Patient Volumes

[Porfirio]

Down so much that there is talk of decreasing coverage hours...

Anyone else having this problem?

I added a poll.

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[e30ftw]

We are down about 50% over the past week.

100% RVU so we just go home early.

 

[Birdstrike]

I'm curious as to ED volumes during this time, also. Like I posted on the other thread, my non-ED multi-specialty group (40+ providers in- & outpatient) is down so much we're going to a 4 day work week, have instituted a freeze on wage increases and are considering lay-offs, not due to the virus, but due to the response to the virus. And it's not because we're not "on the front lines" of dealing with this virus. We are; we're seeing these patients and testing. In fact, most of these patients are outpatients, not ED patients, and not critically ill or dying. But we're far from "overwhelmed." In fact, it's the exact opposite.

It seems NYC and Seattle are the epicenter for this, here in the States. Can anyone from NYC or Seattle chime in, on your volume and what the status of your department is?

 

[Buckeye1992]

We have cut coverage at our shop. Down about 40%.

 

[Cinclus]

It's down where I am. A nurse at work said, "It's good, because only actual emergencies are coming in." And I'm not sure if we're working in the same ED, because I have been discharging the vast majority of patients, and my acuity is usually pretty high. A lot of very non-emergent stuff coming in. It seems like the truly sick are staying home, and young adults and kids with URIs and "shortness of breath" (yeah, they don't have that...) are coming in at an increased rate.

 

[Porfirio]

Hospital admissions are down too.

 

[deleted836128]

I am in AZ. Our ER volume is significantly down. Essentially each day is a little less busy than it is on Christmas.

At our smaller hospital, where we have one PA (like me) and one doc on at a time, I have been seeing about one patient per hour. At that hospital there have been times when there are ZERO in the entire ER. The other night I got sent home almost three hours early. Honestly it’s easily manageable with just a doc so they don’t really need a PA on. The larger hospital we work at is quite a bit more busy than the smaller hospital but still probably a 40 - 50 percent drop in census. Yesterday at one time we had two docs and two PAs on, and everyone had between two and four active patients at one time.

We had added some optional “extra” shifts for the PAs and docs for the winter and spring months because that’s when we are busiest. Because the volume is so low, the shifts have been cancelled until further notice. Kinda sucks for those who were counting on the extra dough, but luckily these were “extra” shifts and our core hours haven’t been cut. Although this could be on the horizon judging by how things are going.

This is still a pay cut, though, because we make a significant amount of money based on RVUs. My RVUs end up being about 35 percent of my take home pay, so it sucks when volume is down this much. Adds insult to injury. Working without proper PPE, being blasted by COVID-19 emails at ALL hours of the night, and taking a massive pay cut. Fun times!

The drop in volume is wild. Unexpected. Family and friends text me and ask me if I am okay with work being so crazy because the media is painting this picture of us being in a war zone. Everyone is saying this is the calm before the storm. Hard to know if they’re right.

 

[Porfirio]

Where are my CHFers, my COPDers, my septic patients, my MIs?????? This is scary. Are my patients dying at home? Is this virus causing these patients to stay home and die?

 

[bravotwozero]

Don’t kid yourselves, this is definitely the calm before the storm. Houston is now seeing a slow uptick in covid related ARDS, although volume is still down. But New Orleans has been hit pretty hard and I suspect it’s only a matter of time before that happens here. That said, Houston has mitigating factors not present elsewhere in the hard hit areas that hopefully will lessen the impact here.


Sent from my iPhone using Tapatalk

 

[deuist]

We've already cut hours to our mid level providers feared we have also been told that the doctors need to leave work early.

 

[thegenius]

I'm curious as to ED volumes during this time, also. Like I posted on the other thread, my non-ED multi-specialty group (40+ providers in- & outpatient) is down so much we're going to a 4 day work week, have instituted a freeze on wage increases and are considering lay-offs, not due to the virus, but due to the response to the virus. And it's not because we're not "on the front lines" of dealing with this virus. We are; we're seeing these patients and testing. In fact, most of these patients are outpatients, not ED patients, and not critically ill or dying. But we're far from "overwhelmed." In fact, it's the exact opposite.

