Hospital ERs making major changes to address patients' COVID-19 fears

From AARP by Michelle Crouch

In the battle against COVID-19, hospitals across the country are taking extreme measures to prevent the spread of contagion, including building walls, erecting tents, creating isolation wards and overhauling hospital procedures to ensure patients are protected.

That means if you have to go to the emergency room for any reason, your experience will be vastly different than it might have been before the coronavirus arrived, says Ryan A. Stanton, M.D., a spokesperson for the American College of Emergency Physicians (ACEP).

Stanton and other medical experts stress you should not let concerns about the virus keep you from getting care if you are experiencing chest pain or other serious symptoms, since risks involved in delaying treatment are much greater than your risk of catching COVID-19 in the hospital.

"You're probably safer in a hospital right now than you are at grocery store,” says Stanton, an emergency medicine physician at Baptist Health in Lexington, Kentucky. “We are taking every step we can to prevent accidental spread, just as much for our protection as for yours."

While medical centers in some hot spots like New York City and Boston have been overwhelmed with COVID-19 patients, most hospitals across the country have plenty of capacity and, in fact, have fewer patients than normal.

Here are some ways hospitals are protecting patients during the pandemic, and what you can expect if you need to go for any reason.

You will undergo a thorough screening, very likely before you even step inside

To isolate those who may have the coronavirus as quickly as possible, hospitals are screening every patient upon arrival for COVID-19, even those with time-sensitive heart attack and stroke symptoms.

Stanton notes that Baptist Health constructed a new wall just inside the front door to separate a screening room from the rest of the hospital. Only one person is allowed to enter at a time.

At other hospitals, the screening takes place before you even get to the door. Health care workers may be posted outside to handle them, or evaluations may take place while patients are in an ambulance or their cars.

Patients with viral symptoms such as a fever, cough, shortness of breath or loss of a sense of taste or smell are immediately isolated and sent to a special triage area for potential COVID-19 patients.

Many hospitals have erected pop-up coronavirus triage tents in their parking lots, where such patients can be evaluated and tested. In some cases, patients with COVID-19 don't need hospitalization, so medical workers send them home with instructions, and ask them to self-quarantine.

If they do need hospital care, they are led into the hospital through a separate entrance.

"We want to make sure anyone with COVID symptoms doesn't have to go inside the hospital at all unless they get admitted,” says Chris Van Gorder, president and CEO of Scripps Health, which has five hospitals in Southern California.

You will be required to wear a mask (and so will everyone else)

Earlier in the pandemic, health systems were masking only patients with suspected infection and frontline health care workers. At most hospitals now, everyone is required to wear a mask, even patients seeking treatment for something like a broken ankle, as well as all staff members.

If you arrive by ambulance, the paramedics will likely have already given you a mask. If not, a hospital staff member will hand you one before you walk in the door.

Depending on the hospital's supply, you may be given a surgical mask or a donated cloth version. Physicians recommend bringing your own mask if you have one.

Because people can spread the virus before showing signs of the disease, treating everyone as potentially infectious helps stem its spread, doctors say.

After Brigham and Women's Hospital in Boston put a “universal masking” policy in place, for instance, new coronavirus infections diagnosed in its staffers dropped by half, according to a hospital spokesperson.

Visitors are not allowed

To reduce the risk of infection, most hospitals are restricting visitors. That means a family member won't be able to accompany you into the emergency room or be with you during treatment. Exceptions are made for laboring mothers, patients who are under 18 and those at the end of life.

Doctors know the restriction is a hardship for families, especially when a patient is critically ill, says Rade Vukmir, M.D., an emergency physician at Highmark's Allegheny Health Network in Pittsburgh. He says he tries to give family members regular updates by phone or in person outside the hospital.

Vukmir says he even uses FaceTime on his personal cell to help a patient see a family member. “Sometimes it's important for everyone to see everyone,” he says. “The daughter who's outside can say, ‘I love you, Mom.’ It's 30 seconds, and it's reassuring for everyone.”

