Tridemic now a Quademic – RI Health officials respond to hospital ER crisis

Hospital and State Leaders Call on Rhode Islanders to Seek Medical Care in the Right Place 

New healthcare staffing regulation aimed at supporting hospitals and other facilities  

With behavioral health issues being added to flu, COVID and RSV, the “tridemic” is now seen as a “quademic” in Rhode Island. With several respiratory viruses currently circulating in Rhode Island and with the holidays coming, State health officials and hospital leaders again urge the public to only go to emergency departments for issues that require emergency care. Hospital emergency departments in Rhode Island are experiencing significant crowding and prolonged waiting times. 

Health issues can often be treated quickly and effectively by a primary care provider, in an urgent care facility, or at a health center are less severe cases of the flu, back pain, minor cuts, sore throats, low-grade fevers, and most cases of norovirus (the “stomach flu”).

Outpatient settings are also currently seeing a very significant number of patients, but seeking care for less serious health issues in non-hospital settings is important to make sure the emergency departments will be accessible for those in most need.

One issue that may be increasing the flow to emergency departments is the overwhelming of the standard healthcare settings – the primary care providers, clinics, etc. Situations where an office can not accommodate an urgent request to be seen, or use telemedicine systems, often result in a referral to “go to the emergency room”. RIDOH is including “Messaging to the primary care provider community about measures that can be taken in that setting to lessen emergency department overcrowding. Examples include making more same-day sick appointments available for patients and offering expanded and/or non-traditional office hours; and seeing patients who have non-urgent symptoms in the office or by telemedicine, instead of referring them to the emergency department.” 

It was also announced that emergency medical services (EMS) workers will be allowed to work under the supervision of “on-site healthcare providers in a hospital or other licensed healthcare facility in Rhode Island”, under a new, temporary health regulation to help alleviate staffing shortages in emergency departments.

“Similar to last fall and winter, we are seeing longer waits at local emergency rooms. While COVID-19 and influenza are circulating again, there are also additional challenges at hospitals throughout the country this year due to RSV, behavioral health needs, and healthcare worker shortages,” said Ana Novais, Acting Secretary of the Executive Office of Health & Human Services.

Cases of RSV usually peak in Rhode Island in early January.  Flu is starting to circulate in Rhode Island as well, and hospitals are still treating patients with COVID-19. The ongoing behavioral health crisis and the national healthcare workers shortage are creating additional challenges for the hospitals in Rhode Island, in addition to the circulation of these respiratory viruses. 

“Emergency departments are perfect for emergency situations. If someone is experiencing a serious health issue, they should absolutely call 911 or go to an emergency department right away. However, emergency departments treat patients with the most serious health issues first, which means that people with less severe conditions will experience long waits,” said Interim Director of Health Utpala Bandy, MD, MPH.

“Some simple prevention measures can help you stay healthy. Regular hand washing and staying home from school or work when sick are two other steps that everyone should be taking, especially kids and people who are in regular contact with school-age children, older adults, and people with underlying health conditions.” 

State leaders highlighted health.ri.gov/rightplace which has links to lists of primary care providers, urgent care centers, and health centers in Rhode Island, and guidance on when and when not to go to the emergency department. The site also has resources for those without insurance, as some free-standing urgent care centers do not accept Medicaid or those without insurance who cannot private pay. 

“These past months we have experienced a steady increase in young patients needing hospitalization due largely to the early peak of the respiratory viral season. This, combined with a national staffing shortage during an ongoing severe children’s behavioral health crisis, has created an unprecedented ‘perfect storm’ for children’s hospitals nationwide. 

For those patients using the ED, please understand there have been long wait times for non-urgent conditions and we know this can be frustrating. We ask for patience as limited staff triage the most critical patients while we devise alternative ways to improve emergency care access. Our valued staff are working tirelessly to provide the best care possible and ensure all patients receive the treatment they need,” said Frank Overly, MD, medical director, Hasbro Children’s Hospital emergency department. 

“Emergency Department overcrowding is a serious threat to patients and staff and has intensified through the pandemic,” said Laura Forman, MD, Chief of Emergency Medicine, Kent Hospital. “Hospital staff across the state are working to ensure that all patients have access to timely care during this crisis.” 