It seems NYC and Seattle are the epicenter for this, here in the States. Can anyone from NYC or Seattle chime in, on your volume and what the status of your department is?

This was posted yesterday by Dr. Craig Spencer. He's an ER doc in NYC. (of note, I used to work with him too).

Thread by @Craig_A_Spencer: Thank you everyone for your incredible messages of support and encouragement. Many of you asked what it was like in the ER right now. I want…

 

[thegenius]

Where are my CHFers, my COPDers, my septic patients, my MIs?????? This is scary. Are my patients dying at home? Is this virus causing these patients to stay home and die?

No

They are staying home because their symptoms are mild

 

[GeneralVeers]

No

They are staying home because their symptoms are mild

The only good thing the newsmedia's hysteria has done is make otherwise healthy people too terrified to come to the hospital for once.

We are seeing about 40% less, so I've been going home 2 hours early.

 

[Brigade4Radiant]

Where are my CHFers, my COPDers, my septic patients, my MIs?????? This is scary. Are my patients dying at home? Is this virus causing these patients to stay home and die?

Most of these are just poorly controlled exacerbations. When they start to worry they actually take their medicine or call their doctor who tells them to double up on their lasix so they don't need to come in.

 

[littlejuan]

.

 

[deleted245139]

It's the tide pulling away from the beach as the tidal wave is inbound. Enjoy light shifts where you are, while you can

 

[TooMuchResearch]

That's concerning, and I'm seeing it too. Where are the normal volume of sick people? Granted I've been at our rural sites the last week, not the big house, but it seems most of the sick ones are avoiding me right now.

Where are my CHFers, my COPDers, my septic patients, my MIs?????? This is scary. Are my patients dying at home? Is this virus causing these patients to stay home and die?

 

[TheSingularity]

Our volume way down. I'm guessing 65%.

We are salaried in a large hospital system so there has been no talk of decreased pay (yet).

I am very glad to no longer work for TH as my friends still there are having 2 hours a shift cut from them.

I am scared that there will eventually be talk of paycuts...

I do think though that this is the calm before the storm. The volume is down but the COVID type patients are presenting sicker and sicker each day. Even if we don't see the uptick in COVID patients, it stands to reason that the normal ER patients will come rushing back eventually with their 3 months of chronic back pain.

 

[NYEMMED]

Volume is down, acuity is up.

 

[miacomet]

Our volumes are down.
I work at a 20 bed critical access hospital, and six beds are already filled with COVID patients. So, I imagine we will be quite busy in the weeks to come.
We are also seeing a ton of kid injuries since parents just won't supervise their kids now that school is out.

 

[miacomet]

I am in AZ. Our ER volume is significantly down. Essentially each day is a little less busy than it is on Christmas.

At our smaller hospital, where we have one PA (like me) and one doc on at a time, I have been seeing about one patient per hour. At that hospital there have been times when there are ZERO in the entire ER. The other night I got sent home almost three hours early. Honestly it’s easily manageable with just a doc so they don’t really need a PA on. The larger hospital we work at is quite a bit more busy than the smaller hospital but still probably a 40 - 50 percent drop in census. Yesterday at one time we had two docs and two PAs on, and everyone had between two and four active patients at one time.

We had added some optional “extra” shifts for the PAs and docs for the winter and spring months because that’s when we are busiest. Because the volume is so low, the shifts have been cancelled until further notice. Kinda sucks for those who were counting on the extra dough, but luckily these were “extra” shifts and our core hours haven’t been cut. Although this could be on the horizon judging by how things are going.

This is still a pay cut, though, because we make a significant amount of money based on RVUs. My RVUs end up being about 35 percent of my take home pay, so it sucks when volume is down this much. Adds insult to injury. Working without proper PPE, being blasted by COVID-19 emails at ALL hours of the night, and taking a massive pay cut. Fun times!

The drop in volume is wild. Unexpected. Family and friends text me and ask me if I am okay with work being so crazy because the media is painting this picture of us being in a war zone. Everyone is saying this is the calm before the storm. Hard to know if they’re right.

