Published in Health Care

Hospitals delay care, add beds, shift staff in ‘most challenging’ COVID surge yet

BY Sunday, January 16, 2022 06:00pm

 Hospitals and their medical personnel who are already deeply strained from high patient volumes face an even tougher time in the weeks ahead as COVID-19 cases rise and hospitalizations reach new peaks.

State health officials fear that their most pessimistic modeling scenario will play out across Michigan in the coming weeks. That could drive already record-high hospitalizations statewide to 8,000 people with COVID-19 before the end of the post-holiday surge — driven largely by the highly contagious omicron variant — peaks in late January or early February.

The projected peak is nearly double the number of statewide hospitalizations from last week.

The situation will further stress hospitals and caregivers that have been on the frontlines of the pandemic for nearly two years and are growing increasingly weary. Hospitals are having to contend with not just high patient volumes but also the disruptions that the omicron variant has caused to staff and daily routines.

“We believe the next month is going to be one of the most challenging months of the entire pandemic, predominantly from the perspective of staffing,” said Chad Tuttle, senior vice president for hospital operations at Spectrum Health in Grand Rapids.

“We are struggling to maintain the standard of care that we would desire,” Tuttle added. “The disruption (that omicron) is causing … is just as challenging to staff as it has ever been in anybody’s memory in their entire career.”

The COVID-19 case rise that started in the fall with the delta variant has combined with high pent-up demand for care from patients who previously delayed seeking treatment for a medical condition that has since worsened and now requires a longer hospital stay.

The number of COVID-19 cases — which some health care executives say has eased a bit in the last week but are expected to rise again in the weeks ahead — has coupled with pent up demand, filling hospitals for weeks.

Hospital staff out

While hospitals have taken various measures to add beds when needed, staffing is the critical issue they now face.

The staffing shortage has worsened in the pandemic as hospitals lost nurses, in particular, from higher burnout rates, retirements, people leaving the profession or moving to another care setting. Moreover, hospital executives say they are dealing with an unprecedented number of clinical and support staff who have become ill with COVID-19 and are out for 10 days because of the omicron variant.

Mercy Health Saint Mary’s last week had 200 staffers in Grand Rapids who were sick with COVID-19.

“Now we’re dealing with the double-edged sword, not just trying to care for patients that are hospitalized with COVID-19, but we’re facing a considerably higher number of staff who are out sick,” Mercy Health Saint Mary’s President Dr. Matt Biersack said. “Although there is capacity on paper for some of our beds, we’re struggling with trying to make decisions to function in a way that we did previously with a lot less staff.”

Many of Saint Mary’s staff who contracted the virus are fully vaccinated, have had a booster and are experiencing mild illness, “but they’re out nonetheless,” Biersack added.

As COVID-19 cases rise in the coming weeks, “we’ll be taxed to the brink,” Biersack said.

University of Michigan Health-West had 150 to 160 staff members who were sick one day last week.

Spectrum Health during the delta variant wave had 20 to 40 staff members a day who had to quarantine, Tuttle said. That’s ballooned to 120 to 200 staff daily with the omicron variant.

About 550 staff members were out one day last week with COVID-19, which is actually down from a peak of 850 a week earlier, Tuttle said. Spectrum Health employs about 31,000 people.

At Bronson Healthcare in Kalamazoo, the number of staff sick during the pandemic has typically run from “a few dozen” to the mid-100s, said Dr. Aaron Lane-Davies, a pediatric hospitalist at Bronson Children’s Hospital and chief of quality for Bronson Medical Group.

Bronson one day last week had 410 employees out with COVID-19, or nearly 5 percent of its 8,500 employees, he said.

The illness among staff “is just adding to the strain,” Lane-Davies said.

“We are very, very stretched from a staff perspective,” he said. “That is a huge toll on departments that are already stretched.”

The Michigan Health & Hospital Association estimates that 1,000 fewer beds across the state are now unstaffed compared to more than a year ago. Michigan has 23,000 licensed hospital beds.

Among the association’s 134 member hospitals, 53 report that they are now operating with a “critical” staffing shortage that’s “jeopardizing their ability to provide access to the full range of services they would traditionally provide to their community,” according to MHA CEO Brian Peters.

“We expect that if this trend continues, that number could dramatically increase in the coming weeks,” Peters said.

Taking action

If there’s “any sliver of optimism” in the present crisis, it’s that the omicron variant appears to cause milder illness and “could potentially burn out more rapidly than delta did,” Peters said.

“I certainly hope that’s the case because our hospitals cannot continue to do what they’ve been doing much longer,” he said. “I really fear for what’s going to happen in the weeks ahead.”

Executives at the larger hospitals in West Michigan say they’re taking a number of steps to keep up and provide needed care. Many hospitals since before Thanksgiving have again been delaying non-emergency procedures and surgeries.

At University of Michigan Health-West, more than 200 surgeries were canceled over several weeks because of a lack of available beds and nurses, Chief Medical Officer Dr. Ronald Grifka said. The health system formerly known as Metro Health, which was at 95 percent of capacity last week, also has been moving nurses from clinics to the hospital setting, Grifka said.

Other hospitals also have temporarily redeployed staff after closing outpatient centers and clinics that provide services such as radiology and diagnostic labs.

Spectrum Health’s hospitals have had to delay more than 1,600 surgeries in the last 10 weeks and “will continue to look at our surgery schedules very closely and certainly will continue with the most urgent” procedures “that cannot be safely deferred or delayed,” Tuttle said.

Spectrum Health also has had to decline patient transfers from other hospitals “to the tune of 250 a month over the past couple months,” he said. Those patients are often “very sick and very frail,” Tuttle said.

At one point last week, Spectrum Health’s 14 hospitals in the region were at a combined 99.4-percent capacity, he said.

Doctors and nurses have also been working longer hours, taking on extra shifts and more patients, and shuffling between departments, according to hospital executives. Many hospitals are also using nurses from high-cost travel nursing agencies to fill gaps.

Executives say they will rely on those steps as cases rise and peak in the weeks ahead.

“What we’re doing now is disaster response,” Biersack said. “We’re just trying to stay nimble and respond on a day-to-day basis to the situation. It’s definitely on a day-by-day basis that we’re flexing and adjusting our operations.”

As well, Spectrum Health and Mercy Health Muskegon each plan to seek extensions for medical teams that have been deployed to their hospitals by the U.S. Department of Defense over the past few months.

The burden has been taking a harsh toll on hospital staff who are feeling fatigued and burned out after working through the pandemic for nearly two years.

“The fatigue among the health care workers is pronounced. It is even harder seeing the unnecessary deaths that occur in those that are unvaccinated and the children and the families that are left behind,” Biersack said. “It is taking a profound toll on our health care workforce. I have never seen the likes of the trauma and the depression that this pandemic and the response to it has caused.” 

Read 4453 times Last modified on Sunday, 16 January 2022 12:20