Struggling with a record number of patients with COVID-19, hundreds of the country’s intensive care units run out of space and supplies and compete to hire temporary travel nurses at a high rate. Many of the facilities are grouped to the south and west.
An Associated Press analysis of federal hospital data shows that since November the share of U.S. hospitals approaching the breaking point has doubled. Currently, more than 40% of Americans live in areas that do not have space in the ICU, with only 15% of beds available.
Intensive care units are the ultimate defense of the sickest of patients, patients nearly asphyxiated or with organic insufficiency. Nurses working in the most stressed ICUs, changing IV bags and controlling patients with respiratory machines, are exhausted.
“Older people can’t be pushed forever. Right? I mean it’s just not possible, ”said Dr. Marc Boom, CEO of Houston Methodists, who is among many hospital leaders who hope the number of critically ill COVID-19 patients has begun to reach Of concern, there are an average of 20,000 new cases a day in Texas, which has the third highest death toll in the country and more than 13,000 people hospitalized with COVID-19-related symptoms.
According to data from Thursday’s COVID follow-up project, hospitalizations remain high in the west and south, with more than 80,000 current COVID-19 hospital patients in these regions. Encouragingly, hospitalizations appear to have spread or are declining in all regions. It is unclear whether the relief will continue with more contagious versions of the virus that emerges and sinks in the deployment of vaccines.
In New Mexico, a growing hospital system attracted 300 temporary nurses from outside the state, at a cost of millions of dollars, to deal with overflowing ICU patients, who were treated in converted procedure rooms and wards. of surgery.
“It’s been horrible,” said Dr. Jason Mitchell, chief physician of the Presbyterian Health Care Services in Albuquerque. He is comforted that the hospital never activated its rescue care rationing plan, which would have required a classification team to classify patients with numerical scores based on who was least likely to survive.
“It’s a relief that we should never have done that,” Mitchell said. “It sounds scary because it’s scary.”
In Los Angeles, Cedars-Sinai Medical Center was short of oxygen tanks to take home, which meant some patients who might otherwise return home stayed longer and occupied the necessary beds. But the biggest problem is competing with other hospitals for traveling nurses.
“Initially, when the rises in COVID hit one part of the country at a time, traveling nurses were able to go to more severely affected areas. Now, with almost the entire country at once, “hospitals pay double and triple what they would normally pay for temporary travel nurses,” said Dr. Jeff Smith, the hospital’s head of operations.
Houston Methodist Hospital recently paid $ 8,000 withholding bonds to prevent staff nurses from enrolling in agencies that would send them to other places of interest. The pay per walk nurse can be as high as $ 6,000 a week, an incentive that can benefit a nurse but may seem to steal hospital executives who see nurses leave.
“There are a lot of these agencies out there that charge absolutely ridiculous sums of money to get the ICU nurses out,” Boom said. “They go to California, in full growth, but they look for some ICU nurses, they send them to Texas, where they charge excessive amounts to fill gaps in Texas, many of which are created for nurses from Texas to Florida or back to California. “.
Space is another issue. The Augusta University Medical Center in Augusta, Georgia, treats adult ICU patients under the age of 30 in a children’s hospital. Recovery wards now have patients with ICUs and, if things get worse, other areas (operating rooms and endoscopy centers) will be the next areas converted into critical care.
To prevent rural hospitals from sending more patients to Augusta, the hospital uses telemedicine to help manage these patients as long as possible at their local hospitals.
“It’s a model that I think will not only survive the pandemic, but thrive after the pandemic,” said Dr. Phillip Coule, chief physician at Augusta Hospital.
Hospitals are urging their communities to wear masks and limit meetings.
“There just hasn’t been much respect for the disease, which is disappointing,” said Dr. William Smith, chief physician at Cullman Regional Medical Center in Cullman, Alabama. He sees that changing now, as more people know someone who has died in person.
“It took a lot of people,” he said of the virus, adding that the death toll (144 people in six months in an 84,000 county) “has opened the eyes to the randomness of this fact.”
The Alabama hospital ICU has been overflowing for the past six weeks, with 16 patients with ventilator viruses from a hospital that a year ago had only 10 of its respiratory machines. “You see the stress on people’s faces and body language. It’s just a lot that people can bring, ”Smith said.
“Only the fatigue of our staff can affect the quality of care. “I feel encouraged to be able to keep the quality of care high,” Smith said. “You feel like you’re in a very precarious situation where mistakes can happen, but luckily we’ve managed to keep up with things.”
Hospitals say they maintain high standards of patient care, but experts say the floods compromise many normal medical practices. Overwhelmed hospitals could be forced to mobilize makeshift ICUs and staff them with no critical care experience. They could run out of sedatives, antibiotics, IV or other supplies they rely on to keep patients calm and comfortable while they are on ventilators.
“He’s really discouraging and mentally recording. You’re doing what you think is best practice, ”said Kiersten Henry, a nurse at MedStar Montgomery Medical Center in Olney, Maryland, and director of the board of the American Association of Critical Care Nurses.
In Oklahoma City, the OU’s Chief Medical Officer of Medicine, Dr. Cameron Mantor said that while vaccines are promising, hope still seems weak as ICU cases continue to rise. The number of COVID-19 hospitalizations at OU Medicine has declined, from more than 100 daily in recent weeks to 98 on Wednesday, Mantor said.
“What is stressing everyone,” Mantor said, “is watching week after week after week, not turning off the breakwater, not knowing there is a break or seeing the proverbial light at the end of the tunnel.”
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Associated Press writers Marion Renault in Rochester, Minnesota, Nomaan Merchant in Houston and Ken Miller in Oklahoma City collaborated.
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The Associated Press Health and Science Department is supported by the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.