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How staff shortages at Bucks, Montco nursing homes, rehabs are delaying hospital discharges, causing longer ER waits

Emergency departments at hospitals in Bucks and Montgomery counties have become especially busy in recent weeks as COVID cases are surging while health care staffing shortages have slowed the hospitals in discharging patients to nursing facilities and rehabilitation centers.

At Lower Bucks Hospital in Bristol Township, delays in discharging patients has affected bed availability throughout the hospital, spokeswoman Michelle Aliprentis said.

"We don't have the ability to discharge them because the nursing homes are unable to accept them. Unfortunately, we are left paralyzed with nowhere to place our patients," she said.

When there are delays in discharges, newer admitted patients must wait in the emergency department for a hospital bed to become available. This has created crowding and delays in treatment for less-acute conditions, officials said.

Numerous 'less-acute conditons' can become deadly if not given the necessary treatment. And we're seeing just that: 10,000+ EXCESS deaths in just 4 months in England, NOT Covid related, lockdown backlog partly to blame

"This results in a little more wait time for people to get their hospital bed and more of the emergency department beds can be filled with people waiting, and that in turn causes a long wait time (in the ED)," said Dr. Gerard Cleary, Jefferson Health-Abington chief medical officer.

The situation with staffing in long-term nursing facilities has become so critical that the Pennsylvania Health Care Association says that the Pennsylvania National Guard members may need to be given basic training in health care in case they are deployed to nursing facilities as some were to a center in Berks County recently.

Deploying nursing staff to do basic care work means hospitals are lacking critically trained staff.

"We have been in communication with the Department of Health, even asking for the National Guard to be prepared to help in facilities," said association President and CEO Zach Shamberg. "What we are seeing now is a domino effect.

"Skilled nursing facilities are unable to accept new residents because they do not have the staff to meet the demand beyond those they are already caring for. We have heard nursing homes have closed wings in their facilities because they don't have enough staff to care for those beds."

Again, over in the UK: Care home closes as vaccine mandate leads to loss of staff, union says industry is "already on its knees"

Doylestown Hospital spokeswoman Beth Long said, "Yes, there are challenges and delays with discharges due to the lack of open beds at the nursing facilities. This affects the ED because we used to be able to discharge some patients from the ED directly to a skilled nursing facility."

Lower Bucks Hospital has 150 beds split between medical and behavioral health, but staffs according to its census which is 50 patients currently.

"As long as the staffing shortages continue, we will have to take steps to address the increasing volume of patients. It's not often we have to take extreme measures like diverting ambulances, but this strain is a direct result of what's happening throughout the region. We are working on operational adjustments to support continuity of care to the best of our ability," Aliprentis said.

Disruption like this is deadly, as we saw during the first lockdowns:

• Sent to die: 4,300 Covid-19 patients sent to New York's vulnerable nursing homes under Cuomo directive
• As a GP in the NHS I witnessed first-hand the catastrophic way Matt Hancock failed the old and vulnerable in care homes

Dr. Larry Brilliant, St. Mary president and CEO, said the hospital with its 377 inpatient beds, is "near capacity."

The hospital is using the new emergency department program, nicknamed PIT for Provider in Triage, to ensure that all patients are treated as quickly as possible and to make the best use of staff and diagnostic equipment.

"We have our surge plans, but they're not being utilized yet; they're ready if we need them," he said.

St. Mary's emergency department has 62 beds for adult patients and 12 for pediatric patients. "If you need a bed, you're going to get a bed," Brilliant said. "We want people to get the care they needed as soon as possible."

Moving patients through emergency rooms quicker

According to a report issued by Medicare, before the PIT program was implemented, the wait time in St. Mary's emergency department averaged 210 minutes, the highest for hospitals in Bucks and Eastern Montgomery County, and higher than the national and Pennsylvania average of 175 minutes for hospitals like St. Mary that have very high volumes of patients, 60,000 or more a year.

The only other similar hospital in the area was Jefferson-Abington, where the wait time averages 197 minutes.

Dr. Darin Geracimos, chairman of the St. Mary Emergency Department, said that with the new PIT program a patient coming in with a heart attack will be seen "in about 5 seconds," as they always have been but someone with a sprained ankle may still have a wait for treatment but during that time, diagnosis of the injury will get underway even when the ED is very busy. That patient will be able to be treated and go home sooner than before.

Despite their attempts to reconfigure how they work, with less staff, adequate care is sacrificed, and patients will inevitably suffer.

The PIT program is used from 10 a.m. to 6 p.m. Monday through Friday.

Doylestown Hospital has a similar program called MACU (Minor Acute Care Unit) to try to get people treated and out of the ED quicker. Jefferson Abington Hospital also is using its fast-track system in the Emergency Department to get people who can be treated and go home the care they need.

St. Mary now treats everyone coming to the ED as if they have COVID and tries to use social distancing and masks to separate people coming for treatment. The hospital's pediatric emergency department also has seen an increase in patients in part because of an increase in respiratory illnesses in children this year.

Lockdowns weakened and compromised people's immune systems leaving them more vulnerable when the ususal circulaiton of viruses resumes: Lockdowns blocked flu spread, what happens when it returns?

Children who need to be hospitalized are sent to a hospital that treats children as inpatients, of the parents' choosing.

At Doylestown Hospital, Long said, "Our pediatric inpatient census has been steady, but we've been able to provide beds for all who need them. The hospital has 271 inpatient beds, including six for children.

Jefferson-Abington has 665 beds and had 77,000 visits to its ED last year while Jefferson-Lansdale has 140 beds and received 23,000 ED visits.

Fighting COVID and other ways to stay out of the ER

Cleary, of Jefferson Health, advised everyone to get vaccinated against COVID for their own safety and that of others. And he said the emergency department is not the place to come for a COVID test except if the person is having serious symptoms.

He stressed that anyone feeling ill should call their family doctor rather than let their illness wait until they need emergency care.

While hospitals are not telling people to put off care they need, Cleary said some people are growing concerned about having elective surgery until they know their rehabilitation placement, should they need it, is guaranteed.

He said the issues right now with health care staffing shortages are caused because many older medical workers have retired or plan to do so and younger people are more hesitant to begin a health care career while the pandemic is ongoing, particular those who would normally apply for a medical assistant or other low-level and lower paying position.

Over in the UK, the lack of doctors is actually partly a result of doctor's wanting to preserve their salaries: UK's "burnt out" GPs warn many will quit if gov't force face-to-face appointments - same doctors who voted against training more doctors in 2008

The national shortage of daycare workers to tend to young children and older adults also is preventing some people from applying for health care jobs.

"We're challenged," Cleary said.