Kat Phillips spends her days in the surgical intensive care unit at UNC Medical Center caring for some of the hospital’s sickest patients.
Some are used in ventilators, dialysis, and ECMO machines, devices that remove a person’s blood and oxygenate it to prevent lungs from performing poorly. The nurse said that when patients leave the unit alive, they are the exception: only 40% improvement.
And they all have COVID.
“Patients are much sicker than they are, they are much younger,” Phillips said, referring to the current and previous differences in the pandemic. “And most of the patients we see aren’t vaccinated.”
The rise in COVID-19 hospitalizations in late summer, driven by the delta variant and a state population that remains nearly 50% unvaccinated, has severely burdened an already loaded health system.
According to a survey conducted by the NC Watchdog Reporting Network in North Carolina hospitals, it found that the facilities divert patients, convert areas into COVID wards, and delay coping procedures. Hospitals say patients get sick faster and stay sick longer, extending hospital stays and ICUs across the state.
The result: more hospitals report a significant shortage of staff to care for people in need of medical care.
“Many of us love what we do, we love the critical aspect,” Phillips said. “We love caring for the sick. But we are also very tired and burned out. “
“I think it’s a lot of death and it’s the new normal,” he added. “A lot of death around here.”
Deviated patients, longer stays
In recent weeks, the number of COVID patients hospitalized has increased in North Carolina to an all-time high of approximately 3,800. This is a tenfold increase in just two months.
As of Wednesday, about 1 in 5 patients in North Carolina hospitals has the virus, according to data from the U.S. Department of Health and Human Services.
People with COVID account for a larger proportion of people in intensive care. Federal data show that 2 out of 5 people in these units have COVID.
This rapid growth appears to have slowed as the number of newly admitted COVID patients has declined, although it is too early to know how Labor Day weekend affected the spread of the virus.
To get a deeper insight into how the pandemic affects North Carolina health care, the NC Watchdog Reporting Network examined hospitals and hospital systems representing more than 120 facilities statewide. The survey sought to measure the impact that the current increase has on access to hospital facilities, scheduling of elective procedures and staffing.
Several hospitals at some point in the last three months have limited the number of new patients entering their hospitals. It includes Mission Hospital and its affiliates in western North Carolina, UNC Southeastern Hospital in Lumberton, UNC Medical Center in Chapel Hill, AdventHealth in Hendersonville and Duke and Novant Health Hospitals at various locations in the state.
They did so by reducing transfers or diverting incoming patients to nearby facilities.
All hospitals and hospital systems said their ability to accept new patients and transfer them fluctuates depending on their capacity, largely dictated by the number of patients with COVID.
“This is a fluid day-to-day situation,” said Leigh Whitfield, a spokeswoman for Lake Medical Regional Medical Center in Mooresville.
At Novant Health, which has hospitals near Charlotte, Winston-Salem and Wilmington, spokeswoman Megan Rivers said they have diverted patients through their own system and other local hospitals to manage emergency room waiting times. and other beds.
A WakeMed spokesman in Raleigh said it created overload spaces to increase the capacity to care for a large volume of patients arriving at their hospital emergency rooms as needed.
Patient volume is just one of the stressors of a system you already have. Almost all hospitals that responded said that patients with COVID stay longer than hospitalized patients with other diseases.
In the Statesville-based Iredell Health System, this is the difference between 4.5 days for a non-COVID patient and 10 days for someone moderately ill with the virus.
“This is due in part to a five-day treatment along with patients who continue to need much longer treatment with steroids and oxygen due to the lung injury caused by COVID infection,” the Iredell Health spokeswoman said. , Meagan Kowalski.
Within the North Carolina Veterans Affairs health care system, the average length of stay of a veteran hospitalized with COVID at Fayetteville VA Medical Center since June 1 was 20 days, compared to an average stay of five days in patients who were not COVID. Veterans treated for COVID at Salisbury VA Medical Center were more than nine days old, compared with an average stay of three days in patients who were not COVID.
Since June 1, Chapel Hill UNC Medical Center reported an average length of stay for all COVID patients in just over nine days, with more than 16 days for ICU patients. This has raised the average stay of all patients to an average of nearly six days, a spokesman said.
Victoria Dunkle, with AdventHealth Hendersonville, said the hospital currently comes to younger, sick patients. Although the average length of stay for patients with respiratory infections and inflammation, which includes patients with COVID-19, is 5.66 days, Dunkle said patients with COVID-19 stayed an average of 13 days, with some in the hospital for a month or more.
Many hospitals also reported that they had to delay some elective procedures at some point in the last three months, and some hospitals specifically canceled surgeries that would require a hospital bed.
“There just aren’t enough staff”
Meanwhile, two of the state’s largest health groups are sounding alarms.
The NC Nurses Association published a survey in late August showing that nurses were burned and worn out by the impacts of the shortage of staff that existed before the pandemic, which has only gotten worse since then. .
“I am really concerned about the nurses out there right now and I am even more concerned about the long-term impact this will have on people and the profession,” the association’s director general Tina Gordon said in a statement.
Approximately 77% of the nurses the association has surveyed said their facilities have a severe or moderate shortage of nursing staff.
And that finding is backed by data from the U.S. Department of Health and Human Services.
The number of hospitals in North Carolina that reported critical staff shortages has tripled in three months, from four to twelve, according to federal data.
But it is not clear exactly which hospitals or departments are experiencing this shortage.
Hospitals report staff information to the federal health agency on a daily basis and it is up to each center to determine if a critical shortage exists. But this issue is only published statewide. Although the government collects data on what positions staffing problems have (ranging from ICU nurses to respiratory therapists), federal officials do not provide that data to the public.
Hospitals across the state feel this shortage, but it is worse in rural hospitals, according to hospital responses to the Watchdog Reporting Network survey.
“There just aren’t enough staff to care for all the patients who need a hospital bed,” Amber Cava told Clinton’s Sampson Regional Medical Center.
“Due to the shortage of health workers, we depend a lot on travel or crisis nurses. These nurses are in high demand and we have to win the bidding war among all the other hospitals,” Cava said.
Tatyana Kelly, a spokeswoman for the NC Hospital Association, said staff shortages were a problem before the pandemic and have only gotten worse over the past 18 months.
“We can’t continue to accommodate the waves of people showing up at our facilities,” Kelly said.
Many hospitals have had to convert additional rooms and wings of a hospital into COVID wards to handle additional patients, which worsens staff shortages, Kelly said.
The result has been delays in treating patients for non-COVID injuries and illnesses and cancellation of non-urgent procedures, he said.
Kelly said modeling her association shows that delta variant growth is likely to peak in October in North Carolina, depending on a large number of variables, including vaccination rate and whether people keep traveling.
About two-thirds of adults in North Carolina have received at least one shot, a rate of less than about 30 more states and the District of Columbia.
Healthcare workers and hospital administrators point to the state’s relatively low vaccination rate as a reason for the continued spread of the delta variant in North Carolina.
Vaccination is said to be the best way to keep people out of the hospital.
“We all need to do our part,” Kelly said.
This story was reported and edited jointly by Laura Lee, Kate Martin and Frank Taylor of Carolina Public Press; Sara Coello of The Charlotte Observer; Cathy Clabby and Tyler Dukes of The News & Observer; Nick Ochsner of WBTV; Michael Praats of WECT; Travis Fain, Ali Ingersoll, Amanda Lamb and Ashley Talley of WRAL; and Jason deBruyn of WUNC.