When to seek emergency care 

If someone is showing any of these signs, seek emergency medical care immediately: 

• Choking 
• Stopped breathing or turning blue 
• Head injury with passing out, throwing up, or not behaving normally 
• Injury to neck or spine 
• Seizure that lasted 3 to 5 minutes 
• Bleeding that cannot be stopped 
• Severe allergic reaction 
• New weakness in an arm, leg, or face 
• New difficulty speaking or confusion 
• Inability to wake or stay awake 
• Suddenly not able to speak, see, walk, or move 

This is not a complete list of health issues that require emergency medical attention. For more information, see health.ri.gov/rightplace. 

Measures being taken at the State level 

An interagency team across the Executive Office of Health and Human Services (EOHHS) is working toward the development and implementation of strategies to address the challenges hospitals are facing. They include: 

• Promulgating an emergency regulation allowing emergency medical services (EMS) professionals to work in hospitals and other healthcare facilities. 
• Launching a broad public education campaign on seeking the right care in the right setting. Messaging is happening through social media, traditional media, schools, and other channels. 
• Messaging to the primary care provider community about measures that can be taken in that setting to lessen emergency department overcrowding. Examples include making more same-day sick appointments available for patients and offering expanded and/or non-traditional office hours; and seeing patients who have non-urgent symptoms in the office or by telemedicine, instead of referring them to the emergency department. 
• Expediting the licensure process to ensure that all new healthcare workers are able to join the workforce in Rhode Island as quickly as possible. 
• DCYF is focusing on expediting discharges from Hasbro and Bradley Hospital, especially for children who can go home if supportive services can be made available.  
• Daily, weekday meetings with BHDDH and all hospitals, BH Link and three Community Mental Health Centers with stabilization units to identify openings to place clients.  
• Throughout this year, we are building the infrastructure for Certified Community Behavioral Health Clinics, which we expect to come online in FY24.  
• RIDOH’s PediPRN Program is available to pediatric providers to help diagnose, assess, and manage mild to moderate behavioral health issues in children 
• Sharing a Family Behavioral Health Crisis Plan that is available multiple languages, to help all families plan for behavioral health emergencies.  
• Launching Mobile Response Stabilization Services, which is a mobile crisis service that can help prevent youth from having to go to or stay at the Emergency Department. 

 
Steps people should take to help stay healthy and out of the hospital 

Non-behavioral health 

• Get your flu shot. Everyone older than six months of age should be vaccinated every year. For information on where to get a flu shot, see health.ri.gov/flu. 
• Be up to date on your COVID-19 vaccinations. For many people, that means getting a booster. For information on how to get vaccinated against COVID-19, see C19vaccineRI.org.   
• Cough or sneeze into your elbow.  
• Wash your hands often with soap and water.  
• Consistent with recommendations from the Centers for Disease Control and Prevention (CDC), people who are at high risk for getting sick should wear masks when COVID-19 levels are “medium,” and everyone should consider wearing masks in crowded indoor settings when COVID-19 levels are “high.” (COVID-19 levels by county are posted here.) 
• Clean and disinfect frequently touched surfaces at home, work, and school.  
• Stay home if you are sick. 
• Keep children home from daycare or school who have fever, especially with a cough, difficulty breathing or shortness of breath, congestion, runny nose, or sore throat, until they are fever-free for 24 hours without medications that reduce fever. Contact your pediatrician or healthcare provider if you believe your child needs medical care. Your provider can offer advice on whether your child needs to be evaluated in person, tested for COVID or flu, and the best location (doctor’s office, urgent care, emergency room) for care.

Behavioral health 

• If you or someone you know is having thoughts of suicide or is experiencing a non-life-threatening mental health or substance use crisis, call 988.  
• Contact Kids’ Link RI if it is needed. Kids’ Link RI is a behavioral health triage service and referral network. A program offered in collaboration with Gateway Healthcare, Lifespan, Hasbro Children’s Hospital and Bradley Hospital, Kids’ Link RI is available 24 hours a day, seven days a week to help triage children and youth in need of mental health services and refer them to treatment providers. To contact Kids’ Link RI, call 1-855-543-5465. 
• Contact BH Link if it is needed. BH Link’s mission is to ensure all Rhode Islanders, 18 and over, experiencing mental health and substance use crises receive the appropriate services they need as quickly as possible in an environment that supports their recovery. To contact BH Link, call  401-414-LINK (5465)