The stress has returned to the Emergency Department at the CHA Everett Hospital this month, as the crew there struggle to keep up with the double whammy of COVID-19 patient increases and large numbers of behavioral/mental health needs also flooding the hospital – while at the same time scrambling to have the right staffing in place at all times.
Dr. Melisa Lai-Becker, chief of the Emergency Department at CHA Everett, said the hospital is seeing a surge of patients right now for COVID-19 complications, with 64 patients having been admitted and the ICU units full for the last two weeks. However, at the same time, they have been hit with a post-holiday surge of behavioral health and mental health needs coming to the hospital as so many people have seemingly reached their breaking points.
“There’s a lot of activity,” she said on Monday. “The hospital is very busy and we are also seeing a near parallel surge and near-crisis levels of mental health and the needs there. A lot of things are boiling down to being able to work with the manpower available and working simultaneously with the vaccine rollout program.”
Cases of COVID-19 in Everett, Chelsea and Revere have surged over the past several weeks – with more than 400 per week in Everett over the last several weeks. That has led to many more people coming to the hospital for treatment, and right now the hospital is working hard to keep staffing levels up so they can treat all of the patients seeking treatment.
“The issue overall with our hospital is not a lack of physical beds, but a question of whether or not we have enough nurses and employees to staff and care for patients,” she said. “We have been trying to hire up traveling nurses, but it’s very hard…It’s like a prize when you find the manpower.”
The COVID-19 surge and staffing concerns have been hit by an underreported issue of surging patient loads seeking treatment for mental health and behavioral health issues. Seemingly, many people are at the end of their rope and seeking help from the hospital as their last hope. Lai-Becker said they are seeing patients who are experiencing issues because of the disruption in life from COVID, who have social needs, who feel isolated, who have lost employment, who have lost income, who have housing insecurity, who have food insecurity, who have drug use issues or who might have relapsed due to a substance use disorder. Many times, too, that is exacerbated by the people also having COVID-19, or perhaps only about one or two degrees removed from someone with the virus.
She said the Emergency Department can handle a total maximum of 42 patients at one time. On a recent day, maybe 19 of them were for behavioral health.
“The situation in Everett is quite similar to Cambridge Hospital and not that different from really most every Emergency Department in the state,” she said. “It’s a back-up due to many months of the challenges related to COVID-19, the switch to tele-health and tele-psych visits.”
That situation has many divergent paths that spider web off from it like a set of hiking trails in a National Park. At one time, CHA Everett only had to worry about COVID-19, as if that wasn’t enough. Now, the mental health effects of 10 long months of the virus wreaking havoc on lives has created an additional issue to account for.
One path branching out from that problem is that the patients for behavioral health many times cannot be placed with a roommate, and require extra staffing to advocate and supervise them. Once they are admitted, they have to have a one-person room and that leaves fewer rooms for patients with COVID.
“Some have a high enough level of acuity, even without COVID-19, they should not be placed with a roommate,” she said. “That can drain available bed capacity…It’s exacerbating the challenges of an already stressed situation that exists.”
As a result, it creates another trail in the network, and that is one where patients have to wait longer in the Emergency Department. In fact, many ER’s are becoming holding areas for those looking for a bed – whether at the hospital or at another facility. At CHA Everett, Lai-Becker said they have always kept wait times to a minimum for those being admitted, but now it is taking a little longer – though it is nowhere near the wait times happening at some of the larger Boston hospitals.
“You may not get in at 1 a.m., but instead 7 a.m.,” she said. “Maybe that happens with a little more frequency for us.”
Yet another divergent path is the situation at the Boston hospitals, which apparently is much more crowded than in the spring. Last spring, many of the larger Boston hospitals were able to provide CHA Everett a “pop-off valve” to give extra capacity when they became inundated. That was true of surrounding hospitals like Winchester Hospital and others, she said. No longer is there a “pop-off valve” available in Everett, and in fact some of the larger hospitals are looking to the CHA network for capacity.
“Everything that was concentrated here in the spring is all over now,” she said. “It’s not just here anymore…It was concentrated at CHA Everett and in hot spot communities of Chelsea, Everett and Revere. Not anymore…It’s not Southern California here by any stretch, but it is very hard. We’re all feeling it. You add in behavioral health challenges and we are all in this together in every hospital feeling this stress and strain.”
Waiting for After Christmas
The end of the year holiday time has carried a nervous energy with it, as those in the hospital wait to see if the surge that came after Thanksgiving will double-up, or ease up.
Dr. Lai-Becker said the large numbers of cases coming to the hospital right now are part of the post-Thanksgiving and early Christmas spread of the virus. Now, they all wonder what awaits them in the new year.
“Globally, we are girding our loins for what’s about to happen downstream in the next three or four weeks,” she said. “It’s a lot of the same things that have been dreaded in other cities and states – and that’s also the case here.”
Already, CHA Everett has begun going back to twice-daily calls within their hospital, and once-daily calls within the network and with other Boston hospitals. Much of what they’re doing is trying to “balance the load,” or make sure that only one or two facilities don’t become overrun while others have capacity.
She said people are working really hard right now, coordinating and putting in long hours to make sure situations don’t arise like in California where life or death care decisions are being made in the hospital. That is known as Crisis Standards of Care operations, and it’s something that the hospital came a hair away from having to use last spring. The work now is to keep that from actually happening this winter.
“I want to give assurance that CHA is working really hard to work in our own system and with all our colleagues and partners,” she said. “Everyone is pulling together and everyone is working hard to make sure we create as many resources as we can…We’re fortunate we’re not Southern California and we don’t have to enact Crisis Standards of Care. We talked about that in April and May and everyone is working really hard to keep that from happening here.”
The COVID-19 vaccine program is moving very quickly and successfully at CHA Everett and in the CHA network, Lai-Becker said.
They have moved through their Group 1A and 1B priority staffers already with a first dose, and have opened up to Category 2 and 3. They have received shipments and are using both the Pfizer and Moderna vaccines.
As of Dec. 31, they have had 2,361 CHA employees get the vaccine.
“That is fantastic because we are looking at about 4,400 of direct care CHA employees to be vaccinated,” she said.
They hope to have the staff vaccinated by the end of the month.
Lai-Becker said they are hiring in a number of different positions and staffing is at a critical level. She said they need people in medical positions like nurses and the Psychiatry Department, but also people without medical backgrounds who could be advocates and “patient watchers.”
“We may not need someone who has previous health care experience as much as we’re looking for compassionate people who are caring and able to be there,” she said. “One thing we need is we need help in terms of people who can be patient safety watchers and patient advocates.”
She encouraged everyone to check the hospital’s website for positions that are available.
“We are hiring,” she said.