MUNSON MEDICAL CENTER

Munson Medical Center in Traverse City.

TRAVERSE CITY — Hour two came and went while Ellen Reed was in the front seat of her car, smoking a cigarette and waiting for emergency room doctors to see her 11-year-old son.

She and her husband took shifts, one parent inside with their son, and the other in a white Ford nestled in the Munson Medical Center parking lot. They suspected food poisoning, or some type of flu. But they still didn’t have any clarity — emergency department staff had taken her son’s blood pressure, given him a bag for the vomit, and asked the family to wait.

So she waited.

What the Reeds experienced Thursday has become common at hospitals across the country. Emergency rooms are slammed with staffing shortages, a plateauing surge of the COVID-19 delta variant, and waves of patients who postponed care for months. The confluence has caused longer wait times and frustrating visits.

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Acute care centers in northwest Michigan report visits stretching inordinately long, leading patients to make a day out of an ER visit: As Reed waited in her car, a DoorDash delivery driver pulled into the lot to bring food to people waiting inside — the first time he’d delivered to people in the waiting area, the driver said.

One registered nurse who works in the emergency room at Munson Medical Center said that they’d seen waits as long as 10 or 15 hours, with one recent patient waiting as long as 24 hours “just to get a bed upstairs.”

The nurse asked not to be named in this story because they fears retribution from their employer.

The same RN said the crush has forced nurses to juggle multiple patients, including ICU patients who should be what nurses called “1:1”, meaning the nurse should only be tending to that patient. On top of that, the emergency department charge nurse has to balance incoming admissions from ambulances, which often jump the list in priority, as well as patients who can become aggressive and verbal abuse from patients in the waiting room, the nurse said.

“Everybody in the waiting room is like ‘What’s going on? We’ve been here for eight hours,’” the nurse said. “They have no idea what’s going on back there.”

The waits have primarily been the product of a tidal wave of COVID-19 cases. That wave hit northwest Michigan in September and has since plateaued, according to data collected by Grand Traverse County. For almost a month, hospitalization numbers have been high at Munson Medical Center, the region’s largest hospital.

That wave has broken over the region while other cases have begun to recede in other hotspots across the country, making the high number of coronavirus cases in the area somewhat of an outlier.

“I think people are hearing that this surge is over,” said Christine Nefcy, Medical Director for Munson Medical Center, while speaking at a press conference on Tuesday. “That is absolutely not what we are experiencing here in Michigan. And definitely not what we are experiencing here in northern Michigan.”

Grand Traverse County is reporting around 44 new cases per day, with a running total of just more than 1,100 active cases.

As they get sicker, those patients are funneling into urgent care centers, health clinics and emergency rooms. When they arrive, they hop in line with a number of other patients who are sick with seasonal symptoms, like sinus infections or the flu, as well as patients with acute needs that might not have seen a doctor in months.

The collision of events has made emergency wait times painfully slow, according to health care workers.

“In 2019, you’d walk in the front door. You’d sign your paperwork and you’d be seen in 15 minutes,” said Pete Balmquist, a nurse at Bayside Docs Urgent Care.

“Now you pull into a parking lot and you call us. You do a screening over the phone. Then you wait for a room to be available. That process alone drives the wait time up,” Balmquist said. “It takes twice as long to see half as many people.”

Balmquist said she’s seeing patients who are sicker when they come in the door. If it’s COVID-19, there’s not much she can do. Monoclonal antibodies are not readily available, even when patients ask for them. The 10-day window in which they’ve been shown to be helpful is a window many patients don’t meet, even as their shortness of breath worsens and the aches and pains of coronavirus sickness refuse to go away.

“There’s nothing we can prescribe as a cure for COVID,” Balmquist said. “We just treat the symptoms.”

The Urgent Care center also is seeing more patients than normal, many who are beginning to come earlier and earlier in the day.

“Sometimes that starts right when we open,” said Shelley Roskey, an office administrator at Bayside. “It’s 9 a.m. and there’s a line out the door.”

The crush continues in the waiting room of the emergency department at Munson, where patients say they’ve sometimes brought pillows and blankets to wait out the queue.

Hospital policy dictates admission on a worst come, first serve basis. Nurses assess patients on a scale of 1 to 5, with 1 being the most severe cases, like cardiac arrests. Cases categorized as a 1 jump to the head of the line to be seen immediately, said hospital staff. Cases categorized as a 2 ideally get seen in 15 minutes.

Meanwhile, cases categorized as 3, 4 or 5 get repeatedly pushed back as more severe cases trickle in.

Those pushbacks become more common in light of heightened levels of acuity being seen in the ER — meaning that patients are coming in with more serious conditions than the hospital normally sees.

Jeninfer Lechota, Munson’s Director of Nursing and Throughput and Emergency Services, described longstanding emergency room strain being made worse by the most recent wave.

“When you take a pre-existing, nationwide, complicated problem and then superimpose a pandemic, it gets very, very complicated, very quickly,” said Lechota. “We’ve seen rapid shifts in how patients are receiving and seeking care, we’re seeing people sometimes choosing to delay their care which then can result in them getting sicker and then presenting to the emergency department in a worse state.”

Lechota estimated patients have been waiting between three and five hours. She said the hospital doesn’t specifically track how long patients sit in the waiting room. The hospital does track the total length of a patient’s stay, but Lechota declined to share those numbers with the Record-Eagle.

Between 2019 and 2020, the average length of stay at Munson Medical Center’s Emergency Department was just more than three hours and 20 minutes, according to data collected by the Centers for Medicare and Medicaid Services and self-reported by the hospital.

Lechota said that without context the number might lead patients to delay seeking care, which is why she said she declined to share the recent figures.

The emergency department is also seeing an increased volume of visits overall. On a given day, emergency room staff treat between 130 and 200 patients.

“We have 43 rooms in the emergency department and let me tell you we use every one of them,” said Brendan Franklin, who manages the emergency department.

Staffing shortages worsen the wait. Nurses are constantly trying to cycle patients upstairs to the main hospital, but while there are physical beds available, there sometimes aren’t enough staff to attend them, which leads to longer stays in the emergency department.

Data from the Department of Health and Human Services shows that this week, the hospital was only able to staff 90 of 112 available ICU beds. Eighty-nine of those beds were used, the data show.

Franklin said the emergency department isn’t having staffing issues, and that they’ve continued to have luck hiring — the hospital now offers new nurses $10,000 signing bonuses — but other facilities in the area haven’t been as lucky.

Skilled nursing facilities in the county often aren’t accepting patients that come through Munson’s emergency room, so patients that can be transferred upstairs sometimes can’t be transferred out of the hospital, either.

In other cases, longer waits at other hospitals have put pressure on Munson’s ER as well, leading patients to drive several hours to come to Munson’s Traverse City location.

“Even places downstate that are having staffing shortages can impact the wait times in our ER,” said Brian Lawson, a spokesperson for Munson Medical Center.

Lechota, the nursing director, said she didn’t want to minimize or sugarcoat the challenges facing the emergency room as patients keep coming through the door.

“This has been 19 months of uncertainty and strain,” Lechota said. “Everyone’s world has been turned upside down with COVID.”

Ellen Reed’s son never ended up being seen. Their family waited 5½ hours before deciding to leave altogether. They drove 40 minutes down the road to Munson’s Kalkaska location, where the emergency department was able to treat her son with anti-nausea medication after waiting for an hour and a half.

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