Sicker patients, population growth strain Triangle hospitals

Iris Smith’s brother was transferred from a nursing home to WakeMed in January where he spent three days in an emergency department bay — even post-surgery — because the hospital did not have a room available.

The 81-year-old man was triaged, treated for internal bleeding and discharged from the emergency department.

“I think the biggest thing that really shocked me was to see all the bays completely filled, hallways completely filled and you have a patient on an ambulance waiting for a space,” Smith recalled. “It was overwhelming. I just felt so sad for the patients, for their care and it was just shocking.”

Five months later, in early May, another family member who needed stitches after an animal bite got treated from a stretcher in an emergency department hallway.

“All of the bays were filled up,” Karen Jones said. “To me, it’s unacceptable.”

Triangle-area hospitals report an increase in patient volumes administrators admit they are facing challenges with finding staff and physical space.

Dr. Seth Brody, executive vice president at WakeMed Health and Hospitals, told WRAL Investigates in February the region’s population growth is putting a strain on resources.

Coming out of the COVID-19 pandemic, Brody said WakeMed is also seeing sicker patients who require longer inpatient stays.

“There are just a lot of patients for a lot of reasons and the acuity — meaning how sick they are — is also higher,” Brody said. “It not only fills up your emergency department, but it also fills up the hospital with patients who need our care.”

Dr. Barbara Griffith, president of Duke Raleigh Hospital, said the challenge of discharging patients to post-hospital care settings like nursing homes and rehab centers makes it harder to free up beds.

A lower number of available beds can translate to backups and longer wait times at the emergency department, especially for less severe injuries and illnesses.

“If we don’t have capacity, we have to create capacity," Griffith said. "Maybe it’s repurposing an area of the hospital that is not used as much and using it for an observation space for patients.

“The sicker you are, the more likely you are going to be seen very quickly. That’s always been the case. That hasn’t changed.”

Wake EMS, which dispatches ambulance across Wake County, tells WRAL Investigates its crews are experiencing longer wait times at the emergency department.

Ambulance turnaround times prior to the pandemic averaged anywhere from 30-45 minutes — reflecting the elapsed time from arrival to when the ambulance is cleaned and returned to service.

The following data shows the average turnaround time from January to March at local hospitals:

• WakeMed Main: 46 minutes
• WakeMed North: 40 minutes
• WakeMed Cary: 40 minutes
• UNC Rex: 40 minutes
• Duke Raleigh: 38 minutes

During the three-month period, Wake EMS data shows nearly 900 calls that took longer than one hour, 44 calls over two hours and nine calls over three hours.

Wake EMS reports 355 calls at UNC Rex and 136 calls at Duke Raleigh that took longer than one hour to return to service during the same time period.

“There’s nowhere to put the patient at times and no staff to take control of the patient,” explained Brian Brooks, Wake EMS assistant chief. “It’s a domino effect. If our crews are out-of-service at the hospital with a patient on the bed they can’t answer 911 calls.”

Brooks, a 17-year veteran of Wake EMS, said the wait times have gotten worse post-pandemic.

Brooks said people with less severe symptoms would receive more efficient service at a primary or urgent care office; however, he acknowledged that for people without insurance the emergency department is their only option.

“Unfortunately, where we are in the healthcare system today, the ED is the only opportunity for some people to receive any sort of care,” Brooks said. “This is their last resort and this is their only access to healthcare.”

Medical professionals also note that hospital overcrowding take a toll on hospitals staff — doctors, nurses, diagnostics and support personnel — making emergency medicine a less attractive placement.