Im a PA and have worked in emergency medicine for 15+ years here in Houston. In addition to working in the ER, several months ago I starting picking up shifts at an Urgent Care (I did this looking for a break, after 15 years of craziness in the ER!)
It has been interesting to see how the two companies (one a large health system, and the other a local urgent care company) have evolved in their response to this craziness.
Couple of reasons for this thread: 1) Self-therapy and 2) I'll assume that some basic information "from the front" is appreciated.
I am not necessarily going to get into answering questions and I'm going to be a little guarded with details
ER
- Starting today at the ER/hospital, all employees have to be screened prior to starting work. We all have to enter through the same door, have our temp taken, and answer a series of questions before starting work. There are different levels of potential outcome ranging from "go home" to "wear a mask".
-As of yesterday, the testing we are conducting in the ER is very selective. We are not testing unless you have a 100% known exposure and are symptomatic, or have symptoms and will likely require admission. I have a feeling this will change soon. Other hospital systems in Houston are doing widespread testing.
-It wasn't overly busy during my shift, especially for a Monday! My patient load was typical and so was the range of complaints. seizures, knee sprains, flu, pneumonia, falls, broken bones, and lacerations.......... I was honestly surprised at the number of "non-emergent" folks still coming in. But then again, so many doctors offices are not seeing patients, so where are they gonna go (I know...maybe stay home?)
-We only had half of our ICU beds occupied while I was there. So that's good. Historically, we have several days of the month (especially Mondays) where we have to board ICU patients in ER due to being at capacity in the ICU. The hospitalist conveyed to me that their load was pretty light over the weekend as well (regular floor admits).
-Please understand.....I have frequently seen that hospital with 50+ people in the ER lobby, all 36 ER beds full, ICU overflowing, and ICU/floor admits residing in the ER due to the hospital being over capacity. And that's just on a random typical non-COVID day. So yesterday was actually pretty nice.
-We'll see how things develop!
-I've worked through horrendous flu seasons. 2009/2018 were nightmares. In the past, the number of "slightly ill, but worried" folks showing up to be tested absolutely overwhelmed the ER. I am hoping that off site testing centers and education (stay home unless you're short of breath) will keep people our of the ERs/hospitals in the coming weeks. But then again, expecting people to self-triage is so unreliable. I've seen folks who are literally on their death bed show up to "be checked out cause they're not feeling good" and I've seen folks who stubbed their toe want to speak to the CEO of the hospital because they had to wait 30 minutes to be seen for their "emergency".
-I wish I had the ability to test patients. At the start of every flu season, I test everyone. After about 30 positives and 70 negatives (making up numbers here), I have a very good sense of what the flu looks like. Knowing what a disease looks like helps in so many ways. I also think it would alleviate some of the anxiety of my patients.
-I'm a little worried about the screening process for healthcare workers. If we get a fever, we are out for 2 weeks minimum. If we test + for COVID, then we are out for 6 weeks, even if asymptotic. I get it......sort of.......but just like every business, we have just enough employees to get by. A loss of a full time person, especially at a time like this, is devastating, both for the patients and the provider's colleagues. A loss of 2 or 3? I don't even want to think about it.
The Urgent Care
-At the urgent care, we are starting to do some testing. The collection is done in the clinic, but the swab is sent to a lab. I believe they are going to start advertising this soon (they started letting patients who call in know that we have three "drive-up testing locations" starting today.) I have a feeling they are going to be quickly overwhelmed.........we will see how this plays out! I work a shift there tomorrow.......yikes.
-for anyone with respiratory symptoms, they are pushing for virtual visits. This is difficult. I can't see your throat. I can't listen to your lungs, I can't check your oxygen saturation. I have always had strict guidelines for who is appropriate for a virtual visit, but with COVID it will be interesting to see if those guidelines will be softened. If they are......then it will rely on very specific and extensive cooperative medical decision making with the patient. They will need to understand the instructions regarding "it looks like this, but could be this"..... and my treatment plan will have to be rather broad.
-Having said that, the urgent care I work for, doctors offices, and other walk in clinics or quick test centers, will be the key to keeping patients out of the ER if and when the number of critically ill patients increases.
I don't want to turn this into a question and answer thread........but If there is something that needs clarification or it looks like I can help provide definitive and useful information, then I will try to respond. I'll leave the official directives to the experts.
