Q&A with URMC doctor on diversion, hospital capacity, and more amid local omicron surge


ROCHESTER, N.Y. (WROC) — URMC released a video interview with Chair of Emergency Medicine Dr. Mike Kamali on Wednesday where he discussed the current impact of COVID-19 to patients and staff members.

Dr. Mike Kamali, Chair of Emergency Medicine at URMC answered a number of questions regarding COVID-19 and updated residents on changes to essential care at the hospital’s emergency department.

The full interview transcript with Dr Kamali:

Q: How busy is the Strong Memorial ED now?

“The ED at Strong has always been busy. Really depends on time of day how busy we are — extremely busy or just very busy,” Dr. Kamali said.

Q: So you’re not seeing high volumes because of a post-holiday omicron spike, specifically?

“In terms of volumes no, our volumes are in line with where they’ve been with our historical numbers,” Dr. Kamali said.

Q: How busy are the Urgent Care Centers?

“Our Urgent Care Centers have seen some incredible volumes over the past couple of months as people seek care and treatment and testing outside of the emergency department or outside of the primary care or pediatric office — those numbers are up even three times what would be normal,” Dr. Kamali said.

Q: How is the ED managing the high volume it’s seeing?

Dr. Kamali explained that the volume challenge is compounded by staffing issues, which are happening around the country right now. “In particular, we’re seeing a challenge with nursing staffing,” he said.

Dr. Kamali said that Urgent Care centers, open 9 am-9 pm 7 days a week, have a bit more flexibility, but staffing challenges led to the temporary closure of Spencerport and Perinton sites.

Q: Closures are happening strategically as part of a plan to maximize function and patient access — can you explain?

Dr. Kamali explained the strategy for which sites close and why — shifting staff to sites where care is most needed.

Q: Please explain what diversion is.

“With the high volumes that people have been reading about in our Emergency Departments and Urgent Care sites, some people are putting off their health care, and/or going to Urgent Care when they have some significant illnesses,” Dr. Kamali said. “And Urgent Care can fit in as a stopgap between care and emergency care, but it’s not an emergency department. We have seen with those higher volumes at our Urgent Care centers some  very sick patients that ultimately get transferred to the Emergency Department.”

“Our Emergency Department at Strong is fully functional. It’s been running. We are busy, we are crowded, we have a lot of patients who are waiting for beds upstairs in the hospital that we’re managing in our ED, but we are still doing our best to see every patient that comes through the doors and really working to see the sickest patients first.”

“Diversion is when a hospital or an emergency department notifies Emergency Medical Services through the state that they can no longer accept any ambulance traffic. New York state is currently doing that under 4-hour increments that requires approval from the Department of Health.” “Across the state we’ve had many hospitals go on diversion, and in our region we’ve had hospitals go on diversion, even some of our smaller EDs in the University of Rochester health system.”

Q: Is diversion a possibility at Strong?

“Is diversion a possibility at Strong Memorial Hospital? I would never rule anything out, but we are working very hard so we do not have to utilize diversion because we don’t feel it is in the best interests of patients,” Dr. Kamali said.

Q: Who is coming to Urgent Care — are there patients who maybe don’t need to come but are seeking a test, for example?

“In our urgent care centers we are seeing quite a wide variety that is driving the uptick in volumes. Some of that is people who have some mild symptoms or an exposure and they would like to have a COVID test.”

“Some of it is people aren’t feeling well and they’d like to be evaluated, they’d like to better understand what’s going on, what are they dealing with — is it COVID, the flu, strep throat, something else….”

“And then there are the standard Urgent Care complaints that people come in with — a sprain, a broken arm, a sprained ankle, a laceration that we deal with. And then there are some people with some very significant injuries from a fall, from trauma, or medical illness that are coming in, that they don’t want to come to the hospital, because they’ve heard of the long waits. Those people we’ll try to see quickly, find out what is going on, and in many cases end up transferring those patients to the Emergency Department.”

Q: What do you want people to remember if they have a medical need?

“We are doing our best to make sure that we are available at all times to care for patients, but can’t guarantee that there won’t be a wait,” Dr. Kamali said. “If you are ill I think you should seek care.”

“The pandemic or COVID shouldn’t prevent you from seeking care and you shouldn’t worry that your seeking care might prevent someone else from getting care. We’re doing our best to manage all of it, what we don’t want is to have someone who’s putting off their care, and then have a bad outcome because they didn’t seek medical treatment. If you think you need the Emergency Department, it is there. If you think you have something that can be managed at Urgent Care, it is there as well.”

Q: Are you hoping people go elsewhere for PCR test?

“We are actively working to dissuade people from coming to our Emergency Departments or our Urgent Care for testing,” Kamali said. That’s so we can take care of people that are sick.” The doctor then outlined the other options — home tests, county, state, upcoming test sites — as alternatives.

Q: What can people expect when they come to the ED?

“You’re going to see a very busy department with a lot of people working hard to take care of patients,” Kamali said. “We will do our best to accommodate visitors but if it is very crowded, visitors may be asked to step out.”

Q: How are staff handling all these challenges? What’s the game plan for keeping going?

“With this current variant the numbers are spiking quickly, which to me means that they are going to come down quickly,” Kamali said. “But when do they start coming down? No one really knows.”

“It’s also great news in a way that this variant is less severe than the previous variants and really less severe if you’re vaccinated. We at Strong Hospital have on a day to day basis been looking at bed counts, capacity, OR cases, what’s going on in the Emergency Department as well as other areas in outpatient settings and trying to adjust, minute by minute, hour by hour and day by day so we can take care of all the patients that come to us. I think that strategy has been exceptionally effective in allowing us to remain open, do the urgent and emergent surgeries that we need to, the urgent and emergent care as well as everything else that is coming down the line.”

“Staff are very tired, it’s been a long haul over two years. It’s been a constant barrage of COVID news and information that does seem to change so at some point we’re taking it slowly. We’re continuing to do what we do, one patient at a time, one day at a time, working to get the job done. This is what we signed up for. This is what we do. And we’ll continue to work at it and deal with it as we can.”

Watch Full Interview:

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