If a patient needs to be admitted, many hospitals provide video-chat technology. Scripps Health hospitals give patients and family members iPads, for example, while Grady Memorial Hospital in Atlanta is experimenting with Amazon Echo Shows.

You may never see a COVID patient

Most hospitals or medical centers have a COVID-only ICU as well as an isolated wing or floor for admitted patients. Some hospitals with more cases have repurposed surgical centers or other separate medical buildings exclusively for contagious patients.

The COVID zones typically have their own dedicated medical team.

"If you come in here and don't have a COVID problem, you will never see a person with COVID, and the nurses who take care of you will never see a COVID patient,” says Todd Taylor, M.D., an emergency medicine physician at Grady Memorial Hospital in Atlanta and an ACEP spokesperson.

Whenever possible, hospitals also put infected patients in so-called “negative pressure” rooms, which are designed to prevent contaminated air from escaping.

Most hospitals initially had only a few such rooms, but many have quickly figured out how to create more by converting their HVAC system and making structural changes. Baptist Health Lexington transformed an entire wing of its ER, as well as two CT scanners, into negative pressure areas, Stanton says.

What's more, COVID-positive patients are kept inside their rooms as much as possible. “We don't send those patients to the X-ray room. We bring the portable X-ray to them,” Vukmir explains.

If an infected patient does have to be moved, the elevator is locked down to prevent anyone else from getting on, and the patient is escorted in a private procession. “It's almost like the president is coming through; we don't let anyone near them,” Stanton says.

Hospitals are finding solutions to PPE shortages

Nationwide, hospitals still face a critical shortage of PPE (personal protective equipment), especially N95 respirator masks, says Akin Demehin, director of policy at the American Hospital Association. But hospitals have been creative in coming up with solutions, he says.

Many are using hydrogen peroxide vaporization to sterilize masks so they can be reused. Others ask medical workers to rotate through a fixed number of masks, placing used ones in a paper bag at the end of a shift and not using them for a specific number of days. (Studies show that coronavirus particles on a surface lose their viability significantly after 72 hours.) Both processes have been temporarily approved by the Centers for Disease Control and Prevention (CDC) during the pandemic.

To help their N95 masks last, many physicians wear a surgical mask or a plastic face shield on top of it. And a growing number have purchased reusable respirators — hard plastic masks with cartridges that trap airborne particles — meant for industrial painting or manufacturing. They can be easily sterilized between patients, and the CDC says they protect as well as, if not better than, N95 masks.

"It looks like an astronaut helmet, but I know I'm breathing in uncontaminated air,” says Angela Fusaro, M.D., an emergency medicine physician in Albany, Ga.

Anyone who enters the room of an infected patient also wears a cap, gown, gloves and eye protection. “They have little PPE stations right outside of the door of all the COVID patients, so you can do everything right there,” Fusaro says.

At some hospitals, trained monitors watch to make sure staff members don't miss a step when they don and remove equipment.

You may be sent home to recuperate

If you do end up in the hospital during these unprecedented times, you may not have to stay as long. To keep beds available for a possible surge of COVID patients and reduce the risk of infection, many doctors are discharging patients a little earlier than usual, Taylor says.

To make the transition easier, they are sending patients home with high-tech systems that allow them to remotely monitor the patient and staying in close contact through telehealth visits.

If a patient has had surgery for a heart attack, for example, cardiologists can send him or her home with wearable devices that offer real-time monitoring of their heart rate, blood pressure, daily step count and sleep habits. They may also require in-person checkups with a visiting nurse service.

Even patients seen in the ER but not admitted to the hospital are being given devices for increased monitoring, Taylor says. The systems can measure a COVID-19 patient's oxygen level remotely, an important indicator that can tell doctors if the patient's health is declining.

"If we're a little worried about a patient, the monitoring systems allow us to send them home but keep closer tabs on them,” Taylor says. “And the patient can connect with us by video just by pushing a button.”