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Hawaii hospitals see overcrowded EDs at the beginning of the year

Officials identify several reasons for patient surge in Oahu emergency departments


Honolulu EMS ambulances at a hospital.

Honolulu Emergency Medical Services/Facebook

By Nina Wu
The Honolulu Star-Advertiser

HONOLULU — The new year is starting off with a bang, and not in a good way, with emergency rooms across Oahu experiencing a surge in patients. Most are running at over capacity.

“We’re seeing four to five hospitals on Oahu being overwhelmed at the same time,” said Dr. Jim Ireland, director of the Honolulu Department of Emergency Services. “It’s getting harder to find places to take people.”

When ER departments are full, ambulances either have to make a longer drive to a different hospital or deal with longer wait times to transfer patients to doctors.

“Historically, that transfer time is under 20 minutes,” said Ireland. “We’re seeing now one hour on a semi-regular basis and, in extreme cases, even up to three hours.”

When patients aren’t transferred to the ER right away, he said, the paramedics are also unable to respond to other 911 calls.

The uptick in ER room visits has been building over the past few months, he said, but growing more intensely in recent weeks, including over the Christmas and New Year’s holidays.

What’s behind the uptick?

Ireland said there may be numerous reasons, including delayed routine care and screening during the height of the pandemic, more illness and an aging population.

“Overall, in certain sections of the population, health is worse,” he said. “There are more heart attacks, strokes, problems with blood pressure, diabetes and overall medical conditions,” he said.

Additionally, the return of tourists, and more people getting out and about means more potential accidents on roadways, in the ocean and on hiking trails.

It’s also respiratory virus season, with some COVID-19 cases and a spike in flu cases, resulting in 911 calls for breathing problems and very high fevers. There are still calls for overdosing on fentanyl and other narcotics, along with self-harm incidents.

Cumulatively, they add up to increased demand for emergency services.

EMS these days is conducting 160 to 180 transports a day, and a greater volume overall than during the same time in 2023.

Ireland said EMS is discussing with the state how to balance out the load and potentially reroute less serious cases to less overwhelmed hospitals.

He also encourages patients with illnesses such as colds, minor sprains and constipation to seek treatment at urgent care rather than in crowded emergency rooms.

On Friday, Oahu’s ER rooms were at 181% capacity, according to Hilton Raethel, president and CEO of the Healthcare Association of Hawaii, according to a dashboard that went live in mid-November tracking hospitals in real-time.

The dashboard showed emergency departments at The Queen’s Medical Center-West Oahu, Pali Momi Medical Center, Kapiolani Medical Center for Women & Children and Straub Medical Center all to be at over-capacity.

That means more patients than available beds, which requires bringing out gurneys or treating patients sitting upright, and higher demands on ER staff.

“It’s very challenging,” he said. “We were dealing with this over Christmas and New Year’s break, and in early January it’s not getting any better.”

Rise in West Oahu

What’s unprecedented, as well, is a rise in demand for ER services on Oahu’s West side.

“What’s been happening over the last few weeks is that Queen’s West on a regular basis now has more ER patients on any given day than Queen’s Punchbowl, which for years has been the biggest, busiest ER in the state,” said Raethel.

He believes the growth may have to do with new developments on the West side, along with more people working from home seeking care nearby.

Ireland said some days, Queen’s West is the busiest hospital in the state for ER volume, with up to 40 or more ambulances, about 25% of all EMS transports for Oahu .

“If patients are in critical, we always take them to the closest facility,” said Ireland. “If it’s serious or minor, there’s definitely delays at many of the hospitals on Oahu getting care transferred from paramedics to the ER team.”

Queen’s West is the closest hospital available for the Leeward side, but if it’s full, then Raethel said patients will need to be diverted to Pali Momi or Straub, and if those are full, then possibly to Wahiawa, Kuakini or Adventist Castle.

Adventist Health Castle in Kailua recently became certified as a Level 3 trauma center, which means patients with traumatic injuries now can be taken there instead of over Pali Highway, easing the load at The Queen’s Medical Center in Honolulu.

On Oahu, Queen’s at Punchbowl is certified as a Level 1 Trauma Center for the most life-threatening and critical injuries, while Pali Momi and Castle are certified Level 3 Trauma Centers.

Queen’s said despite the challenges, it remains committed to providing high-quality health care as Hawaii’s only Level 1 Trauma Center with a comprehensive stroke center.

“This distinction signifies our commitment to the people of Hawaii that when seconds count, Queen’s is prepared to provide comprehensive care for every aspect of injury using advanced life-saving technologies and the highest level of care and compassion,” said Dr. Rick Bruno, president of The Queen’s Medical Center, in a statement.

The West Oahu campus is using additional space at its hospital at this time to evaluate patients for their illnesses, along with high-quality video telemedicine technology.

Queen’s is also in the midst of expansion projects for the emergency departments at both its West and Punchbowl locations.

Statewide there are 304 emergency department beds — 160 on Oahu, 76 on Hawaii Island, 42 on Maui, and 26 on Kauai, according to the Healthcare Association of Hawaii.

Hospitals overall are also at full capacity, according to Raethel, with more than 2,400 patients in hospital beds per day since Jan. 3, which is putting a strain on the system.

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