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Critical condition

UPMC Emergency Department under fire for long wait times due to staffing shortages

UPMC Altoona’s Emergency Department is facing criticism for long wait times due to a high number of COVID-19 inpatients and continuing staffing shortages. Mirror photo by Patrick Waksmunski

Shari Routch, director of enrollment management at Penn State Altoona, awoke at 3 a.m. Oct. 7, sweating and nauseous, in excruciating pain in her chest, neck, jaw and armpits, and thought — correctly, it turned out — that she was having a heart attack.

Her husband, Mike, drove her fast to UPMC Altoona’s Emergency Department, and she hobbled in, hunched over, and sat on the floor, moaning.

Almost 7.5 hours later, Routch left the Emergency Department, by which time she had received no real assistance pertaining to her case from the hospital.

She’s OK now, having gone to her primary care doctor after that 7.5-hour wait to begin getting the needed help, but her experience at the emergency room is symptomatic of a situation there that isn’t OK — as the hospital itself admits — because there are too many patients and too few health care workers.

“We empathize with those who have had to wait for … care,” UPMC Altoona President Jan Fisher stated in an email forwarded by a spokeswoman in answer to questions from the Mirror.

Routch

“Yes, we are extremely busy in our Emergency Department right now,” Fisher wrote. “It is a struggle.”

The hospital is especially busy because it has a high number of COVID-19 inpatients, who often need to stay longer, who are often in intensive care and who are often difficult to send home, because of “current regulations and factors outside of our control — such as long-term care facility capacity and or COVID-19 testing requirements,” Fisher stated.

Unlike other hospitals that divert patients to Altoona, UPMC Altoona doesn’t reduce pressure on its ER by diverting patients itself, Fisher noted. “It is our mission to be there when our community members need us most,” she wrote.

The hospital is trying to staff up, Fisher said.

But all the other hospitals in the region are also looking for health care workers, she wrote.

Recruiting is difficult, for many health care workers have begun to reexamine their careers, leading them to seek new employment choices, with “less time at the bedside or additional flexibility” or else to seek work in different organizations, Fisher wrote. Some have left the workforce entirely, she added.

UPMC has tried to make up for the worker shortfall by expanding its recruitment and retention offerings and by holding “multiple” job fairs over the last few months, she wrote.

The hospital is having trouble retaining and recruiting because it doesn’t pay enough, according to Ashley A., a licensed practical nurse at UPMC Altoona, who posted on the Mirror website, then spoke by phone to a reporter.

“Many RNs have left to be travelers to make twice as much as they could ever make here,” Ashley wrote. “LPN wages don’t even come close to other competitors.”

Those LPN starting wages are between $12 and $14 an hour, she wrote.

“Lowest paid in our area,” she wrote. LPNs could work at a local convenience store and do just as well, she added.

Anesthesia medication clerks earn $12.04; cardiology techs $12.89, Emergency Department communication techs $13.92 and ED techs $12.89, as of July 2020, according to the wage chart in the contract between the American Federation of County, State and Municipal Employees local to which Ashley belongs and the hospital.

Routch, the heart attack patient who came to the ER in the middle of the night, needed to wait in line for the ER receptionist when she arrived at the hospital.

When it was her turn to speak to the clerk behind the window, she said she thought she was having a heart attack and described her symptoms.

“OK, have a seat,” the clerk said, according to Routch.

Routch settled into a wheelchair, still moaning in pain.

After about an hour and 20 minutes, the pain began to dissipate.

She was called back, and a triage person took her vitals and asked how she felt.

Better than before, Routch said.

The triage person sent her back to the waiting room.

Another hour went by, and workers took her for a chest X-ray.

Then she returned to the waiting room.

At some point, her husband opened her UPMC “portal,” which stated that her chest X-ray was normal, and that she had presented with a cough.

That was not descriptive of her symptoms, so she got up to complain to the clerk at the window, who said she would call back to someone in the ER who could explain what was going on, Routch said.

At this point, it had been about five hours since Routch had come to the ER.

The waiting room was still packed, she said.

No one came to explain why her portal stated that she had presented with a cough.

Not long after that, the waiting room denizens were told that everyone was going to be re-triaged, Routch said.

Routch went to the clerk at the window, hoping that meant she’d be seen, but learned that it would be done based on the order in which people had arrived.

Routch tried to convince the clerk that it made more sense to prioritize by severity of symptoms, to no avail.

It was now about 10 a.m.

So the Routches called the office of Shari’s primary care doctor.

That office told her that someone would call the ER and insist that Routch be treated immediately.

That apparently didn’t work.

