JUANA SUMMERS, HOST:
This month marks the end of both federal and global public health emergencies sparked by COVID-19. While much of the world seems to be moving on, last week, World Health Organization epidemiologist Maria Van Kerkhove made a plea.
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MARIA VAN KERKHOVE: We can't forget the images of the hospitals filled to capacity, the images of our loved ones who died, with health care workers who ensured that they didn't die alone.
UNIDENTIFIED PERSON #1: So we don't have a fresh bed?
UNIDENTIFIED PERSON #2: We do.
UNIDENTIFIED PERSON #1: Great.
UNIDENTIFIED PERSON #2: We do.
SUMMERS: That mission has stuck with Carol Ann Sperry, who's been a nurse for more than four decades.
CAROL ANN SPERRY: While a lot of people were frightened away by COVID and during all those changes, it reminded me why I do what I do. I had the privilege of being with patients in their dying moments when families couldn't be here.
SUMMERS: Sperry is the director of Emergency Services and Emergency Management at the University of Maryland, Baltimore Washington Medical Center.
UNIDENTIFIED DISPATCHER: Patient is coming from a rehab facility...
SUMMERS: She and her colleagues recently walked us through the emergency department to explain how emergency care has changed - in some ways for the better and, in many ways, irreversibly.
UNIDENTIFIED ANNOUNCER: Priority one patient to room nine - ETA now. Priority one...
SUMMERS: We saw a priority one patient, meaning someone in serious critical condition. The man - a double amputee in cardiac arrest - was wheeled past us and into a room, surrounded at times by nearly a dozen health care workers. A situation like this one is an example of what Sperry called the controlled chaos of working in the emergency department.
SPERRY: Then we'll put the patient on the ventilator, and then we'll hook him up to all the equipment in here.
SUMMERS: One thing that's changed has been the number of nurses still working on staff.
SPERRY: We've lost about 55% of our staff since 2020.
SUMMERS: The hospital says that number was accurate as of January 2023. Now, their nurse vacancy rate is at 20% - lower, but still close to the current national average for hospitals, and climbing back to 100% will be tough. A new nationwide survey out this month from AMN Healthcare, a traveling nurse and medical staffing company, found only 15% of nurses plan to keep working as they are a year from now.
SPERRY: I don't think that the world or the emergency department has equilibrated since 2020, and I think that we are still searching for a new normal.
SUMMERS: Did you ever consider leaving at any point...
SPERRY: Yes.
SUMMERS: ...During the pandemic? Tell us about that.
SPERRY: There comes a time where you have to reassess whether you are finding joy and satisfaction in what you do. And there certainly have been periods where I couldn't find that joy. And so you have to work through that. You have to reassess, set smaller goals and then just continue to move forward.
SUMMERS: There's another big change that nearly everyone we spoke to on staff mentioned.
SPERRY: The acuity and how critically ill they are.
NEEL VIBHAKAR: The challenges that we've seen post-COVID, including acuity.
CHIRAG CHAUDHARI: Acuity of the patients is a little bit higher.
SUMMERS: Acuity, meaning the intensity of the care that people need, has shifted since 2020, in a way that Sperry called traumatic.
SPERRY: I think patients today are much more complicated and much sicker than they were in the past, if that's believable. I think a lot of people did not attend to their health care for several years, either because of lack of ability to do so or fear.
GAIL EDENSO-BAILEY: One of my biggest fears with the hospitals is that I won't be listened to - that the staff won't be friendly.
SUMMERS: That's 42-year-old ER patient Gail Edenso-Bailey, whose fears were unfounded during this visit to treat dangerously low oxygen levels. Her breathing was shallow and her gaze bleary, but she was still able to laugh.
EDENSO-BAILEY: I probably would have waited it out. I'm that kind of person that's like, if I don't need it and it's not bothering me, I'm not going to come in (laughter).
SUMMERS: Some patients also avoid the ER because they don't want to spend hours and hours in the waiting room. Reports of longer wait times during the pandemic have not helped.
