Crowded Minnesota ERs overflow into waiting rooms amid flu surge

Minnesota hospitals are leaning on triage systems, created out of desperation during peaks of the COVID-19 pandemic, to weather the current surge of patients with influenza and other viral illnesses who are crowding their emergency rooms.

United Hospital in St. Paul was the latest to adopt the so-called “split flow” approach last month, providing initial care to patients in its waiting room when its ER bays were full. More than 20 patients sat in its waiting room Thursday afternoon, but some already were receiving fluids intravenously while others were awaiting results of blood tests and one frail patient was lying on a hospital bed that had been wheeled out.

“Our patients are seeing providers more quickly than prior to implementing split flow, despite having our highest patient volumes of all time” over the past four weeks, said Dr. Kelsey Echols, medical director of United’s ER, who herself suffered influenza on Christmas and endured a 104-degree fever.

Hospitals reported a little relief this week as Minnesota emerged from the holiday season — a time when families and friends spread germs as well as cheer.

Thursday’s weekly state update showed that flu-related hospitalizations had peaked in Minnesota at 877 in the first week of January and then declined to 742 in the week ending Jan. 11. The latest total was still higher than in any other week in the last five flu seasons, though, presenting challenges for hospitals that also were busy treating patients with COVID-19, RSV and norovirus infections.

“Take care of yourself, folks,” said Dr. Will Nicholson, vice president of medical affairs for M Health Fairview’s East Metro Hospitals. He encouraged people to seek vaccinations, stay home when sick and take other precautions to avoid illness.

Fairview has used the triage approach at St. John’s Hospital in Maplewood. Allina Health added it at United in December, expecting a surge of ill patients, but already had it in place at Abbott Northwestern Hospital in Minneapolis and Mercy Hospital in Coon Rapids.

Forty ER bays were full Thursday afternoon at United, and the wait time for arriving patients was 50 minutes. Still, that was shorter than it could have been because many in the waiting room received triage care, Echols said. A couple of ER bays were held in reserve for trauma cases and emergencies, which she stressed had a waiting time of zero minutes.

Dave Peterson, 72, of Blaine arrived at the United ER at 10:30 a.m. Thursday, complaining of numbness in one hand, a possible stroke symptom. He didn’t get to a room in the ER until almost 3 p.m., but by then he had received a blood test and an imaging scan that confirmed he had a mild stroke because of a blood clot.

“It’s been busy,” Peterson said, “and you just wait your turn because there’s a lot of people here and most of them are worse than I am.”

Peterson admitted it felt weird to receive medical care in a triage room and then be shuttled back among other patients in the waiting room. His daughter helped an older woman next to her by putting her feet up in her wheelchair and putting padding behind her back.

Previously, though, “they probably would have been waiting for four and a half hours before anything happened,” Echols said.

The logjam upstream in hospitals remains part of the problem. Thirty of the 40 patients in the United ER, including Peterson, were waiting for inpatient beds to open upstairs in the hospital.

Influenza outbreaks in 14 long-term care facilities in Minnesota last week won’t help. That was an increase from eight outbreaks the prior week. Nursing homes often lose workers to illness during outbreaks, which means they can’t take as many patients when they are ready to be discharged from hospitals. That in turn keeps inpatient hospital beds occupied, which clogs up the emergency rooms.

Nicholson said triage care is only part of the solution for hospitals such as St. John’s, which is smaller and has less waiting space than other hospitals. At peak times during the pandemic, patients sat beyond the St. John’s waiting room and in the front-door vestibule while they waited for their names to be called.

The hospital responded by renovating ER space into a triage center and installing a pre-fabricated short-stay unit last year for patients who needed observation for a day or two but not inpatient admission. Nicholson said Fairview has pursued more solutions since that time, improving connections with clinics that can schedule post-hospital evaluations and prevent patients from needing to return to the ER.

Even so, he said the “goalposts keep moving” because the population is getting older and patients are encountering more complex medical problems that eventually demand hospital care, especially when they also suffer infections.

“We’ve got boarding at various places all the time in our EDs that we’re working through,” he said. “So it’s continual.”

COVID-19 has contributed to the pressure on hospitals, although the infectious disease has caused fewer hospitalizations in Minnesota than at the same time last year. Levels of the coronavirus that causes COVID-19 also peaked in early January in Minnesota, based on wastewater sampling. So COVID-related hospitalizations may decline in the coming weeks.

COVID-19 remains a lethal threat, being associated with more than 230 deaths in Minnesota since the start of October, almost entirely among people 65 and older. Influenza in that timeframe in Minnesota caused 50 deaths among people, with a median age of 81.

Wisconsin on Thursday reported its first influenza-related death of a child. None have been reported so far this season in Minnesota.