Sneaking under a record number of COVID-19 patients, hundreds of national intensive care units run out of space and supplies and compete to hire temporary nurses who travel at increasing rates. Many of the facilities are grouped in the south and west.
An Associated Press analysis of data on federal hospitals shows that since November, the share of US hospitals approaching the breaking point has doubled. More than 40% of Americans now live in areas that lack space for intensive care, with only 15% of beds still available.
Intensive care units are the ultimate defense for the sickest of patients, patients who are almost suffocating or who are experiencing organic insufficiency. Nurses working in the most stressful intensive care units, changing IV bags and monitoring patients on the breathing apparatus are exhausted.
“You can’t push great people forever. Right? I mean, it’s just not possible, “said Houston Methodist CEO Dr. Marc Boom, who is among many hospital leaders, hoping that the number of COVID-19 patients who are seriously ill has begun to pay off. Worryingly, there is an average of 20,000 new cases a day in Texas, which has the third highest number of deaths in the country and more than 13,000 people hospitalized with COVID-19-associated symptoms.
According to data from Thursday’s COVID follow-up project, hospitalizations are still high in the west and south, with more than 80,000 current COVID-19 hospital patients in those regions. Encouragingly, hospitalizations appear to have either plateau or downward trends in all regions. It is unclear whether the release will continue with more contagious versions of the virus that appears and gets stuck in vaccine launches.
In New Mexico, a growing hospital system has brought in 300 out-of-state temporary nurses at a cost of millions of dollars to deal with overflowing ICU patients who have been treated in transformed procedure rooms and operating rooms. .
“It was awful,” said Dr. Jason Mitchell, chief medical officer for the Presbyterian Nursing Services in Albuquerque. He is comforted that the hospital has never activated its life-saving care rationing plan, which would have required a triage team to classify patients with numerical scores based on the least likely to survive.
“It’s a relief that we never had to,” Mitchell said. “It sounds scary because it’s scary.”
In Los Angeles, Cedars-Sinai Medical Center was hit by the lack of oxygen tanks leading home, which meant that some patients who might otherwise go home were kept longer, taking the necessary beds. But the biggest problem is competition with other hospitals for mobile nurses.
“Initially, when COVID increases hit part of the country at some point, traveling nurses were able to go to more severely affected areas. Now, with almost the entire country growing at the same time, “hospitals pay twice and three times what they would normally pay for temporary assistants who travel,” said Dr. Jeff Smith, the hospital’s chief operating officer.
The Houston Methodist Hospital recently paid $ 8,000 withholding bonuses to prevent nurses from enrolling in agencies that send them to other hot spots. Paying for traveling nurses can reach $ 6,000 a week, an attraction that can benefit a nurse, but may seem poaching to hospital executives who follow away nurses.
“There are a lot of these agencies that collect absolutely ridiculous amounts of money there to get nurses into the ICU,” Boom said. “I’m going to California, which is growing, but I’m poaching some intensive care nurses there, I’m sending them to Texas, where they charge excessive amounts to fill the gaps in Texas, many of which are created because in Florida or back in California. ”
Space is another issue. Augusta University Medical Center in Augusta, Georgia, treats adult patients with intensive care under the age of 30 in a children’s hospital. Recovery rooms now have patients with intensive care, and if things get worse, other areas – operating rooms and endoscopy centers – will be the next areas transformed for critical care.
To prevent rural hospitals from sending more patients to Augusta, the hospital uses telemedicine to help manage these patients as much as possible in their local hospitals.
“It’s a model that I think will not only survive the pandemic, but it will flourish after the pandemic,” said Dr. Phillip Coule, chief physician at Augusta Hospital.
Hospitals advocate with their communities to wear masks and limit gatherings.
“There just wasn’t much respect for the disease, which is disappointing,” said Dr. William Smith, chief medical officer at Cullman Regional Medical Center in Cullman, Alabama. He sees that he is changing now, with more people personally knowing someone who has died.
“It took a lot of people,” he said of the virus, adding that the death toll – 144 in six months in a county of 84,000 – “opened its eyes to what happened.”
The Alabama hospital’s intensive care unit has been overflowing for six weeks, with 16 patients with ventilator virus in a hospital that a year ago had only 10 of its respirators. “You can see the stress on people’s faces and in their body language. People just need to be able to wear it, ”Smith said.
“Only the fatigue of our staff can affect the quality of care. We were encouraged to maintain the quality of care at a high level, ”said Smith. “You feel that you are in a very precarious situation where mistakes could occur, but fortunately we managed to keep up with things.”
Hospitals say they meet high standards for patient care, but experts say the increases compromise many normal medical practices. Overcrowded hospitals could be forced to mobilize makeshift ICUs and provide them with staff with no experience in critical care. You may be left without sedatives, antibiotics, IV or other consumables on which to rely to keep patients calm and comfortable while on ventilators.
“It’s really discouraging and mentally taxing. Do what you think is best practice, ”said Kiersten Henry, a nurse at MedStar Montgomery Medical Center in Olney, Maryland, and director of the American Association of Critical Nurses.
In Oklahoma City, OU’s chief medical officer, Dr. Cameron Mantor, said that while vaccines are promising, hope still looks weak as intensive care cases continue to rise. The number of COVID-19 hospitalizations at OU Medicine has dropped from more than 100 daily in recent weeks to 98 on Wednesday, Mantor said.
“Which stresses everyone out,” Mantor said, “he looks week after week, the peak isn’t stopped, he doesn’t know there’s a break, he doesn’t see the proverbial light at the end of the tunnel.”
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Associated Press writers Marion Renault of Rochester, Minnesota, Nomaan Merchant of Houston and Ken Miller of Oklahoma City contributed.
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The Associated Press Department of Health and Science receives support from the Howard Hughes Medical Institute’s Department of Science Education. AP is solely responsible for all content.