Safe and Sound in the E.D.: RWJUH New Brunswick

Rigorous Procedures Ensure the Safety of Emergency Department Patients and Staff

Emergency Department (ED) visits fell sharply during the height of the coronavirus crisis, in New Jersey and nationally as well—and that has doctors worried.

“At Robert Wood Johnson University Hospital, we’ve seen our ED volume decline by 50 percent overall, and by about 75 percent for the pediatric ED,” says Robert Eisenstein, MD, Chief, Ambulatory Service/Division of Emergency Care at RWJUH and Chair of Emergency Medicine at Rutgers Robert Wood Johnson Medical School. “The problem is that disease prevalence doesn’t change,” he explains.

“Heart attacks, strokes, asthma, intra-abdominal diseases such as appendicitis and diverticulitis—COVID-19 didn’t make them go away, but we’ve been seeing these patients in the ED less and less.”

The probable reason: fear.

“The likelihood is that people have been putting off care because they’re afraid to go into the hospitals and be exposed to COVID-19,” says Dr. Eisenstein. “That concerns us because delaying care for many conditions can lead to disability and even death, and those risks are not necessary.

“The main message we want people to hear is that it’s safe to come to the Emergency Department, so don’t put it off,” he continues. “We’ve put many layers of protection in place for our patients and for our staff.”

Safety Measures

Safety steps taken by Emergency Departments throughout the RWJBH system include:

  • Separation of COVID-19 and non-COVID-19 patients upon entry
  • Setting aside special areas that are completely separate from COVID-19 patients and caregivers
  • Creation of “negative pressure” isolation rooms that prevent airborne contaminants from drifting to other areas in the hospital
  • Provision of masks for all staff and patients
  • Frequent disinfectant wiping of surfaces and equipment

“Our environmental services staff is doing a fantastic job of deep-cleaning our EDs,” says Dr. Eisenstein. “Every doorknob, every surface, is continuously being wiped with disinfectant.”

Cardiac Concerns

Doctors have long pounded the drum for patients to call 911 if they experience symptoms of a heart attack. “Time is heart muscle, and the sooner we can treat you after the onset of symptoms—ideally, within 90 minutes—the less damage to your heart,” says Anthony Altobelli III, MD, Chief of Clinical Cardiology at RWJUH.

Dr. Altobelli urges people to be aware not only of the classic symptoms of a heart attack such as chest pain or a feeling of heaviness in the chest, but of non-traditional symptoms such as shortness of breath as well.

Adding complexity to the situation is the fact that the novel coronavirus seems to exacerbate a range of other cardiovascular problems. “COVID-19 is a vascular disease as well as a respiratory disease,” says Dr. Altobelli. “It can lead to clotting in the arteries. It’s possible that a patient may have heart disease that has not been recognized, and with the stress of COVID-19 illness a cardiac event occurs. The event can be any of the known cardiac syndromes, including heart attack or heart failure. We just don’t have the answers yet.”

The important thing to know, he says, is that the advice for going to the ED is the same now as it was before COVID-19.

“Pay attention to symptoms,” says Dr. Altobelli, “and don’t hesitate to call 911.”

Stroke Risk

The coronavirus-related clotting that can lead to heart attacks also appears to increase risk for stroke.

A stroke occurs when a blood vessel that leads to the brain is blocked by a clot, or ruptures, leading to death of brain cells as they’re robbed of oxygen- and nutrient-rich blood.

Immediate treatment can minimize the long-term effects of stroke, such as speech and movement difficulties, and even prevent death.

People with uncontrolled high blood pressure or diabetes are at increased risk of stroke, as are smokers. But the pandemic has introduced a new wrinkle: a striking increase in strokes among COVID-19 patients as young as their 30s and 40s, who had no stroke risk factors and no other COVID-19 symptoms. This new risk makes it all the more important for people to act when they have symptoms (see list, below).

“Pay attention to the suddenness of the symptoms, which could include confusion and severe headache, and call 911 so you can be taken to the hospital right away,” advises Kiwon Lee, MD, Chief of Neurology Service, Director of the Comprehensive Stroke Center, Director of the Neuro Intensive Care Unit at RWJUH and Professor of Neurology and Chief of the Division of Stroke and Neurocritical Care in the Department of Neurology at Rutgers Robert Wood Johnson Medical School.

COVID-19, can affect the nervous system in other ways, too. “One of the most
common ways is the loss of smell,” Dr. Lee says. “Another is exacerbation of seizures in people who are prone to them. All of these things have to be further investigated.”

What’s not in question is this emphatic advice from doctors: Don’t be afraid to go to the hospital if you need to. “You really have to weigh the risks and benefits,” says Dr. Lee, “and realize that the risks are much higher if you stay at home.”