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The Bruno Brief: Are Brown students taking up too many hospital beds?

Hospitals around the United States have been ravaged by the pandemic, and the Rhode Island hospitals near Brown University's campus are no exception. We spoke to Senior Staff Writer Neil Mehta ’25 about the additional strain that Brown student intoxication hospitalizations have put on these hospitals in recent months.

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Livi Burdette 

Before we get into the episode, we wanted to include a quick plug. As a student-run nonprofit, The Herald was hit hard by the COVID crisis, and we're still feeling the effects. More than ever, we rely on donations in order to continue breaking news and training generations of young journalists. Please consider making a donation today through our website at www.browndailyherald.com/donate. Thanks for listening.

Welcome back to The Bruno Brief from the Brown Daily Herald and WBRU. I'm Livi Burdette. This week, The Herald looked into the issue of Brown students being hospitalized for intoxication. How do cases of students being EMS'd put a strain on Rhode Island hospitals during a pandemic that continues to take a toll on local medical services? Senior Staff Writer Neil Mehta has the story. 

Neil, thank you so much for joining us on the podcast today.

Neil Mehta 

Thanks so much for having me. 

Livi Burdette 

So first off, where did you get the idea for reporting this story?

Neil Mehta 

Well, to be honest, the story was inspired by an experience I had with a friend that needed EMS after an alcohol incident. And I am a public health major, so in the days following that incident, I just started thinking, "Oh, I wonder how this is affecting the larger Providence community?" Because when you do go on one of these calls, and when you take a patient from, you know, a dorm all the way to the hospital, there's so many different health resources that you interact with.

Livi Burdette 

So where did you start with reporting the story? Who did you reach out to first for interviews?

Neil Mehta 

Well, so first, I wanted to get the perspective of somebody who's outside of College Hill. So I started out by speaking with Dr. David Portelli, who's the (medical) director of the (Andrew F. Anderson) Emergency Center at Rhode Island Hospital, who receives a number of alcohol-related cases from Brown. And he explained that, especially during COVID-19, the emergency centers (are) facing these volume challenges.

Livi Burdette 

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Did you get a sense of what the scale of these volume challenges is? And, what kind of strain that Brown EMS patients are putting on emergency departments in Rhode Island?

Neil Mehta 

For sure, so to answer the first half of your question, according to Dr. Portelli, at any point, there's somewhere between 20 and 50 patients waiting in the emergency center waiting room at any time. And those are dozens of patients that need a bed soon. And this sort of can be attributed to two different problems, both of which are exacerbated by COVID-19. So one is because of COVID-19 related precautions, they're not able to implement some of the changes that they made to their patient flow model to make it more efficient (and) accessible.

Dr. David Portelli 

So the model that we put into place, it's called a split flow model. And it basically tries to get patients to the beds or the areas of the services and emergency department they need as quickly as possible. And that model, the impact it would have was that we were successful and better meeting the needs of our patients who came to us, so less people would walk out the door, and we decreased some of our turnaround times.

Neil Mehta 

And the second thing is that because of COVID-19, hospitals around the country are facing a nursing and nursing assistant shortage. So with both of those factors taken into account, it's no surprise that the hospital is facing some significant challenges. However, the hospital didn't have data on which intoxicant patients were Brown students. But they did have data on which patients were college age. So that's 17 to 22 years old.

Dr. David Portelli 

For those for that age group who comes in with alcohol presentation, their length of stay, on average, is about 10 hours. So they're locking up the bed for almost half of the day. So if you said well, that doesn't sound like too much of a burden, I would come back and tell you that I've got, you know, 20 to 40 to 50 patients in the waiting room, depending on what time of the day it is, and I need every bed I get.

Neil Mehta 

So we found out that on average, about 10% of intoxicant cases come from college-age patients.

Livi Burdette 

10% of intoxicated patients who are brought to the emergency department because of drinking.

Neil Mehta 

Right. So these are primarily intoxicated cases too. This isn't just someone who fell over and had to go to the emergency room where they found that they happen to be drinking, these are people who primarily come because of intoxication. So in the emergency department, about 484 cases every month are intoxicant cases. And what's really important to know is that, if you look at the numbers, that will average out to just about 1.4 patients a day which doesn't seem like much, but as I explained in the article, these patients are locking up beds for much longer than the average admission. Also, these cases are heightened on the weekend. So this is a month-long average. But when they're concentrated in Friday nights, Saturday nights, that can place an especially troublesome burden on emergency departments.

Livi Burdette 

So what did Dr. Portelli have to say anecdotally about what effect these intoxication cases have on the emergency department, especially during a pandemic?

Neil Mehta 

So the biggest takeaway from my conversation with Dr. Portelli was that in an emergency department, every minute does matter. So they measure their turnaround time in minutes, not in hours or days. And an intoxicated patient, on average will stay for 596 minutes. And that is quite a big burden, especially when you have dozens of patients lined up to be treated. But what Portelli told me was that when patients wait for longer, especially disinhibited patients, are more likely to lash out against the providers that are caring for them.

Dr. David Portelli 

You have patients who are sort of waiting in a triage area, who have alcohol on board, other substances, psychiatric problems, who tend to trigger each other instead of being in a safe, quiet location. And that creates a problem.

