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At R.I.’s largest hospital, scarcity is leading to terrible but necessary choices

“The bottom line is that although we may not have a formal declaration from the state (yet) regarding crisis levels of care, in our ED and ICUs we are already there,” said Dr. Stephen Traub, a top doctor at the independent emergency physician group that works at Lifespan hospitals

An ambulance outside Rhode Island Hospital in Providence, R.I., Feb. 20, 2021.DAVID DEGNER/NYT

Rhode Island Hospital in Providence is the state’s largest and only level one trauma center, but is facing difficult choices from the intensive care unit to the emergency department because of staffing shortages.

“The bottom line is that although we may not have a formal declaration from the state (yet) regarding crisis levels of care, in our ED and ICUs we are already there,” Dr. Stephen Traub, a top doctor at the independent emergency physician group that works at Lifespan hospitals, wrote in a Wednesday letter to colleagues. “This has led to several discussions about how to care for patients in an era of scarcity, and we are working with ICU leadership to identify patients who under normal circumstances would go to the ICU who we can manage in the RICU or the floor. This is terrible. But it is necessary.”


The RICU is an intermediate intensive care unit.

Staffing shortages, particularly of nurses, are putting immense pressure on hospitals around the state and around the country. That includes Lifespan’s two hospitals in Providence, Rhode Island Hospital and the Miriam Hospital.

Though COVID-19 hospitalizations are roughly half their peak from a year ago, and vaccinations are protecting many Rhode Islanders from the worst outcomes from the virus, the system is ill-equipped to handle even a smaller uptick in serious cases — most of which, experts say, are concentrated among the unvaccinated.

At Rhode Island Hospital, patients are waiting longer to be seen. And the rate of patients leaving without being seen has risen dramatically, “not because we are inefficient but because we simply do not have the resources to see patients when they come in,” Traub, the vice chair of clinical affairs at Brown Emergency Medicine, said. “This is heartbreaking.” Traub urged his colleagues not to be angry with their ICU colleagues if they decline to take a patient.


Annemarie Beardsworth, a spokeswoman for the Rhode Island Department of Health, said in an email: “RIDOH is not currently implementing Crisis Standards of Care. What we are doing is working extremely closely with all of our hospital partners to identify and resolve immediate challenges and concerns.”

The alarm bells over the crisis in Rhode Island’s hospitals have been going off for months now. They are getting louder: The president of the Rhode Island chapter of the American College of Emergency Physicians, Dr. Nadine Himelfarb, said in a recent letter to Gov. Dan McKee and the Health Department that the state’s health care system “is currently collapsing.”

Many medical professionals around the state are frustrated by the pace of the response from the McKee administration. Some have proposed a centralized system to dispatch ambulances depending on which hospitals can handle patients at the time. The state says it’s planning to put in place a new coordination plan for EMS providers — in the spring.

“I’m not sure they realize the true state of affairs that we’re facing,” Dr. Selim Suner, a top disaster doctor who also works at Rhode Island Hospital, said in an interview Monday.

The governor’s office said they’re acting with urgency to address the health care crisis.

McKee on Wednesday signed a new executive order on hospital capacity. Among other things, the order — which his office apparently did not publicly announce — protects hospitals and health care workers from civil damages from the level of care they’re able to give if that care was affected by staffing or supply shortages.


Dr. Jeremiah Schuur, the president of Brown Emergency Medicine and physician-in-chief of emergency medicine at Lifespan, said in an emailed statement Wednesday regarding the Traub letter:

“Our nurses, doctors, technologists, and other healthcare teams are exhausted after 22 months of this battle, with no end in sight. As has been widely reported, we are in crisis staffing levels as many of our employees have left the workforce, and regrettably we do not have the staff to care for all the patients who need our help,” Schurr wrote. “We are trying to stretch our scarce resources, particularly in the ICUs and emergency departments, we have severely limited ability to accept transfers given lack of capacity, and are experiencing prolonged waiting times in our EDs. We continue to try to find ways to manage within the limited resources and the current situation of this crisis. Our clinical leaders update our teams regularly as conditions change. We are particularly focused on supporting one another as our care teams navigate through these unprecedented times.”

Brian Amaral can be reached at brian.amaral@globe.com. Follow him on Twitter @bamaral44.