Quit.

 

[ShockIndex]

Volume is down, acuity is up.

That is what happen when an emergency department starts living up to its name and stops being a clinic of convenience to everyone. By everyone, I mean the public and providers who can’t (or won’t) take responsibility for their patients.

 

[Brigade4Radiant]

One of my side shops is thinking of cutting coverage. Lol when the storm hits see if I’ll bail you out unless you give me extra

 

[TwoHighways]

This is actually a really great thing and I hope the trend holds after the paranoia surrounding corona fades. I doubt it continues though. I have little faith in the system and the people within it as it exists currently.

 

[AlmostAnMD]

So all these overwhelmed, stressed, madmen doctors that the news keeps showing are from the same 3 hospitals or something?

Our system is the same, cutting hours. The CMG I work PRN at is the same, cutting hours.

Our main site I would see somewhere around 30 patients in a shift, and the last shift I worked it was 4 hours between seeing patients looooooool

 

[TwoHighways]

So all these overwhelmed, stressed, madmen doctors that the news keeps showing are from the same 3 hospitals or something?

Our system is the same, cutting hours. The CMG I work PRN at is the same, cutting hours.

Our main site I would see somewhere around 30 patients in a shift, and the last shift I worked it was 4 hours between seeing patients looooooool

Doesn’t fit the narrative.

 

[deleted1027621]

I am seeing the same amount as usual, including a six month old who had a rash for 10 minutes prior to arrival in the ED.

 

[TooMuchResearch]

I'm not seeing any kid injuries right now, just assumed people had locked them inside.

Our volumes are down.
I work at a 20 bed critical access hospital, and six beds are already filled with COVID patients. So, I imagine we will be quite busy in the weeks to come.
We are also seeing a ton of kid injuries since parents just won't supervise their kids now that school is out.

 

[BoardingDoc]

I am seeing the same amount as usual, including a six month old who had a rash for 10 minutes prior to arrival in the ED.

If you're in the US I assume you live somewhere non coastal and somewhat ruralish? It seems like COVID hasn't broken into the middle of the country yet the way it has on the coasts.

 

[Fox800]

20 bed ED yesterday, normally 1 attending and 1 midlevel. We saw six patients between 7AM-4PM. Half of which were nonsense that was discharged expeditiously - typical.

 

[Brigade4Radiant]

Now my main gig is cutting hours. When this picks up I'm not going to be a "soldier" I'm going to be a mercenary.

 

[Money-Moniker]

Yep. Like I mentioned on another thread, if you look at the social media accounts of our staff right now you'd think our hospital was in a war zone. The reality is we're all getting our hours cut because it's a ghost town. People want to look and feel important, and will do and say all kinds of things to make that happen. It's like that friend you know on Facebook who is actually depressed and broke, but constantly publishes pictures of their smiling "perfect" family on yet another vacation. That's why there are all these tenth hand accounts of "my husband's cousin's nephew's mailman's dog groomer knows a guy who knows a guy who's a nurse in NYC who says it's so bad that 50% of their healthcare staff has gotten Covid and died!!" Yet then you look at the actual national numbers and go wait, total deaths are still under 1000, I don't get it?

When Wuhan was hit hard in January with thousands dying, NYC doctors weren't seeing a single SARS2 patient. Now they are being overwhelmed with SARS2. Don't worry, you'll get your SARS as well sooner rather than later. This kind of thinking is so weird, it's like people have forgotten that things don't happen ALL AT ONCE but instead progress sequentially. Even the Titanic didn't fill up with water instantaneously but compartment by compartment.

 

[bravotwozero]

Metro Detroit getting hit hard right now. Some hospitals have turned ORs and PACUs into ICUs, and are running out of ventilators.

 

[evilbooyaa]

So all these overwhelmed, stressed, madmen doctors that the news keeps showing are from the same 3 hospitals or something?

Our system is the same, cutting hours. The CMG I work PRN at is the same, cutting hours.

