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Intoxicated students add to R.I. Hospital volume

COVID-19 restrictions, staffing shortages have limited Rhode Island hospital capacity

When Madigan King ’25 saw peers carrying an intoxicated student into a dorm lounge, they immediately wondered whether Brown EMS had already been called to the location. 

“We were scared that (the student) needed medical care that we couldn’t provide,” King said. BEMS showed up shortly after a nearby student contacted its emergency line. 

Alcohol-related incidents like this are no anomaly on campus — they make up about 25% of BEMS calls, according to BEMS Chief Amy Sanderson, with the majority of calls taking place on weekends. 

Most intoxicated students that need hospitalization are transported to Rhode Island Hospital or Miriam Hospital, Sanderson said.

“We will choose the hospital that is accepting patients and that is going to provide the necessary care, and Rhode Island Hospital is a level one trauma center,” she said. “If we feel that someone needs that degree of care, that’s definitely where we’re going to go.”

Besides its proximity to campus, Rhode Island Hospital has more resources available at late hours, Sanderson said. 

For the Rhode Island Hospital emergency department, which receives patients from as far as southern Massachusetts, each alcohol-related admission can fill up a bed for hours. 

About 10% of intoxicated patients in the emergency room are college aged — between 17 and 22 years old — according to David Portelli, medical director of the Rhode Island Hospital Andrew F. Anderson Emergency Center.

“For that age group who comes in with alcohol presentation … their length of stay on average is 10 hours, so they’re locking up a bed for almost half of the day,” he said. Since the emergency department measures patient turnaround times in minutes, this means an average turnaround of 596 minutes. “I need every minute we can have, and yes, that’s a burden,” he added.

These cases can increase wait times for dozens of patients in need of a bed in the emergency department. 

“If you say, ‘That doesn’t sound like too much of a burden,’ I would tell you that I’ve got 20 ... to 50 patients (in the waiting room) depending on what time of day it is,” Portelli said. “And I need every bed I can get.”

According to Portelli, hospitals are already especially constrained because of staffing shortages and COVID-19 protocols.  

“A year and a half ago, we were telling people to stay away from the emergency department because of COVID,” he said. “The problem now is a capacity issue, and much of that is driven by nursing shortages and nursing assistant shortages.” 

Many nurses have retired or changed professions in the wake of COVID-19, Portelli noted, further exacerbating volume challenges. 

Longer wait times can make patients more likely to lash out against providers. “We’ve noticed an increase in violence, … and a lot of it has to do with our capacity challenges,” Portelli said. “The impact is (on) the mental health of the nurse. … It doesn’t help when we’re having a national nursing shortage.”

Pandemic-related precautions also eroded efforts to make the emergency department’s patient flow more efficient. In 2016, the emergency center adopted a split-flow model to match patients with resources they need as quickly as possible.

“That model was … predicated on the fact that we could put relatively well patients together, two to a room,” a level of density that was no longer possible with the implementation of COVID-19 protocols, Portelli said. 

Amid staffing shortages and COVID-era challenges, alcohol misuse “certainly impacts the community” that the hospital serves, Portelli said. 

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“The hospitals in the state … are all capacity constrained right now, especially a year and a half into this global pandemic,” he said. “And whatever you can do to control your behavior — whether that’s drinking, … wearing your seatbelt or wearing your bicycle helmet — to avoid a visit to the emergency department is for your own benefit and for the benefit of the larger community.”

At the University, BWell Health Promotion is working to mitigate alcohol misuse that leads to student hospitalizations.

“The role we play at orientation is one of the first steps in education around alcohol use and … having a healthier relationship with alcohol,” said Tanya Purdy, director of BWell Health Promotion. “And drinking in ways that are not harmful to them or other people — that’s how we start framing” alcohol use. 

BWell also responds to cases of alcohol misuse through referrals from the Office of Student Conduct, meeting with individual students to discuss alcohol use following hospitalizations. These referrals are made “so that a student can receive amnesty,” Purdy added. 

Purdy also stressed the importance of seeking care when needed. “Even if all people are underage, … there is no punishment” for seeking emergency care for intoxication, she said. 

“EMS is going to do a thorough evaluation,” she added. “Having a medical professional come and evaluate you … is completely invaluable, (and) EMS is confidential.”

Despite volume challenges at Rhode Island Hospital, Portelli also stressed the importance of seeking emergency medical attention when needed.

 “I’m not telling people not to come to the emergency department,” he said. “What we’re talking about is trying to avoid … (the) dangerous situations that might put you in the emergency department.” 

“We’re not there because it’s about alcohol,” Sanderson added. “We’re there because it’s about someone who’s having a medical emergency.”

Clarifications: A previous version of this article did not include the full name of Rhode Island Hospital's emergency center and misstated David Portelli's title — Portelli is the medical director of the Andrew F. Anderson Emergency Center at Rhode Island Hospital.



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