This story by Nora Doyle-Burr was first published Feb. 14 in the Valley News.
LEBANON, N.H. — Because of overcrowding, Dartmouth Hitchcock Medical Center is warning patients with “less pressing healthcare concerns” to expect extended wait times in the emergency department.
“The DHMC emergency department and our inpatient clinical units are caring for an unprecedented volume of patients with very complex medical needs,” Dartmouth Health CEO Dr. Joanne Conroy said in a recorded YouTube message released on Wednesday.
The hospital will prioritize patients who are most urgently in need of care, such as people experiencing a heart attack or stroke, or who are critically injured, she said.
The increased wait times are due to the ongoing respiratory virus season combined with the nationwide shortage of health care workers, according to the warning issued by Conroy. She noted that flu and RSV continue to be a challenge for employees and for the community.
“If you must be admitted to the hospital, there are waits, sometimes for up to 24 hours, for inpatient beds,” Conroy said. “I understand and everyone who’s working with you gets it — these wait times are very frustrating.”
Dr. Colin Stack, Dartmouth Health’s medical director for care coordination, attributed the unprecedented nature of the overcrowding to the demand for post-acute care, skilled nursing facility beds, and other post-hospital resources, which he said in an emailed statement, “has never been higher.”
While the crowding is a challenge for other hospitals across the region, Stack said it is “most pronounced” at academic and tertiary care facilities such as DHMC because “this is where the most complex cases and patients end up requiring care.”
To address the crowding, Stack said, “Dartmouth Health is exploring options, investments, and partnerships to provide our patients with better access to these limited facilities and resources.”
Staffing shortages continue to create challenges on the outpatient side of things, although Dartmouth Hitchcock Clinics Heater Road Primary Care in Lebanon is now bringing on nearly 300 new patients a month and is seeing the majority of new patients in less than 10 days, according to Dr. Elisabeth Wilson, Dartmouth Health’s chair of community and family medicine.
“Our current workforce crisis is actually staffing shortages, rather than providers, including nursing and medical assistants,” she said in an emailed statement on Wednesday. “We are creating new workflows and encourage patients to take advantage of telehealth visits while we work to fill multiple open positions.”
The Vermont Association of Hospitals and Health Systems on Monday also called attention to the ongoing bed crunch across the region in a legislative update. In Vermont, as of Feb. 6, there were 142 individuals waiting to be discharged from hospitals and 28 patients waiting for beds in emergency departments, Devon Green, the association’s vice president of government relations, said in the update.
Because patients often have no place to go following their hospital stay, Green said, “health care providers are having to treat individuals in waiting rooms and at least one emergency department went on diversion.”
Diversion is a term used when a hospital’s emergency department is crowded and it asks ambulances to bring patients elsewhere.
To address the crunch, the group is advocating for strengthening the state’s post-acute care system, including skilled nursing facilities and home health agencies.
“The Agency of Human Services has some good forward momentum in stabilizing skilled nursing facilities and home health agencies, but we hope the legislature can go even further to strengthen these organizations so Vermonters can get care in the right place at the right time,” Green wrote.
In addition to respiratory viruses and workforce shortages, Steve Ahnen, president of the New Hampshire Hospital Association, also pointed to difficulties hospitals face in discharging patients as a cause of backups and delays across the health care system. To help reduce demand on the system, in a Wednesday statement he urged community members to “remain vigilant about basic health care and hygiene, such as regular handwashing, to stay healthy.”
In addition, he said, “masking, testing, vaccines, and other mitigation methods are still important tools against COVID-19 and other respiratory illnesses. There is no one solution that can completely eliminate the risk of spreading infections, but when layered together, these interventions can have a significant impact on the rate of infections, hospitalizations and deaths in New Hampshire, and ultimately on the capacity challenges facing our health care system today.”
In early January, amid increasing rates of respiratory illness, DHMC resumed masking requirements for staff in patient rooms and treatment areas. Patients and visitors with respiratory symptoms also were encouraged, but not required, to wear masks.
Corrections: Dr. Joanne Conroy was misquoted in an earlier version of this story, which also included an incorrect name for the Vermont Association of Hospitals and Health Systems.
