staff," Fukuda observed.

Facilities, in an attempt to address the shortage, have tried to recruit applicants from other countries like Canada, and as far away as the Philippines, with only middling success, Harrison said.

"The nursing shortage has hit us hard," said Maureen Swick, vice president of Patient Care Services for Monmouth Medical Center, Long Branch.

Swick said, "Once the cold air hit, we’ve gotten very, very busy," especially in pediatrics.

Monmouth Medical’s emergency department last year treated 47,000 patients. That was an increase of 3,000 from the previous year, Swick said. (The medical center has 320 beds.)

"It does backlog," she acknowledged.

To accommodate increasing demand, Swick said Monmouth Medical has expanded its emergency department, added another triage area, and moved and rearranged some service areas to allow for additional inpatient space.

"The hospital tries to be creative," she said.

"We have had people remain in the ED [emergency department] longer than we would like," conceded Patricia Hansen, director of public relations for Bayshore Community Hospital, Holmdel.

Bayshore, Hansen said, sees an average 30,000 patients a year in its ED. And this year, it has been seeing many patients with stomach viruses who are suffering from dehydration. But the facility, she said, currently is not holding anyone in its ED, and has not downsized any of its units.

Actually, she said, the 225-bed facility is not at capacity.

When a facility’s emergency department becomes too busy, the facility goes on "divert," an advisory capacity redirecting ambulances to other facilities.

This, Sweeney noted, has a ripple effect. If Bayshore Community Hospital gets too busy, first aid squads are asked, if possible, to go to Riverview. If the same happens to Riverview, patients are taken to Monmouth Medical or Jersey Shore.

"All these things stretch their resources," Sweeney said.

In any given year, approximately 110,000 people are hospitalized for the flu. And as many as 20,000 die each year from the effects and complications of influenza, Fukuda noted.

The flu, and ancillary conditions such as bronchitis and pneumonia, can be quite serious.

Faced with feeling ill, dealing with medical professionals who are strained to capacity can be less than comforting.

"It’s just stressful for everyone," Sweeney said.