From hospital staff to patient wait times, the frontline workers at the emergency department in Glen Burnie, Maryland, share how they are keeping abreast of the changes and challenges brought by the pandemic.
Joanna Summers, host:
This month marks the end of the federal and global public health emergencies triggered by COVID-19. While much of the world appears to be moving forward, WHO epidemiologist Maria Van Kerkhove made an appeal last week.
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Maria van Kerkhove: We can’t forget the pictures of hospitals overwhelmed to capacity, and the pictures of our loved ones who have died, with healthcare workers assured that they won’t die alone.
UNIDENTIFIED PERSON #1: So we don’t have a new bed?
UNIDENTIFIED PERSON #2: We do.
UNIDENTIFIED PERSON #1: Great.
UNIDENTIFIED PERSON #2: We do.
Summer: That assignment stuck with Carol Ann Sperry, who’s been a nurse for more than four decades.
Carol Ann Spry: While a lot of people were scared of the novel coronavirus and during all of those changes, it reminded me why I’m doing what I’m doing. I have had the privilege of being with patients in their dying moments when families could not be here.
SUMMER: Sperry is the director of emergency services and emergency management at the University of Maryland, Baltimore Washington Medical Center.
Unidentified sender: The patient is coming from a rehab facility…
Summer: She and her colleagues recently guided us in the emergency department to explain how emergency care has changed—in some ways for the better, and in many ways, irrevocably.
Unspecified Announcer: Priority for 1 patient in Room IX – ETA now. First priority…
Summer: We saw one priority patient, someone in seriously critical condition. The man — amputee twice in cardiac arrest — was wheeled alongside us into a room, flanked at times by nearly a dozen healthcare workers. A situation like this is an example of what Sperry calls the controlled chaos of emergency department work.
Spree: Then we’ll put the patient on a ventilator, and then we’ll hook him up to all the equipment that’s here.
Summer: The only thing that has changed is the number of nurses still on staff.
Sperry: We’ve lost about 55% of our employees since 2020.
Summer: The hospital says that number was accurate as of January 2023. Now, the nurse vacancy rate is at 20% — lower, but still close to the current national average for hospitals, and climbing back to 100% will be tough. A new nationwide survey this month from AMN Healthcare, a mobile nurse and medical staffing company, shows that only 15% of nurses plan to continue working the same a year from now.
Spree: I don’t think the world or the ED has leveled off since 2020, and I think we’re still looking for a new normal.
Summer: Have you ever considered leaving at any time…
Spree: Yes.
Summer: ..during an epidemic? Tell us about it.
Sperry: There comes a time when you have to reevaluate whether you find joy and satisfaction in what you do. Certainly there were periods when I did not find that joy. And so you have to work through that. You have to reassess, set smaller goals, and then keep moving forward.
Summer: Another big change that almost every employee we spoke to mentioned.
Sperry: The sharpness and how awkward they are.
NEEL VIBHAKAR: The challenges we’ve seen post-COVID, including severity.
Shraj Chowdhury: Patients’ acuity is a little bit higher.
Summer: Attention acuity, that is, the intensity of care people need, has changed since 2020, in a way that Sperry described as distressing.
Spree: I think patients today are much more complex and sicker than they were in the past, if that is believable. I think many people have not taken care of their health care for several years, either because of an inability to do so or because of fear.
Gail Edinso Bailey: One of my biggest fears with hospitals is that they won’t listen to me – that the staff won’t be friendly.
SUMMER: This is a 42-year-old patient, Jill Edenso-Bailey, whose concerns were unfounded during this visit to treat dangerously low oxygen levels. Her breathing was shallow and her eyesight clouded, but she was still able to laugh.
Edenso Bailey: I probably would have waited for him. I’m the kind of person that, if I didn’t need it and it didn’t bother me, I wouldn’t come (laughter).
Summer: Some patients also avoid the emergency room because they don’t want to spend hours and hours in a waiting room. Reports of long wait times during the pandemic haven’t helped.
how do you feel today?
Roma Row: lousy.
Summer: This is Roma Row. She is in her 70s and has liver cancer. We met her briefly in the emergency room, as she refused the TV to talk to us. She and her husband, Kathleen, were coming over the night before, but…
Kathleen: It’s very busy at night. So we waited until this morning, we arrived around quarter past eight this morning. And there were about five people in the waiting room ahead of us, so it wasn’t a long day.
Summer: Have you all been here before when it was really busy?
Grade: Yes.
Kathleen: I was here…
Grade: Yes.
Kathleen: The last time I was here with my sister…
Ro: We’ve been here all night.
Kathleen: …it’s been 12 and a half hours waiting until I get back to this part.
Summer: twelve and a half hours—not typical.
Vibhakar: I think that, unfortunately, emergency departments have developed this reputation of having a waiting time. As a result, patients wait electively. We hope they don’t.
SUMMER: Dr. Neil Vibhakar is the chief medical officer at UM Baltimore Washington Medical Center.
Vibhakar: Although we’ve seen these average wait times increase over the past few years, we’re excited about the interventions we’ve put in place.
Summer: One of the main interventions explained by Vibhakar and Sperry is vertical care. Patients who can remain upright without being placed in an emergency room bed are cared for. There is also a rapid medical evaluation, where doctors and nurses sometimes perform tests and treatment for a patient right in the waiting room.
Sperry: And we can mitigate the risk of not having clinical capacity to treat our patients.
Summer: But the hospital says waiting room treatment is not a long-term solution to its patient flow requirements, which have fluctuated.
Choudary: We thought we saw the light at the end of the tunnel about 18 months ago. As many people have said, the light at the end of the tunnel was just an oncoming train.
SUMMER: This is the emergency department physician, Chirag Chaudhary, who we spoke with during his shift. As we talked, there were constant beeps and alerts from various monitors near his workstation.
Chowdhury: As emergency medicine professionals, we consider ourselves the MacGyver of the medicine house, and we can kind of address these challenges.
Summer: Another ongoing challenge—patients with mental health needs, in particular, are staying in the emergency room for longer.
Chowdhury: Which we did not witness before the spread of the epidemic – to this extent.
Summer: The number of people reporting symptoms of anxiety or depression tripled in the first 15 months of the pandemic. Emergency room visits for overdoses also rose 26% in 2020, according to a May report from the American Hospital Association. Choudhury says a lack of available beds and staff at post-acute care facilities can leave patients with few choices about where to go after an emergency.
Chowdhury: Any emergency department you ask in the country will have a story about someone that they had to house in their walls for a long period of time — it could be weeks, it could be months, you know, even for some of these patients. It’s awful when you can’t connect a patient with the care they need.
Summer: That feeling — knowing that some aspects of patient care are beyond your control — has always been part of the job. This is another reason why hospital leaders should focus on the needs of their employees as well.
SPERRY: It used to be a work-life balance. Now it’s a work-life balance, right? What do we put first?
Summer: Before we left the hospital, we asked Carol Ann Sperry about the stress she and her colleagues faced during the pandemic.
Spree: Oh, my God.
Summer: Long pause.
Sperry: Bringing new nurses into an environment — that was very difficult. You know, kind of my mother’s mentality crept in. And I wanted to protect them and keep them from grinding their knees, but I couldn’t do that, you know? We’ve had 23-year-old nurses experience their first death in the workplace, right? And you know, we have to continue to focus on them and continue to benefit — what made you make that choice? And what else can we do to make sure that’s your choice tomorrow and the day after and the day after, right?
Mary Louise Kelly, host:
That was our co-host, Joanna Summers, reporting from Glen Burnie, Maryland.
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