How are you feeling today?
ROMA ROWE: Lousy.
SUMMERS: That's Roma Rowe. She's in her 70s and has liver cancer. We met her briefly in an ER room, where she turned down the TV to talk with us. She and her spouse, Kathleen, were going to come in the night before, but...
KATHLEEN: It's too busy over at nighttime. So we waited till this morning, came in about quarter to 8 this morning. And there was about five people in the waiting room before us, so it hasn't been a long day.
SUMMERS: Have you all been here before when it's been really busy?
ROWE: Yes.
KATHLEEN: I've been in here...
ROWE: Yes.
KATHLEEN: The last time I was in here with my sister...
ROWE: We were in here all night.
KATHLEEN: ...It was 12 1/2 hours waiting to even get back to this part.
SUMMERS: Twelve-and-a-half hours - which isn't typical.
VIBHAKAR: I think that, unfortunately, emergency departments have developed this reputation of having a wait time. And as a result, patients electively wait. And we would hope that they don't do that.
SUMMERS: Dr. Neel Vibhakar is the chief medical officer at UM Baltimore Washington Medical Center.
VIBHAKAR: While we have seen those median wait times increase over the last few years, we're excited about the interventions that we've put into place.
SUMMERS: One key intervention Vibhakar and Sperry explained is vertical care. Patients who can stay upright are cared for without putting them in an ER bed. There's also rapid medical evaluation, where doctor and nurse teams sometimes bring testing and treatment to a patient right in the waiting room.
SPERRY: And we can mitigate the downstream risk of not having bed capacity to treat our patients.
SUMMERS: But the hospital says waiting room treatment isn't a long-term solution for patient flow demands, which have fluctuated.
CHAUDHARI: We thought we saw the light at the end of the tunnel about 18 months ago. And as many people have said, that light at the end of the tunnel was just an oncoming train.
SUMMERS: That's emergency department physician Chirag Chaudhari, who we spoke with during his shift. As we talked, there were steady pings and alerts from various monitors going off near his workstation.
CHAUDHARI: As emergency medicine workers, we consider ourselves to be the MacGyvers in the house of medicine, and we can sort of weather these challenges.
SUMMERS: Another ongoing challenge - patients with mental health needs, in particular, are staying in the ER longer.
CHAUDHARI: Which we hadn't seen prior to the pandemic - to this extent.
SUMMERS: The number of people reporting anxiety or depression symptoms tripled in the first 15 months of the pandemic. ER visits for overdoses also went up 26% in 2020. That's according to a report last May from the American Hospital Association. Chaudhari says a lack of available beds and staff at post-acute care facilities can leave patients with few options on where to go after the ER.
CHAUDHARI: Any emergency department you ask in the country is going to have a story of somebody that they had to harbor in their walls for an extended period of time - could be weeks, could be months, you know, even, for some of these patients. It's awful when you can't get a patient to the care that they need.
SUMMERS: That feeling - knowing that some aspects of patient care are out of your control - has always been a part of the job. It's another reason hospital leaders have kept a focus on their own staff's needs too.
SPERRY: It used to be a work-life balance. Now it's a life-work balance, right? What are we putting first?
SUMMERS: Before we left the hospital, we asked Carol Ann Sperry about the strain she and her colleagues faced during the pandemic.
SPERRY: Oh, gosh.
SUMMERS: A long pause.
SPERRY: Bringing new nurses into an environment - that was extremely challenging. You know, sort of a little bit of my mother mentality snuck in. And I wanted to protect them and keep them from skinning their knees, but I couldn't do that, you know? We had 23-year-old nurses experiencing death for the first time in the workplace, right? And you know, we have to really continue to focus on them and continue to tap into - what made you make that choice? And what else can we do to make sure that that's your choice tomorrow and the next day and the next day, right?
MARY LOUISE KELLY, HOST:
That was our co-host, Juana Summers, reporting from Glen Burnie, Md.
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