Neil Mehta 

And as a result, they've seen an increase in violence against nurses. And that increase in violence coupled with a national nursing shortage is only going to make matters worse.

Livi Burdette 

So we don't know exactly what portion of the college-aged intoxicated patients at the Rhode Island hospitals are Brown students. But you did speak with the chief of Brown EMS, Amy Sanderson, about intoxication cases. What did she have to say about this?

Neil Mehta 

The first thing I learned from Amy Sanderson, was that about a quarter of all BEMS calls are intoxication related. And that's a number that's remained very consistent over the last 10 to 20 years.

Livi Burdette 

That's really interesting to hear that those numbers have stayed pretty consistent for so long. Did that change at all during the pandemic with social distancing restrictions?

Neil Mehta 

Well, when we talk about the pandemic, and its effects on BEMS this year, things get a little bit interesting.

Amy Sanderson 

We are running dual operations, which is that we are running our ambulance service, and simultaneously running what we call COVID support operations and our COVID car.

Neil Mehta 

That means that the BEMS has one less vehicle, which means that more calls to BEMS are going to be sent to, for example, the Providence Fire Department. So if we look at the numbers, comparing September 2019 to September of this year: In 2019, BEMS had 124 calls, about 27% of those were alcohol-related calls; and this year, the BEMS had 63 calls and only 6% of those calls related to alcohol. And that doesn't mean that students necessarily are drinking less, or that students need less BEMS services. That could just mean that because they are using one vehicle to deal with COVID issues and COVID operations, more calls are being sent to other emergency medical services.

Neil Mehta 

So at Brown, we are very lucky to have our own EMS service. That's something that not a lot of universities have. The way that BEMS looks at it is that they're taking a lot of strain off of Providence systems. And they also just happen to know the, you know, the layout of Brown better, they're able to get into places that Providence can't.

Livi Burdette 

Brown's campus COVID positivity rate is far lower than Rhode Island's as a whole right now. How does the continuing pandemic outside of the "Brown bubble" affect hospitals' capacities?

Neil Mehta 

Well, COVID is still very real and happening both in Brown and in the larger Providence community. But it's important to know that it's not overwhelming hospitals in the same way that it was, say a year ago. So right now a lot of the limitations that hospitals are facing because of COVID are collateral damage of the pandemic.

Dr. David Portelli 

The problem really now is capacity issues in the hospital and much of that is driven by nursing shortages and nursing assistant shortages as well.

Neil Mehta 

So even though there isn't a huge influx of COVID-19 patients like there was in 2020 the pandemic is still limiting the hospitals’ ability to treat patients, and it's still worsening volume challenges.

Livi Burdette 

On the Brown side again, you also talked with a representative from BWell Health Promotion. What do they have to say about what the University is doing to prevent alcohol related hospitalizations?

Neil Mehta 

So I spoke with Tanya Purdy, who's the director of BWell Health Promotions. And what I learned was that the University is doing a number of things to prevent alcohol hospitalizations. And some of these are preventative: Like, they're putting out educational modules for incoming students at Brown; they're making sure that students at Brown who committed to even a substance free lifestyle feel welcome and feel equipped to go forward with that. They're also doing things to respond to cases of alcohol hospitalizations: So when a student is hospitalized, Student Conduct will make a referral to BWell, who then will meet with the patient and help them understand how the situation took place and how to prevent it from happening again. 

Tanya Purdy 

You know, nobody is intentionally drinking in that way they end up in the emergency room. And so we want to work with people, right. And so sitting down and having that conversation with students where they can just be totally honest, and say that maybe they're not sure how it got to that point and we can kind of backtrack. Maybe they are, maybe it was a very specific thing that they did, they drank on an empty stomach, you know, and then we can talk about plans for making sure that that doesn't happen so they can kind of safety plan.

Neil Mehta 

Their goal really does seem to be mitigating the harm of alcohol use on campus, rather than punishing students for it. 

So none of this is to say that students shouldn't seek out emergency medical care whenever they or one of their friends are facing an intoxication case. It's very important that students err on the side of caution, and call EMS if someone's having an emergency. That should never stop. What's important though, is from a public health perspective, understanding how alcohol use on campus is affecting the larger Providence community and not feeling like what happens at Brown is insulated from the residents of Providence.

Livi Burdette 

Neil, thank you so much for being on the podcast.

Neil Mehta 

It was my pleasure. Thanks for having me.

Livi Burdette 

This has been The Bruno Brief. Our show is produced by Corey Gelb-Bicknell, Max Karpawich, Katie Pickens, Da-Young Kim and me, Livi Burdette. If you like what you hear, subscribe to The Bruno Brief wherever you get your podcasts and leave a review. Thanks for listening. We'll see you next week.

This transcript has been edited for length and clarity.

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This episode was produced by Olivia Burdette, Corey Gelb-Bicknell, Max Karpawich, Katy Pickens and Da-Young Kim.

Music:

Denzel Sprak by Blue Dot Sessions (www.sessions.blue)

Calisson by Blue Dot Sessions (www.sessions.blue)

Taoudella by Blue Dot Sessions (www.sessions.blue)




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