Emergency departments in Arizona are extremely busy and while an uptick in respiratory illness is part of the problem, health providers say it's not the only cause.
Winter visitors, overburdened primary care doctors and a lack of insurance accountability are all part of the problem, some Arizona health experts say. Metal Hospital Bed
As a result, providers say patients are regularly spending hours and even days in emergency departments waiting for an inpatient bed: a problem known as "patient boarding" that negatively affects both outcomes and patient safety, studies have shown.
"I've been here at Valleywise for 13 years and I've never seen it this busy," said Dr. Kara Geren, an emergency medicine physician at Valleywise Health Medical Center in Phoenix, who says she's seeing patients of all ages, not just one age group. "It's many more patients waiting for beds than I've ever seen. ... Some of it is from respiratory illnesses, but it's certainly not the only reason."
Influenza, RSV (respiratory syncytial virus) and the virus that causes COVID-19 are in circulation now and both flu and RSV infections are at a higher-than-average level for this time of year, state data shows.
Geren said the colder weather tends to bring in more patients who are unsheltered and have substance misuse and behavioral health problems because "things just get worse if you have to be outside, and it's even worse when it gets cold." But there are likely multiple factors at play, including overall health system workforce shortages, she said.
"If something doesn't work, go to the emergency department. If this gets worse, go to the emergency department," Geren said. "If the system is not working, we're the receivers."
Prior to the COVID-19 pandemic, Valleywise Health Medical Center's emergency department saw between 160 and 170 patients daily. During the last few weeks, it’s been averaging 200 to 210 per day, with nearly 300 on peak days, Valleywise spokesperson Michael Murphy wrote in an email.
"Our emergency department is 14% busier than we expected it to be so far in the month of January and that was also true in the month of December," said Mimi Coomler, the chief executive officer for Tucson Medical Center, which has the busiest emergency department in Southern Arizona and one of the busiest in the state.
One factor is that snowbirds who may have stayed away during COVID-19 have now returned and the winter population has increased significantly, Coomler said.
Emergency room visits are also up at Banner University Medical Center Phoenix, emergency physician Dr. Moneesh Bhow said.
"January is classically our busiest month but we were looking at our volumes compared to a few years ago and we are up five to 10% compared to previous years. It has been a really busy January," Bhow said. "We're busier than we were in January 2022 and 2023."
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"We physically have more patients than we had during COVID, but the patients that we had with COVID, especially towards the beginning of the pandemic, were just sicker," Geren said. "And now there are certainly sick patients, but the average patient is not as sick."
Geren said she's seeing patients of all ages. The vast majority of people with COVID-19 and influenza are discharged from the emergency department without being admitted to the hospital. But people in higher risk groups, including older adults and people with compromised immune systems, are more likely to need a hospital bed, she said.
Geren said she sees a "huge amount" of people in the Valleywise emergency department who were unable to get immediate help from their primary care physician, or they don't have a primary care doctor at all.
"It's fair to say from a workforce perspective, there's a physician shortage," Tucson Medical Center spokesperson Julia Strange said. "And one of the reasons people are ending up in the emergency department is because they can't get into a provider, or there isn't a provider on call."
Coomler, the Tucson Medical Center CEO, said that there's been a recent issue with the availability of on-call subspecialist physicians for emergency departments in Southern Arizona, such as gynecological surgeons and ear, nose and throat specialists. As a regional hospital, TMC gets emergency transfers from other hospitals that don't have the subspecialists their patients need, she said.
One reason people are winding up in emergency departments is a systemic issue with health insurance accountability that can lead to fewer practicing physicians in the community, Coomler said.
House Bill 2035, introduced by Rep. David Cook, R-Globe, mandates health plans provide comprehensive information on claim denials and calls for streamlining the appeals process and reducing time wasted by health care workers seeking clarification.
Cook's proposal also calls for reducing the credentialing timeframe for physicians and other healthcare providers to 45 calendar days, from the current 100 days, with retroactive payment for claims accrued during the credentialing process, a news release from the Arizona Hospital and Healthcare Association says.
"I really believe that the only way to solve this is through policy change," Coomler said of the increased emergency department volumes. "If you are an independent physician and you are practicing in a market where payers are unchecked, you can't get paid for the work you do and you leave ... Payer accountability is a really important change we can make."
Another bill, House Bill 2290, was introduced by Rep. Alexander Kolodin, R-Scottsdale, and is aimed at fixing delays in transporting patients between hospitals, which affects the availability of beds.
Arizona patients often face extensive wait times when they are transferring between hospitals, and Coomler said Kolodin's bill would reduce those delays by allowing hospitals to manage their own transportation services or contract with local fire departments and districts.
"If you are not critically ill, you might have to wait," Geren said. "We're not going to forget about you, it just takes us a long time to get done what we need to get done."
Providers say it's always helpful for patients to know when they should go to an emergency room rather than an urgent care or primary care provider. Chest pains, shortness of breath, difficulty breathing, confusion, loss of speech or mobility or a high fever are all signs that someone should go to an emergency room, whereas a sore throat, runny nose and cough can typically be handled by a primary care doctor, a virtual visit or an urgent care.
The real problem with crowded emergency rooms is that it results in patient boarding, which is not unique to Arizona, Geren said.
"This is a national system problem that we're seeing at a local level and we just try to deal with it," she said Jan. 9. "We have someone here who has been here for 73 hours. It's almost three days. They've been sitting in the emergency department. ... Studies have shown that patients who are boarded in the emergency department rather than having an inpatient bed, the mortality goes up."
Emergency department volumes are up across the country, U.S. Health and Human Services Secretary Xavier Becerra wrote in a Dec. 18 letter to U.S. Rep. Debbie Dingell, D-Michigan.
"Crowding and boarding problems in EDs are not new but significantly worsened during and since the COVID-19 pandemic," Becerra wrote. "This situation is far from ideal patient care and can exacerbate health inequities, cause workforce burnout, and create risks for patient safety and public health."
At one point on Jan. 8, 150 patients were holding in emergency departments waiting for an inpatient bed in hospitals in Tucson, Coomler said.
"The ED (emergency department) can never say no. We don't ever close our doors, we just continue to expand to the extent that we can," she said. "We certainly have adapted our systems to provide good patient care in the emergency department but our preference, and the patient's preference, is to be in an inpatient room."
Delivery Bed In Hospital Reach health care reporter Stephanie Innes at Stephanie.Innes@gannett.com or at 602-444-8369. Follow her on X, formerly Twitter: @stephanieinnes.