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Hospitals ponder what changes may linger after pandemic

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Dignity Health Memorial Hospital.

Now that hospitals are no longer overrun with COVID-19 patients, administrators are taking stock of some changes brought on by the pandemic. 

One of the most noticeable is the plunge in emergency room visits that began at the start of the pandemic but has continued, at some facilities, even as COVID-19 hospitalizations and cases taper off.

The drop in ER volume has been attributed to both concern about being exposed to COVID-19 at the hospital and adherence to stay-at-home orders, which has reduced the spread of illnesses other than the coronavirus.

But now that the most recent COVID-19 surge has subsided and vaccinations are picking up, ER visits have not picked up much, according to Bakersfield Memorial Hospital President and CEO Ken Keller. And he expects it could stay that way for some time.

"When trends like use of the ER, going to the movies, going out to eat, are limited or restricted, it’s going to take people a while to get back in the habit of taking advantage of that asset or resource," Keller said.

Keller said some experts believe people found a new normal for health care during the pandemic. Whereas before they may have gone to the hospital for something like a headache or a cut to the finger, during the pandemic they sought care elsewhere — at an urgent care or by scheduling a visit or telehelath appointment with a family physician. Or they may have just waited a few days and the condition subsided. And in the future, they may do the same.

A recent study by the Keck School of Medicine at the University of Southern California found that in a Los Angeles County hospital with one of the busiest emergency rooms in the nation, ER visits dropped by almost 40 percent at the start of the pandemic. That raises important questions about who is not getting care, the study's authors said. Their review found that people who continue to go to the ER tended to be "older, male, Black, uninsured or publicly insured."

Delayed care during the pandemic — whether from avoided trips to the hospital or routine health visits — is also an emerging concern. Memorial's CEO Keller said that in addition to a return of scheduled elective surgeries at the hospital, there has been a dramatic increase in urgent surgery or procedures, likely because a condition has worsened to a critical point after not seeking care. 

Adventist Health hospital physician Jonathan Dario said he's seen a similar trend and noted the pandemic made it harder for people with chronic, long-term conditions to manage their health. 

"We do see patients where they haven’t been able to follow up and now they’re coming in and they’re more sick," Dario said.

While delayed care surely accounts for some of the lull in ER visits, a silver lining of the pandemic may also have played a part.

Zara Arboleda, a spokeswoman for Valley Children's Hospital in Madera, said flu and other respiratory viruses common in children, like RSV, often land children in the ER. But during COVID-19, those illnesses have been virtually non-existent.

"Normally our emergency department is overrun with flu and RSV cases and we are not seeing that," Arboleda said.

Like other hospitals, Valley Children's ER volumes have fallen significantly, from about 120,000 ER visits a year to about 72,000 in 2020.

One exception appears to be Kern Medical, where chief medical officer Glenn Goldis said ER visits are back up to 93 percent of normal. The rise is mainly driven by trauma and behavioral health cases, which are two areas in which Kern Medical specializes.

Outside of the effects of delayed care and reduced ER volumes, many health officials locally and nationwide believe the wearing of masks, shields and disposable gowns by hospital workers will remain in heavy use even after COVID-19 is under control due to the infection control benefits they have provided.

"This is just another piece that we as an industry have adopted and we’ve seen presenting positive results," said Keller. "We have to ask, does giving it up justify the extra risk the patient may see?"

Telehealth is also widely expected to continue.

"We've realized there are more things that can be done at home instead of in-person," said Dario, of Adventist Health. "With the right tools we can use those as a benefit for medicine overall."

But for good measure, COVID-19 is not completely in the rearview mirror.

"We are not out of the pandemic yet. There’s still variants out there. We could start to see outbreaks again," said Jan Emerson-Shea, spokesperson for the California Hospitals Association.

But if there is yet another wave of cases, she said, the public should continue to seek care and not put it off — especially for serious conditions that warrant a trip to the ER.

"People should not be avoiding seeking emergency care. It’s always better to go and get checked out," Emerson-Shea said. "Hospitals are probably among the safest places you can be."

Coronavirus Cases widget

  • Positive Cases Among Kern Residents: 158,270

  • Deaths: 1,828

  • Recovered and Presumed Recovered Residents: 150,950 

  • Percentage of all cases that are unvaccinated: 92.04

  • Percentage of all hospitalizations that are unvaccinated: 92.62 Updated: 12/3/2021.

  • Source: Kern County Public Health Services Department