Are Covid patients in ERs counted as Covid hospitalizations?

[haapai]

I ask because I live in Michigan, where almost all of our hospitals are full and not admitting new patients or accepting transfers.  Because the ERs must still treat patients, there are staggering numbers of patients being treated in ERs that have taken over hallways and meeting rooms.  If they have not been formally admitted, are they still counted as Covid-related hospitalizations?

A lot of what I have been reading recently has encouraged me to de-emphasize new case counts and pay more attention to hospitalization numbers but I worry that those numbers don't mean much when hospitals reach or exceed capacity.  Anything that anyone can tell me about how those numbers are compiled would be very welcome. 

[pulmonarymd]

Dec 16, 2021 14:47:27 GMT -5 haapai said:

I ask because I live in Michigan, where almost all of our hospitals are full and not admitting new patients or accepting transfers.  Because the ERs must still treat patients, there are staggering numbers of patients being treated in ERs that have taken over hallways and meeting rooms.  If they have not been formally admitted, are they still counted as Covid-related hospitalizations?

A lot of what I have been reading recently has encouraged me to de-emphasize new case counts and pay more attention to hospitalization numbers but I worry that those numbers don't mean much when hospitals reach or exceed capacity.  Anything that anyone can tell me about how those numbers are compiled would be very welcome. 

Patients who are kept in the ED because there are no beds count as inpatients. Hospitals have every incentive to admit them, because they will not be paid if they are inpatients, but will only get paid for the ED visits. They will be leaving a lot of money on the table by not officially admitting them

[haapai]

That's a far more cynical answer than I had expected.  It's a useful thing to understand, but it doesn't really answer my question. 

[haapai]

Oh wait, you did answer the question.  I just did not understand the terminology.  Thank you. 

[pulmonarymd]

Patients are frequently boarded in the ED when there are no beds and they need to be admitted

Medicine is a business. People who work in it like to be paid. If you do not play the game correctly, you do not make enough to pay these people and they leave. Cynical, perhaps, but reality

[djAdvocate]

Dec 16, 2021 14:47:27 GMT -5 haapai said:

I ask because I live in Michigan, where almost all of our hospitals are full and not admitting new patients or accepting transfers.  Because the ERs must still treat patients, there are staggering numbers of patients being treated in ERs that have taken over hallways and meeting rooms.  If they have not been formally admitted, are they still counted as Covid-related hospitalizations?

A lot of what I have been reading recently has encouraged me to de-emphasize new case counts and pay more attention to hospitalization numbers but I worry that those numbers don't mean much when hospitals reach or exceed capacity.  Anything that anyone can tell me about how those numbers are compiled would be very welcome. 

probably not. but they will be counted as Covid Deaths, if they are so unlucky.

[haapai]

Dec 16, 2021 16:07:19 GMT -5 djAdvocate said:

Dec 16, 2021 14:47:27 GMT -5 haapai said:

I ask because I live in Michigan, where almost all of our hospitals are full and not admitting new patients or accepting transfers.  Because the ERs must still treat patients, there are staggering numbers of patients being treated in ERs that have taken over hallways and meeting rooms.  If they have not been formally admitted, are they still counted as Covid-related hospitalizations?

A lot of what I have been reading recently has encouraged me to de-emphasize new case counts and pay more attention to hospitalization numbers but I worry that those numbers don't mean much when hospitals reach or exceed capacity.  Anything that anyone can tell me about how those numbers are compiled would be very welcome. 

probably not. but they will be counted as Covid Deaths, if they are so unlucky.

Damnit!  Two people that I trust and admire are not answering my question directly and they are saying contradicting things.  I think that this means that I have to go read the tiny, hard to find, hard to interpret, boring as hell, footnoted things on CDC websites. 

I'm not sure if I am up for this right now.  Bad glasses, small screen, whine ....

[djAdvocate]

Dec 16, 2021 16:30:15 GMT -5 haapai said:

Dec 16, 2021 16:07:19 GMT -5 djAdvocate said:

probably not. but they will be counted as Covid Deaths, if they are so unlucky.

Damnit!  Two people that I trust and admire are not answering my question directly and they are saying contradicting things.  I think that this means that I have to go read the tiny, hard to find, hard to interpret, boring as hell, footnoted things on CDC websites. 

I'm not sure if I am up for this right now.  Bad glasses, small screen, whine ....

as much as I appreciate the deference, I would accede to pmd.

he is definitely more knowledgeable than i.

[pulmonarymd]

Patients are either admitted from the ED or they are discharged. They do not(except for psych patients) remain in limbo. If you are ill enough to be admitted, you are admitted. Admission criteria may change, and we may send home someone, who under normal circumstances, we would admit. Such as was done at times when people were sent home on oxygen. But, if they are ill enough to admit, they will be admitted. Hospitals have been at 110-120% of there licensed census, so patients are either being admitted and kept in the ED or admitted to whatever new area they have created to care for them.

One hospital in NY, Long Island Jewish, is licensed for just under 600 inpatient beds. At the height of COVID in April 2020, the had over 900 patients and about 100 on ventilators. Every possible space was converted into hospital wards. So someone who has COVID and is sick enough to be admitted will be admitted. The exceptions will not make up a meaningful difference.

And most importantly, it makes a big difference in what hospitals get paid. They have a significant incentive to count these people as inpatients.

[Tiny]

If they have not been formally admitted, are they still counted as Covid-related hospitalizations?

I suspect it comes down to the status on their records - if they've been formally admitted - it doesn't mean they've been moved from the ER to a room. Years ago my friend's mom was deathly ill and spent 6 hours in the ER, her doctor finally signed off on having her admitted, but there were no beds/rooms available. Mom then spent another 8 hours in the ER waiting for a room/bed.

I'm guessing for Covid19 there's two statistics that can be tracked - Admitted with Covid19 and released from the ER with Covid19. When reading "reported numbers" I'm guessing you need to know WHAT numbers are being used - and so will need to read the fine print.

It's kind of like trying to figure out what "retirement" means when you are talking about it with other people (for some people it means when they will start taking SS, for other people it means when they stop working full time, you get the idea. )

[pulmonarymd]

When they give a number for hospitalizations, it means patients who have been admitted. They can be anywhere in the hospital

[azucena]

I'm not sure you're asking the right question. If you're trying to gage covid numbers in your area, lack of hospital beds available are a leading indicator. It really doesn't matter % of covid cases being reported. The excess is coming from covid. And if hospital resources are maxed out or close to it, then it is definitely high. There is no other reason right now.

Life insurance actuaries are differentiating between covid deaths and what we are calling pandemic deaths. Pandemic deaths are all of the excess deaths that occurred due to pandemic factors - covid, delayed/unavailable surgeries, delayed cancer screenings and treatment, delayed cardiovascular diagnosis and treatment, higher motor vehicle accidents during the heart of shut down, etc.