Eight-hour waiting times. Patients leaving before being seen. Mass. hospital emergency departments are beyond the brink.
The emergency department at Massachusetts General Hospital was so backed up one Friday night last month that Janet Cook waited for nearly eight hours in a wheelchair in a crowded hallway before an inpatient bed opened up. That was after the 69-year-old Norfolk resident had writhed in pain for almost two hours before receiving medication.
“The halls were lined with patients on stretchers and the nurses would say to you, ‘We are sorry, we have no beds,’” said Cook, who was diagnosed with a bowel obstruction. “The lady across from me had a broken vertebrae in her neck, and there were people calling out for help. It was like a war zone.”
Cook’s recent experience at Mass General is hardly an isolated one. While hospital emergency departments across Massachusetts have weathered surges of sick patients throughout the pandemic and in years past, doctors say what they’re seeing now is unprecedented. Staffing shortages are at a peak — an estimated 19,000 positions are unfilled, according to a report released earlier this week from the Massachusetts Health & Hospital Association — and ERs are continuing to see a flood of desperately sick patients who delayed care during the pandemic. An early start to flu and respiratory virus season, and a steady stream of COVID-19 hospitalizations, has further strained the system.
Not only have wait times for patients increased, but doctors are citing an even more alarming statistic: a rising tide of ER patients who give up and leave before ever seeing a doctor. A recent national study found that the rate at which people are leaving hospital waiting rooms before getting care nearly doubled from 1 to about 2 percent between 2017 and the end of 2021, putting themselves at risk for even more severe illness.
To better understand the toll that overcrowded ERs are having on patients, the Globe asked readers to share their recent experiences. Some spoke of waiting for hours in pain. One recently retired physician suffered a stroke in September and had to wait 20 hours in the emergency department before a bed opened up. She spent much of the time on a gurney, just feet from a row of patients with antibiotic-resistant infections.
Several people who sought treatment at other hospitals described instances of overhearing intimate details of other patients’ medical histories and symptoms, as frazzled doctors and nurses tried to treat people in crowded waiting rooms.
“Most caregivers are saying this is the worst they have ever seen it,” said Steve Walsh, president of the Massachusetts Health & Hospital Association. “There is a enormous concern about the fragility of the system.”
Dr. Alexander Janke, an emergency medicine physician at the VA Ann Arbor Healthcare System/University of Michigan, has studied hospital crowding across the country and said it’s as if the levees have broken in the nation’s health care system.
“It’s not like we are on the brink. It’s like we are past the brink,” he said.
Janke and colleagues studied emergency department boarding — holding admitted patients in the ER, often in hallways, while awaiting an inpatient bed —nationwide between January 2020 and December 2021.
They found that when a hospital was more than 85 percent full, boarding times in the emergency department often exceeded the national standard of four hours. (Across Massachusetts, hospital beds are 94 percent occupied, according to the latest state data.)
Health experts say boarding longer than four hours creates concerns for patient safety, such as a higher risk for medical errors as overwhelmed doctors and nurses rush among patients to deliver care.
The researchers also found that when hospital occupancy exceeded that 85 percent mark, the median boarding time was 6.58 hours, compared with 2.42 hours in other times.
While emergency departments have periodically struggled over the years with overcrowding, the crisis now is considerably beyond that, Janke said. And the situation is continuing to decline.
“It’s unprecedented in my career,” said Dr. Michael VanRooyen, chief of enterprise emergency medicine at Mass General Brigham, who has worked in emergency medicine for 30 years.
Hospitals can’t free up enough beds in emergency departments because many of the places where patients are discharged to, like nursing homes, are also swamped.
Janke puts it this way: “All of us are at risk for being in a bad car accident, and you want the system to be ready for you. And it’s not ready for you right now.”
Janke and his colleagues also found that among the worst performing hospitals, roughly 10 percent of ER patients left before a medical evaluation at the end of 2021, compared with 4.3 percent at the beginning of 2017.
At Mass General Brigham, the state’s largest health system, an average of 6 percent of patients seeking emergency care from July through October left without being seen — three times higher than a level that used to set off alarms.
“We’ve never seen averages, to this degree, of 6 percent,” VanRooyen said, adding that he’s seen peaks above 10 percent during that same time period.
VanRooyen is concerned because, he said, the people who walk out before receiving care aren’t necessarily leaving because they are less sick.
“There’s been pretty good evidence that shows that people who leave without being seen are equally as ill as those coming into the hospital.”
Other health care systems in Massachusetts declined to share data about the percentage of their patients who left before being seen.
Yolette, a Randolph mother, said she saw patients repeatedly leave the emergency department waiting room in mid-September when she rushed her teenage son to South Shore Hospital because he was having trouble breathing. She asked that her last name not be used to protect her family’s privacy.
“It was so packed, and people kept coming in, and this head nurse was making announcements, saying it’s going to be eight hours until you are seen,” Yolette said. “And every time she made that announcement, people got up and left.”
She said they waited about three hours before her son was finally treated with oxygen, steroids, and intravenous fluids. He has since recovered.
Yolette was worried about the delayed care, but she said what prompted her to write a stern letter to the hospital was patient privacy concerns. During her hours-long wait, she said she inadvertently heard intimate details about other patients’ symptoms and test results as doctors were forced to treat many in the waiting room.
In a statement, South Shore hospital said the “extremely high” emergency department volumes they and so many other health systems are facing is challenging.
“While we are respectful of privacy at all times, we are also mindful of the importance of initiating care as promptly as possible during a patient’s visit, and this may include the need to communicate with a patient and/or a patient’s family in a lobby or waiting area,” it said.
The Baker administration on Tuesday raised the level of alarm it uses to track the number of staffed hospital beds available, marking an important signal for hospitals that crowding was worsening. The action requires weekly, regional meetings of hospital leaders to strategize ways to address the overcrowding and also consider voluntarily reducing elective, non-urgent procedures and surgeries.
But with no immediate relief in sight, VanRooyen said more patients may spend their entire time in the emergency department treated in a hospital hallway, or have blood drawn and intravenous fluids started in a waiting area chair.
The hope is that these “crazy accommodations” may ward off VanRooyen’s worst nightmare: someone who desperately needs emergency care leaving and deteriorating.
“There’s a very real risk,” he said, “of missing a surgical issue, a cardiac issue, a heart attack.”
Jessica Bartlett of the Globe staff contributed to this story.
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