At 11:15 a.m. or so, the Routches called the primary doctor’s office again.

This time, someone in that office suggested she leave and come over to their facility on Logan Boulevard.

They left about 11:20 a.m.

At the primary care doctor’s office, employees did an electrocardiogram and bloodwork and referred Routch to a cardiologist at Station Medical Center.

The cardiologist saw her immediately, ran tests based on the bloodwork and confirmed that she had had a heart attack.

The cardiologist directed her back to the hospital ER, and when Routch objected, he told her he’d call ahead with instructions.

She found the waiting room at the ER far more crowded even than before.

“Standing room only,” she said.

There was a different clerk behind the window, and the Routches didn’t hold back.

“My wife could have died,” Mike yelled, according to Shari. “Nobody here was paying attention!”

Shari herself “screamed something you can’t publish,” she said.

Shari was given a bed this time, in a hallway.

“The nurses were very nice,” she said. “They were trying their very best.”

They also apologized for what had happened.

She remained in that bed until next morning, when she was taken back for a heart catheterization, she said.

The report from the catheterization was good, and she eventually went home with medications.

“I feel very lucky I didn’t die there,” Routch said about her initial experience in the ER. “It was chaos.”

She’s sympathetic to the situation, but believes that prioritizing patients based on severity of symptoms would at least make things safer.

She also questioned a protocol that seemed to be based on the assumption that everyone was there for COVID-19.

Actually, the ER does prioritize according to severity, “focusing on those with the highest level of concern first,” Fisher wrote.

The ER seemed to be prioritizing patients according to severity of need when he was there this week, according to Michael McLanahan, who reached out to the Mirror by email.

“There was a gentleman who was in a wheelchair, patiently watching developments for what had to be 20 hours — he arrived before me,” McLanahan wrote. “His condition seemed to be less of a concern than mine so I went into treatment before he did.”

Fisher assigned no blame to the workers for the hospital’s current struggles.

“We are grateful for our selfless employees who (labor) so hard to care for people,” she wrote. “Our UPMC Altoona team members’ commitment and dedication is unparalleled.”

McLanahan, an emeritus trustee at Mount Aloysius College, who was in for five days for a gallbladder issue, including 16 hours in the ER, lauded the workers.

While in the ER, he was “marveling at the kindness and courtesy extended by nurses and other staff” as they evaluated crash victims, overdose patients, people with dementia, domestic abuse victims and other crime victims, he wrote.

“Many (patients) spoke crudely or rudely, mumbled or failed to respond at all to the nurses who were trying to help,” he wrote. “(But) never once did I observe a nurse speak back to any of them in (the) same fashion.”

One overdose patient “was screaming that she was on a beautiful high and resented the fact, in colorful words, (saying) that she hate(d) the person who gave her a shot of Narcan,” McLanahan wrote.

Every nurse who tried to treat the woman was abused, sometimes physically, he wrote. “But each of them responded with kind, soothing words,” he said.

The overload of patients come to Altoona because Altoona “has the laudable goal of never turning away any person who has a need to be admitted,” he said.

Up on the floors, where he had a gallbladder operation, two of his three roommates posed additional challenges to employees, he wrote.

One with dementia “made it very difficult for the five or six providers to uncover his actual need(s)” — especially as he had no family members to help them.

That roommate also frequently set off alarms “which brought nurses scrambling,” he added.

That man was eventually moved to another area. McLanahan had another roommate who also had issues that made it hard for the nurses to hear and understand, and he repeatedly set off his IV alarm because he was confused. The alarm would summon nurses who would “shut it off and try to get him to understand the cause,” McLanahan wrote.

Yet they were all “magnificent in the face of all these challenges,” McLanahan wrote. “None of them ever quit on a patient.”

A large part of the responsibility for solving the problem rests with the community, according to Fisher.

“Here are some ways the community can do its part,” she wrote:

* Get vaccinated against COVID-19 and the flu.

* Wear a mask indoors in public or when in a large group.

* Get tested for COVID-19 if you have symptoms.

* Use the ER only for more serious medical concerns.

Blair and Bedford have the lowest vaccination rates in the state, according to Fisher. Vaccination won’t guarantee you won’t get infected, but it will make it much less likely you’ll need to go to the hospital or that you will die, she wrote.

Rather than go to the ER for minor issues, people should consider seeking help from their primary care doctors, from urgent care centers, through virtual care and other non-hospital providers, Fisher wrote.

They should also be kind to health care workers, she wrote.

“Give them your grace, show your support for them and have patience,” she wrote.

Mirror Staff Writer William Kibler is at 814-949-7038.

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