When first responders decide which hospital to bring a patient to, it depends not only on the patient’s condition, but also on the nearest hospital’s status.
Over the last six months, hospitals in Maryland have alerted EMTs to take patients elsewhere more than ever before, because they’re overwhelmed.
It’s called going on yellow status. When a hospital is seeing a surge in patients, is short-staffed, or busy, its staff can change its status on the County Hospital Alert Tracking System, essentially alerting EMTs on incoming ambulances of the current situation at their hospital.
“It’s an indicator from the emergency department staff that they’re feeling stressed, that they are a bit overwhelmed, and that they need a break from the EMTs if one can be gotten,” said Dr. Ted Delbridge, the executive director of the tracking system, which is operated by the Maryland Institute for Emergency Medical Service Systems (MIEMSS).
Delbridge said hospitals in Maryland are showing “historical high levels of yellow alert.” Where they used to be on yellow status less than 10% of the time, some hospitals are in that status nearly half the time.
There is no threshold a hospital must meet to put itself into yellow status, so it varies by hospital. Staff is also is responsible for taking their hospital off of yellow status, so human error can muck up the system if staff forgets to return it to a normal intake status. But those variables have always existed, and Delbridge said there’s data to support why it is being used more frequently.
At the start of the pandemic, many people were staying at home, and calls for emergency services fell. But there are more calls for service now than before the pandemic began, Delbridge said.
“While earlier in the pandemic, the EMS system across the state of Maryland was averaging 700 to 800 calls per day, now it is routine for it to be in excess of 1,500, on some days more than 1.600 calls across the state,” he said.
He added that COVID-19 is not playing as large a role as you might think: “The numbers of patients in Maryland hospitals, which have done an extraordinary job taking care of people affected by the pandemic, are less than half of what they were when the pandemic hospitalizations were at their high last winter,” he said.
Despite Maryland’s high vaccination rate, with 83% of eligible recipients having had at least one dose according to state data, Bob Atlas, president of the Maryland Hospital Association, attributes the stress on hospitals to an uptick in COVID-19 due to kids returning to school and adults to work, as well as a high-demand from non-COVID-19 patients who may have delayed care during the pandemic.
“At the same time, hospital caregivers have been on the front lines more than 570 days and staffing concerns are becoming more prevalent. So, the combination of strong demand and personnel constraints is forcing hospitals to ask EMS to divert patients more often than in normal times. And yet, the situation in Maryland hospitals is not as dire as it is in other states where COVID continues to rage unabated,” Atlas said in a statement.
With sometimes triple the usual number of ambulances arriving at hospital emergency rooms, what would have been called a surge during fall 2019 now seems to be the constant. Some hospitals are on yellow status three times more often than before the pandemic arrived in the D.C. area in mid-March 2020, according to MIEMSS data.
At Level 2 trauma hospitals, Adventist Healthcare Shady Grove Medical Center, in Rockville, was on yellow status 44 days over the last six months, compared with 28 days in the six months before the pandemic began. Meanwhile, Holy Cross Hospital, in Silver Spring, was on yellow status 78 days in the last six months, compared with 52 days in the six months pre-pandemic. And White Oak Medical Center, in Calverton, alerted twice as often as it did before the pandemic began — spending 84 days on yellow status, according to MIEMSS data.
Suburban Hospital, in Bethesda, spent 59 days on yellow alert status compared with 34 in the six months pre-pandemic. And Capital Regional Medical Center/Prince George’s Hospital Center spend 60 days on yellow status, requesting EMTs take patients elsewhere, according to MIEMSS data.
Among regional hospitals, Fort Washington Hospital has had 47 days on yellow status in the past six months, a three-fold increase over the six months before than pandemic began. Charles Regional Medical Center, in La Plata, spent 23 days alerting EMTs to take patients elsewhere, and Southern Maryland Hospital, in Clinton, spent 42 days on yellow status, as compared with nine days in the six months before the pandemic.