Our main site I would see somewhere around 30 patients in a shift, and the last shift I worked it was 4 hours between seeing patients looooooool

Most stories, especially those about running out of supplies, or close to running out of ventilators are from the Seattle and NYC areas, yes.

Lots of hospitals, especially in NYC and surrounding areas.

 

[bravotwozero]

Would be interesting to read about, is there a source for this?

Don't have a source for you, heard from a colleague i trained with who is working there. His words:

'We have been unbelievably hit hard. We have twice as many patients as University of Michigan and we are just a community hospital. 63 vented patients. 32 confirmed positives. 75 pending results, 1 vent left right now."

 

[Dr Mantis Toboggan]

Don't have a source from you, heard from a colleague i trained with who is working there. His words:

'We have been unbelievably hit hard. We have twice as many patients as University of Michigan and we are just a community hospital. 63 vented patients. 32 confirmed positives. 75 pending results, 1 vent left right now."

Scary.

 

[GeneralVeers]

Scary.

Scary, but I'd really like actual statistics and not anecdotes.

 

[deleted836128]

Quit.

Seriously? Why do you say that?

 

[turkeyjerky]

We're down as well. But I think y'all cutting hours are about to in for a rude awakening.

Our profile of patients is starting to match up w/ what the Italians described in the early days. I've definitely seen an of unseasonal ILI's w/ true fever over the past 2-3 days.

Already staring to run low on PPE b/c of all the asshats who wasted a new N95 on every patient two weeks ago.

 

[Birdstrike]

Who do you think got COVID-19 first, Italy or the United States? Certainly Italy, right, because you've heard countless times, "We're 10 days behind Italy" and "We're going to be Italy in 10 days"?

The first case of COVID-19 in United States, was detected on Jan 19th, 2020. -New England Journal of Medicine.

The first case of COVID-19 in Italy, was on detected 11 days later after the United States, on Jan 30th, 2020. -Medscape

So, not only are we not "10 days behind Italy," Italy is 11 days behind us, yet has 800% more deaths from COVID-19 than us. That's not a typo, 800% more deaths (7503 Italy deaths/942 US deaths x 100 = 796%) than us.

 

[Birdstrike]

Would be interesting to read about, is there a source for this?

Scary, but I'd really like actual statistics and not anecdotes.

It is frustrating as hell, isn't it? On this thread I have posted and linked countless peer review articles supporting my positions, New England Journal of Medicine, clinical trials, Virology Departments, CDC data, Nobel Laureates, Journal of Science, data on viral growth patterns, Medscape, Johns Hopkins along with my reasoning.

Yet people just skip over it, pop over here from social media for two seconds, drop an anecdote, then log off and go back to the rumor mill.

There's no skepticism whatsoever, just instantaneous “viral spread” of whatever is the most grim and anxiety provoking scenario they stumble across, no matter how improbable.

 

[pkwraith]

Down 25-30%, we're cutting coverage too. Right now most of our COVID positive patients are young healthy people with essentialy URI symptoms that are discharged.

 

[ShockIndex]

For those incapable of the simplest of Google searches, simply typing “Detroit hospitals” into the mystery machine (browser) yields this:

Henry Ford Health reaches capacity at 2 hospitals for COVID-19 patients

Henry Ford Health announces two of its hospitals have reached capacity for treating COVID-19 patients.

www.google.com

“As of Wednesday morning, the Henry Ford Health system had 282 patients with COVID-19. By the afternoon, that number was at 304, with another 107 patients suspected by waiting on test results.

The hospitals are in discussion with hotels and universities where dorms could soon be in use. If the surge reached extremely high levels and staff were not able to go home in between shifts, they could have a place close by to stay.”

and this

https://www.google.com/amp/s/www.usnews.com/news/best-states/michigan/articles/2020-03-25/detroit-police-captain-dies-from-covid-19-complications%3fcontext=amp

”Beaumont Health and Henry Ford Health System in southeastern Michigan said they were caring for more than 1,000 COVID-19 patients at their 13 hospitals. Operating rooms were being converted into intensive care units and clinics had been turned into rooms for patients needing other medical care.“

 

[Dr Mantis Toboggan]

 

[Renaissance Man]

In addition to your rigorous journal quotations...you have also posted gems such as:

2019-2020 US Deaths

Influenza: >8,000 (including >50 children)

Coronavirus: 0

-CDC

and...

