UPMC ER still facing shortage
56-hour wait time for service reported; hospital officials call situation ‘difficult’
When a relative of Altoona City Councilman Jesse Ickes went to the UPMC Altoona emergency room with heart-related symptoms one day this week, an ER employee warned of a 56-hour wait for service, Ickes said at a meeting next day.
“It’s astonishing that that is the status of the ER in our local hospital,” Ickes told fellow council members. “Our ER has turned into Venezuela.”
Strong words: and yet when asked about Ickes’ claim, a high-ranking official of UPMC — which bills itself as “a leading academic medical center with world-class clinical expertise” — didn’t deny or push back Thursday during a virtual news conference devoted to COVID-19 issues.
It’s a “volatile” situation, a “difficult challenge” that has grown out of dramatically increased patients from the pandemic and out of many, many workers moving on under the duress of
“22 months of continuous activity,” said UPMC Chief Medical Officer Donald Yealy.
“Of course there are longer waits now, given all those dynamics,” Yealy said.
Despite the struggle, UPMC has kept the ER open, Yealy said.
It has also monitored wait times and done what it can to prioritize patients, while keeping others safe and while promoting alternative “platforms” for unscheduled care, like urgent care, telemedicine and UPMC’s contingent of primary care doctors, according to Yealy.
Teams at UPMC Altoona “work each and every day to find new solutions and invigorate current solutions,” Yealy said. “(To) make sure the stories you hear won’t happen again.”
“We have been handling this,” he said. “(But) this is not easy.”
It’s not easy because hospitals failed for a long time to heed warnings about the need to increase the nursing supply and because lawmakers, influenced by hospitals, didn’t pass legislation to set staffing formulas that would have forced them to hire more nurses, said Betsy Snook, CEO of the Pennsylvania State Nurses Association, in phone interview Friday.
“We’ve been talking about a nursing shortage for almost 10 years,” Snook said, citing a 2010 report by the Institute of Medicine that identified the problem.
Hospitals dismissed concerns and said they couldn’t afford what the association wanted, Snook said, “as if we’re crying ‘wolf.'”
When COVID-19 came, things got much worse, because patient demand spiked, even as burnout shrank the nursing cohort, she said.
Nationally, almost 20 percent of nurses have left the profession.
“It’s costing (the hospitals) a whole lot more now” to get the work done, she said.
The average starting salary for a registered nurse on staff is between $28 and $32 an hour, while agency or traveling nurses that hospitals are using to fill the gaps are earning between $90 and $100 an hour, she said.
And as agencies fill the gaps, they are siphoning more staff nurses away with the higher pay.
Some nurses who join an agency may opt for sunnier and more exotic locations, which could reduce the total number of nurses remaining in an area like central Pennsylvania, according to Carl Moen, executive director of the Southern Alleghenies EMS Council.
The real problem — the overall shortage — can’t be fixed quickly, according to Snook. “It takes a long time to educate a nurse.”
The preference now is for nurses to have a full undergraduate degree, as that leads to better patient outcomes, Snook said.
That means four years of post-secondary schooling.
It also means that collegiate nursing programs will need to staff up, because there is a shortage of instructors and many of the ones on staff are near retirement age, according to Snook.
The instructors need at least a master’s degree, she said.
Fixing the nursing shortage also requires a nudge on the hospitals from the public, according to Snook.
“Until the public gets upset about this, nothing is going to change,” she said. “The public needs to say, ‘this is not OK.'”
Staffing the issue
Local masonry contractor Tom Fahr was admitted to UPMC Altoona a couple months ago twice and received what his daughter, Christine Fahr, considers mixed care, which she attributes that to lack of staff.
But she doesn’t blame the nurses.
“They’re stretched so thin,” said Fahr, who is a nurse practitioner and formerly an RN. “They are put in a horrible position.”
Many years ago, she experienced overwork in a hospital, when her unit was short-staffed and she was mandated to work four more hours after a 12-hour shift caring for critically ill patients.