I'm just a dude who works in the ER!
It has been interesting to see how the two companies (one a large health system, and the other a local urgent care company) have evolved in their response to this craziness.
Couple of reasons for this thread: 1) Self-therapy and 2) I'll assume that some basic information "from the front" is appreciated.
I am not necessarily going to get into answering questions and I'm going to be a little guarded with details
ER
- Starting today at the ER/hospital, all employees have to be screened prior to starting work. We all have to enter through the same door, have our temp taken, and answer a series of questions before starting work. There are different levels of potential outcome ranging from "go home" to "wear a mask".
-As of yesterday, the testing we are conducting in the ER is very selective. We are not testing unless you have a 100% known exposure and are symptomatic, or have symptoms and will likely require admission. I have a feeling this will change soon. Other hospital systems in Houston are doing widespread testing.
-It wasn't overly busy during my shift, especially for a Monday! My patient load was typical and so was the range of complaints. seizures, knee sprains, flu, pneumonia, falls, broken bones, and lacerations.......... I was honestly surprised at the number of "non-emergent" folks still coming in. But then again, so many doctors offices are not seeing patients, so where are they gonna go (I know...maybe stay home?)
-We only had half of our ICU beds occupied while I was there. So that's good. Historically, we have several days of the month (especially Mondays) where we have to board ICU patients in ER due to being at capacity in the ICU. The hospitalist conveyed to me that their load was pretty light over the weekend as well (regular floor admits).
-Please understand.....I have frequently seen that hospital with 50+ people in the ER lobby, all 36 ER beds full, ICU overflowing, and ICU/floor admits residing in the ER due to the hospital being over capacity. And that's just on a random typical non-COVID day. So yesterday was actually pretty nice.
-We'll see how things develop!
-I've worked through horrendous flu seasons. 2009/2018 were nightmares. In the past, the number of "slightly ill, but worried" folks showing up to be tested absolutely overwhelmed the ER. I am hoping that off site testing centers and education (stay home unless you're short of breath) will keep people our of the ERs/hospitals in the coming weeks. But then again, expecting people to self-triage is so unreliable. I've seen folks who are literally on their death bed show up to "be checked out cause they're not feeling good" and I've seen folks who stubbed their toe want to speak to the CEO of the hospital because they had to wait 30 minutes to be seen for their "emergency".
-I wish I had the ability to test patients. At the start of every flu season, I test everyone. After about 30 positives and 70 negatives (making up numbers here), I have a very good sense of what the flu looks like. Knowing what a disease looks like helps in so many ways. I also think it would alleviate some of the anxiety of my patients.
-I'm a little worried about the screening process for healthcare workers. If we get a fever, we are out for 2 weeks minimum. If we test + for COVID, then we are out for 6 weeks, even if asymptotic. I get it......sort of.......but just like every business, we have just enough employees to get by. A loss of a full time person, especially at a time like this, is devastating, both for the patients and the provider's colleagues. A loss of 2 or 3? I don't even want to think about it.
The Urgent Care
-At the urgent care, we are starting to do some testing. The collection is done in the clinic, but the swab is sent to a lab. I believe they are going to start advertising this soon (they started letting patients who call in know that we have three "drive-up testing locations" starting today.) I have a feeling they are going to be quickly overwhelmed.........we will see how this plays out! I work a shift there tomorrow.......yikes.
-for anyone with respiratory symptoms, they are pushing for virtual visits. This is difficult. I can't see your throat. I can't listen to your lungs, I can't check your oxygen saturation. I have always had strict guidelines for who is appropriate for a virtual visit, but with COVID it will be interesting to see if those guidelines will be softened. If they are......then it will rely on very specific and extensive cooperative medical decision making with the patient. They will need to understand the instructions regarding "it looks like this, but could be this"..... and my treatment plan will have to be rather broad.
-Having said that, the urgent care I work for, doctors offices, and other walk in clinics or quick test centers, will be the key to keeping patients out of the ER if and when the number of critically ill patients increases.
I don't want to turn this into a question and answer thread........but If there is something that needs clarification or it looks like I can help provide definitive and useful information, then I will try to respond. I'll leave the official directives to the experts.
I'm just a dude who works in the ER!