Next up: People are going to start testing for coronavirus in the millions, and it's going to unjustifiably create a panic-generating spike in positive cases, not due to new and rapidly spreading infections, but simply by them finding the thousands of pre-existing cases we didn't know were spreading around, causing mostly benign colds and "flu-like" viral illnesses. Wait for it. It'll be in the news in about a week and it won't be a sign of The End of Days, but if fact the opposite. They'll be finding the virus was benign enough (99.9% of the time) to be spreading around without us even knowing it all along.

It is not hard to either use Google, pick up a newspaper, turn on the news, network with current doctors/nurses to see that multiple hospitals are already underwater due to ventilator issues, PPE shortages, staffing, etc. NY seems to be at epicenter right now, but other cities/communities also struggling. Wake up.

 

[Birdstrike]

Alright, since you're keeping score. Here we go ...

In addition to your rigorous journal quotations...you have also posted gems such as:

The CDC stats that you're referring to (below) were accurate on that day. I'd be happy to look at any correction you can find that shows they were wrong at that time. I simply posted facts with no conclusions drawn, so any incorrect conclusions made from that were yours, because I presented the stats without comment. You can't honestly believe that when the CDC posts numbers of how many people have gotten a disease at a given time, that they're telling you no additional people will ever get the disease, right?

Absolutely 100% accurate at the time posted, almost 2 months ago (Feb 3rd):

2019-2020 US Deaths


Influenza: >8,000 (including >50 children)

Coronavirus: 0


-CDC

This was also accurate when posted (today):

Influenza: 23,000-59,000 deaths (149 children, season, 5 children, past week)
COVID-19: 1,001 deaths (1 child, which now they're saying may not be due to COVID-19.)

So, I'm not sure how the posting of accurate and well-sourced statistics, presented without comment or conclusion, is bad in your view, but whatever. They are accurate statistics. If you think posting accurate statistics is bad, I'm okay with that.

It is not hard to either use Google, pick up a newspaper, turn on the news, network with current doctors/nurses to see that multiple hospitals are already underwater due to ventilator issues, PPE shortages, staffing, etc. NY seems to be at epicenter right now, but other cities/communities also struggling. Wake up.

Yes, we all know of the news reports of NY having a lot of coronavirus cases and that they're getting slammed. I've posted multiple articles, including a big one yesterday with multiple pictures on the "What do I need to know about coronavirus" thread, railing De Blasio for not busting up virus-spreading crowds right outside his mansion window. I've posted the CDC stats and virus-tracker (Johns Hopkins) numbers multiple times which document New York's case numbers. I'm aware of what's going on in New York. I know they're getting slammed. I know Trump ordered a 1,000 bed hospital ship to New York harbor as well as 4,000 more vents. So, I'm not sure where the disagreement is on this, specifically.

It's also worth noting though, that so far 100% of the respondents to the poll on this thread which includes people in EDs all across the country, are reporting that their EDs have the same or slower volume and 0% report being overwhelmed. That's not to say it won't change. It might. Or it might not. I hope the "overwhelmed" numbers stay as close to 0% as possible, on this poll and anywhere currently not overwhelmed. We know what's going on in New York. That matters. But not everyone on this thread works in Manhattan. What's happening in their departments matters, too.


This one that you've referred to is a little tougher to parse out, because there's a lot here, and some of it needs more time to play out. But I'll tell you what I think I got right and wrong in this post, so far, below:

Next up: People are going to start testing for coronavirus in the millions, and it's going to unjustifiably create a panic-generating spike in positive cases, not due to new and rapidly spreading infections, but simply by them finding the thousands of pre-existing cases we didn't know were spreading around, causing mostly benign colds and "flu-like" viral illnesses. Wait for it. It'll be in the news in about a week and it won't be a sign of The End of Days, but if fact the opposite. They'll be finding the virus was benign enough (99.9% of the time) to be spreading around without us even knowing it all along.