“You’re sleepy, you’re tired, you’re terrified you’ll make a mistake,” Fahr said. “One minor mistake could mean life or death.”
One nurse in the ER who tended to her father was kind and pleasant when her father first went in, but later grew impatient and angry, Fahr said.
She was triggered when her father, who was weak and confused, became uncooperative as workers tried to insert a “central line” IV, Fahr said.
The nurse, who was doing a shift of at least 12 hours, walked out, Fahr said.
“I don’t know if she was overwhelmed,” Fahr said.
The first time her father was admitted, he was sent home after four days, before the family could get the hospice-style care he needed, following a cancer diagnosis, Fahr said.
The second time he was admitted, it required Fahr’s intervention to get him transported to the floor after he’d been technically discharged from the ER, she said.
And when he was in palliative care, he didn’t receive as much attention as she would have liked — although she admitted she wasn’t aware of the standards of practice for that kind of department.
Still, the nurse practitioner on palliative care was “excellent,” Fahr said.
Pastoral care, too, “was excellent and comforting,” she said.
And UPMC was generous in letting both her and her mother remain with her father throughout both stints in the hospital, she said.
Her father died at age 77 on Oct. 12, two weeks after his cancer diagnosis, before which he’d been healthy and active in his construction business.
“They’re doing their best,” Fahr said of the nurses. “It’s just a really flawed system.”
Squeezed by Medicaid
Local primary care doctor Zane Gates agrees. It’s not the fault of the nurses and doctors.
“They’re under the gun,” he said. “They’re killing themselves.” Their situation is reflective of what’s happening all over the country.
For years, hospitals “downstaffed,” “trying to be more efficient,” Gates said.
Part of the reason was Medicaid, whose slender reimbursements “squeezed” the hospitals, Gates said.
Hospital consolidations, like the merger of the former Altoona Hospital with Bon Secours-Holy Family Hospital in 2004, reduced the number of beds, he said.
Then, when COVID-19 arrived, “it just crushed them,” Gates said.
Then came the release of the pent-up demand for regular care created by the initial moratoriums on elective procedures, Gates said.
Now flu season is here, which threatens to add even more patients, Moen said.
It would help ease pressure on the hospital if people don’t use the emergency room for minor issues like sprained ankles or wrists or sore backs, Gates and Moen said.
“Engage the family physician first,” Gates said. “They will have a lot of solutions for you.”
Urgent care is another alternative, he said.
The ER should be for chest pain and “bad COVID,” Gates said.
“Eliminate the unnecessary stuff,” he said.
“(Yet) we don’t want to scare people away from going to the hospital,” Moen said.
Perhaps most important is for people to get vaccinated against COVID-19, according to Moen, who noted the low vaccination rate in this region.
A local EMS official posting recently on Facebook was less diplomatic.
“If you haven’t gotten your shots, shame on you,” the poster wrote.
Filled emergency rooms mean that ambulance crews often need to wait before they can “hand off” a patient at the ER and go back on duty, Moen said.
Before COVID, there was typically little or no wait, he said.
Now, at Altoona, 20 minutes is typical, sometimes stretching as long as 40 minutes, he said.
In California, there have been ambulance backups as long as eight, 10 and 12 hours, Moen said.
The press of patients in emergency rooms is also causing a spate of “diversions” — hospitals requesting that ambulances take patients elsewhere, although diversion requests must be ignored if a patient or medical necessity demands it, according to information provided by Moen.
UPMC Altoona has not requested a diversion, Penn Highlands Tyrone and Mount Nittany Medical Center in State College have, he said. Conemaugh Memorial Medical Center in Johnstown and Chan Soon-Shiong Medical Center in Windber have requested diversions “essentially daily,” he said.
Hospitals that request diversions lead to longer trips for ambulance crews.
“What if…it’s your family member…waiting…and waiting…because all the ambulances in the area are transporting to hospitals hours away,” the poster wrote. “GET YOUR SHOT…dont be selfish, save someone else’s life.”
Mirror Staff Writer William Kibler is at 814-949-7038.