The worst U.S. flu season in almost a decade has forced hospitals to find extra space to treat patients

Source: Sarah Toy

Emergency departments across the U.S. have been slammed in recent weeks by an onslaught of flu visits, forcing hospitals to devise new spaces to house patients, to restrict visitors and to postpone elective surgeries.

Visits to hospital emergency departments, urgent care centers and other outpatient clinics by people with flu symptoms have been skyrocketing for several weeks. As of mid-January, such visits had surpassed every flu season except 2009-10, when a new flu strain caused a global pandemic. The dominant strain this season, H3N2, is particularly virulent, and the vaccine isn’t very effective against it.

NYC Health & Hospitals has seen a 40% increase in the number of people being tested for the flu compared with this time last year, according to Sean Studer, deputy chief medical officer of the group, which runs New York City’s public hospitals, clinics and long-term care facilities.

Feverish ActivityCumulative flu hospitalization rate for each week since early November for the 2017-2018 season comparedwith previous seasonsSource: Centers for Disease Control and Prevention
.per 100,0002013-20142014-20152015-20162016-20172017-2018012345678910110510152025303540452015-2016x5x0.8 per 100,000

To cope with greater traffic to the emergency department, hospitals in the network are opening up so-called “flex” spaces that aren’t usually needed for routine care. Patients coming to the hospital reporting flu symptoms are also placed in a separate waiting area and given masks to help prevent transmission, Dr. Studer said. If they need to be admitted, patients are given a room with a single bed when possible.

In Atlanta, the emergency department at Grady Memorial Hospital is caring for up to 25% more patients than it did at this time last year. The department usually sees around 400 patients a day, but there have been times this month when that number shot up to 502, according to Hany Atallah, Grady Memorial Hospital’s chief of emergency medicine.

“Our emergency department is full, and our inpatient services are full,” he said. “Overfull, actually.”

But people are still coming, so the hospital has set up a temporary mobile medical unit on its premises for 30 days to deal with the overflow. Fully equipped with medical supplies and 14 beds, it is essentially a second emergency room, Dr. Atallah said. Staff began seeing patients in the mobile unit on Tuesday.

A mobile emergency room is set up outside Grady Memorial Hospital to help handle the ever-growing number of flu cases.
A mobile emergency room is set up outside Grady Memorial Hospital to help handle the ever-growing number of flu cases. Photo: David Goldman/Associated Press

In addition to the mobile unit, Grady Memorial is using “family waiting rooms, holding areas and literally some hall spots” for patient beds, said Dr. Atallah.

Not everyone who comes to the emergency department needs to be admitted to the hospital, Dr. Atallah said. A patient who is young and otherwise healthy will likely be treated for fever, muscle aches and dehydration and then sent home to rest. Those most at risk for complications are the elderly, very young children, or people who have other health issues that the flu can exacerbate.

Given the severity of the flu this season and its potential complications, the hospital isn’t allowing children 14 years old and younger to visit hospitalized patients. Children tend to harbor more infections, Dr. Atallah said, and they may not be as diligent about hand sanitization.

The University of Alabama at Birmingham Hospital, which sees an average of 250 to 300 patients each day, has experienced a jump in volume of about 10%, largely because of the flu outbreak. “We’ve not only seen an increase in volume, but an increase in acuity,” said Sarah Nafziger, physician adviser for the Center for Patient Flow at UAB Hospital. “People are sicker than they were in previous years.

“It’s not just people with flu symptoms, but people who have chronic medical conditions that are exacerbated by the flu,” she added.

To deal with the higher number of emergency department visits, UAB is placing patients in areas that would normally be used for postoperative patients, such as anesthesia recovery rooms. The hospital has also delayed some elective surgeries that would require an overnight stay to open up more beds for admitted patients.

“As you can imagine, that’s a costly decision for the hospital because elective surgeries and nonelective surgeries are the way hospitals increase their revenue,” said Dr. Nafziger. “But sometimes you have to make those decisions to make sure you can safely care for patients.”

Visits to hospital emergency departments, urgent care centers and other outpatient clinics by people with flu symptoms have been skyrocketing. Above, a medical assistant gives a patient a flu shot at the Sea Mar Community Health Center in Seattle on Jan. 11.
Visits to hospital emergency departments, urgent care centers and other outpatient clinics by people with flu symptoms have been skyrocketing. Above, a medical assistant gives a patient a flu shot at the Sea Mar Community Health Center in Seattle on Jan. 11. Photo: Ted S. Warren/Associated Press

The surge in flu-related admissions will place pressure on hospital margins because reimbursement for flu admissions is often insufficient to cover the cost of treatment, Moody’s Investors Service said in a report Monday. It can also crowd out elective procedures, which command higher reimbursement rates, Moody’s said.

In its latest brief on flu season, the Centers for Disease Control and Prevention said Friday that 49 states were reporting widespread flu activity, though California and other West Coast states were beginning to see a turnaround.