As far as the ramp up in testing causing a spike in positive cases causing more anxiety, I think that absolutely has happened. People were anxious when this whole thing started. We weren't testing much more. The numbers were growing but not by a lot initially. Testing started to ramp up and therefore we're finding more cases that were out there, most of them mild, and now those numbers are bigger and it's causing more anxiety. I think that has happened and is happening. If I had to write that over again, I'd take the word "unjustifiable" out, since we are dealing a communicable disease and any level of anxiety is justified if it's you, your family or friends affected or potentially affected.

I will admit at this point that I was wrong in assuming SARS-COV-2 would fizzle out as quickly as SARS-COV in 2003-2004. I was clearly wrong about that. It's gotten worse than that coronavirus, for sure, worldwide and in the US. That being said, I still think the estimates of 1.6 and 2.2 million Americans dying of this were way wrong and that we won't get even close. I sincerely hope to God, I'm not wrong on that one. I also think that despite disagreeing with the initial panic inducing "worst case scenarios," that my statements early on about simultaneously agreeing with the precautions we were taking and agreeing with the shutdowns, have aged well. Prepare for the worst, hope for the best. Feel free to go dig those statements up too, because there are many, Don't just dig up the ones you disagree with.

Next up: People are going to start testing for coronavirus in the millions, and it's going to unjustifiably create a panic-generating spike in positive cases, not due to new and rapidly spreading infections, but simply by them finding the thousands of pre-existing cases we didn't know were spreading around, causing mostly benign colds and "flu-like" viral illnesses. Wait for it. It'll be in the news in about a week and it won't be a sign of The End of Days, but if fact the opposite. They'll be finding the virus was benign enough (99.9% of the time) to be spreading around without us even knowing it all along.

This one is tougher to assess, right now. There is some data starting to come out that COVID-19 may have been around longer than we thought (by a few months) and that very large portions of the populations of countries have already been exposed and didn't know it (read links in quoted post below). It's preliminary, it's still early in this and everything is changing too fast to know for sure on this yet. We clearly know it's the majority that are benign, but we won't know exactly what that percentage is until we do antibody testing to determine what part of the population has already been exposed and resolved without knowing it. At least one group out of Oxford published a paper a few days ago that estimates that >50% of certain countries have already been exposed and that the 99.9% number may not be far off. I could turn out right or wrong on this, but it's way too early to say for sure. Regardless, here's what the Oxford group thinks:

Here's study out of Oxford’s Evolutionary Ecology of Infectious Disease group estimating that 36-68% of the U.K. population and 60-80% of Italy likely have already have been infected with COVID-19, that COVID-19 was around longer than we thought, that fewer than 1 in a 1000 of those infected will become ill enough to need treatment in a hospital, while also agreeing with the social distancing measures enacted.

Here's the study itself.
Here's a layman's summary from @thegenius 's fave, Financial Times.

Either way, what I do know with 100% certainty, is that this pandemic needs to end, because it's causing me to spend w a y too much time on SDN. In that sense, I think we can all agree the end to this pandemic will be a great help to us all .

 

[Birdstrike]

Suggestion to those that voted in this thread. If you voted one way, and the status of your ED volume changes such that your vote would have changed, write a quick line with an update. Thanks.

 

[thegenius]

In addition to your rigorous journal quotations...you have also posted gems such as:



and...




It is not hard to either use Google, pick up a newspaper, turn on the news, network with current doctors/nurses to see that multiple hospitals are already underwater due to ventilator issues, PPE shortages, staffing, etc. NY seems to be at epicenter right now, but other cities/communities also struggling. Wake up.

Oh boy
why do some people stoke the fire

 

[Birdstrike]

Oh boy
why do some people stoke the fire

I know. You and me both. This pandemic needs to end fast, not only to save lives, but as a public service to get me off SDN, asap!
I was coming to SDN to discuss inspiring Grateful Dead tunes. Now I'm posting death stats and journal papers, and I hate it!

 

[asdf123g]

Can anyone comment on r/medicine and why over there the reaction appears to be the end of the world? (the opposite to here)