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No surge in patients yet at most hospitals; DHMC in Lebanon tries to reduce emergency room visits

Monitor staff
Published: 3/13/2020 6:07:01 PM
Modified: 3/13/2020 6:06:47 PM

New Hampshire hospitals are preparing for a rush of patients, especially to emergency rooms, with the state’s biggest medical facility is telling doctors not to send patients to the ER unless absolutely necessary.

Dartmouth-Hitchcock Medical Center in Lebanon, which has almost one-fifth of the state’s staffed hospital beds, sent a notification to providers and patients Friday “in response to an increase in the number of patients who are being sent directly to the Dartmouth-Hitchcock Medical Center Emergency Department in Lebanon for screening and testing.”

“If a patient does not exhibit signs that warrant an emergency department evaluation or immediate hospital admission, providers should ask the patient to don a mask and return to their home for self-quarantine, and follow CDC guidelines pending further decisions on COVID-19 testing,” the center said in a release to providers and the public. Patients who have COVID-19 symptoms should call a hotline at 650-1818 “for screening and, if appropriate, scheduling testing.”

The note also asks patients of Dartmouth-Hitchcock not to come directly to the emergency room if they are “experiencing fever, cough, or shortness of breath or are concerned about potential exposure to COVID-19” but first call a hotline 650-1818 “for screening and, if appropriate, scheduling testing.”

The DHMC has 422 staffed beds, according to the American Hospital Association.

The state’s 13 acute-care hospitals in total have 2,266 beds. That includes 221 beds at Concord Hospital, 96 at Lakes Region General Hospital in Laconia, and 491 between the two hospitals in Manchester.

Medical facilities around the country are concerned about being overwhelmed as the coronavirus spreads, particularly since treatment of serious COVID-19 cases can require patients to be kept in bed on respirators for days or weeks.

One of the main reasons for canceling public events is to slow the spread of disease and reduce the chance of too many people getting sick at once.

Concord Hospital has not issued any caution about its emergency room. It has created a designated area in the emergency department “where patients who present with COVID-19 symptoms will be evaluated … to reduce transmission risk,” wrote  Dr. James Noble, chief of the Infectious Diseases at Concord Hospital, in an article for the Monitor.

Vanessa Stafford, spokeswoman for the New Hampshire Hospital Association, said the statewide group was surveying hospitals “to gain situational awareness on things like supply inventory, which now includes ventilators.” As of Friday afternoon, she said, “we haven’t seen a surge” in patients, but she noted that the situation can change rapidly.

Cass Walker, vice president of administrative and support services for Lakes Region Healthcare, said Laconia General Hospital has not seen a surge in patients and has not made changes to staffing or room layouts, but is ready to do so.

Like some other hospitals, Laconia has instituted drive-up testing. If a doctor sends an order to the emergency room, technicians will come to a patient’s car when they arrive and take a swab that will be sent to the state laboratory in Concord for testing.

“They know what number to call when they arrive, and don’t have to get out of their car,” said Walker of the patients.

The patients go home, self-isolate and monitor themselves. If signs or symptoms develop, they can come to the ER, she said.

Currently it takes 48 to 72 hours for test results to come back, Walker said.

Kathy Bizarro-Thunberg, executive vice-president of the state Hospital Association, noted that all hospitals have the capability to isolate COVID-19 patients.

“That can range from private rooms to fully outfitted rooms with negative pressure capabilities. Hospitals can also add enhanced isolation capacity by utilizing portable isolation units that can transform a private room into a negative pressure isolation room,” she wrote. Negative pressure isolation is a system where air flows into a room but not out into the rest of the hospital, which keeps airborne virus droplets from being spread.

“Not all individuals that have been diagnosed with COVID-19 or other respiratory infections need to be hospitalized. If hospitalization is not medically necessary, the individual can be taken care of at home (if appropriate),” Bizarro-Thunberg wrote.

(David Brooks can be reached at 369-3313 or or on Twitter @GraniteGeek.) 

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