Tired of a record number of COVID-19 patients, hundreds of intensive care units in the country are left without space and supplies and are vying to hire temporary traveling nurses at a high rate. Many of the facilities are grouped to the south and west.
An analysis by the Associated Press of data from federal hospitals shows that since November, the share of US hospitals near the break point has doubled. More than 40% of Americans now live in areas where there is no space for an intensive care unit, with only 15% of beds still available.
Intensive care is the last resort for the most sick of patients, patients who are almost suffocating or facing organ failure. Nurses who work in the most stressed intensive care units, change IV bags and monitor patients on breathing machines are exhausted.
According to data from Thursday of the COVID Tracking Project, hospitalizations are still high in the West and South, with more than 80,000 current hospital patients with COVID-19 in those regions. Hopefully, hospitalizations appear to be either plateau-like or downward in all regions. It is unclear whether relief will continue with more contagious versions of the virus, which occurs and is difficult to get vaccines.
In New Mexico, a growing hospital system brought 300 temporary nurses out of the state at a cost of millions of dollars to deal with overcrowded patients in the intensive care unit who were being treated in remodeled treatment rooms and surgical suites.
“It was awful,” said Dr. Jason Mitchell, chief medical officer of the Presbyterian Health Services in Albuquerque. He takes comfort in the fact that the hospital has never implemented its life-saving care rationing plan, which would require a triage team to rank patients with numerical scores based on who is least likely to survive.
“It’s a relief that we never had to do that,” Mitchell said. “Sounds scary because it’s scary.”
In Los Angeles, Cedars-Sinai Medical Center is facing a shortage of oxygen tanks to take home, which means that some patients who might otherwise be able to go home stay longer in the necessary beds. But the biggest problem is competing with other hospitals for traveling nurses.
“Initially, when COVID outbreaks hit part of the country, traveling nurses were able to go to more severely affected areas. Now that almost the entire country is growing at the same time, “hospitals pay twice and three times more than they usually pay for temporary traveling nurses,” said Dr. Jeff Smith, the hospital’s chief operating officer.
Houston Methodist Hospital recently paid $ 8,000 in detention bonuses to prevent staff nurses from registering with agencies that would send them to other hotspots. The salary of traveling nurses can be as high as $ 6,000 a week, which can be beneficial to the nurse, but may seem like poaching to hospital managers who watch the nurses leave.
“There are a lot of these agencies that raise absolutely ridiculous amounts of money to put nurses in the intensive care unit,” Boom said. “They go to California, which is in the midst of a wave, but they look for some nurses there, send them to Texas, where they charge unlimited sums to fill the gaps in Texas, many of which were created because nurses in Texas have gone to Florida or back to California. “
Space is another problem. Augusta University Medical Center in Augusta, Georgia, treats adult patients in the intensive care unit under the age of 30 at the Children’s Hospital. There are already intensive care patients in the recovery rooms, and if things get worse, other areas – operating rooms and endoscopy centers – will be the next areas rebuilt for critical care.
To prevent rural hospitals from sending more patients to Augusta, the hospital uses telemedicine to help manage these patients for as long as possible in their local hospitals.
“This is a model that I believe will not only survive the pandemic, but will thrive after the pandemic,” said Dr. Philip Cool, chief medical officer of Augusta Hospital.
Hospitals are asking their communities to wear masks and restrict gatherings.
“There just wasn’t much respect for the disease, which is disappointing,” said Dr. William Smith, chief medical officer of the Culman Regional Medical Center in Cullman, Alabama. He sees this changing now with more people who know someone who has died personally.
“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 their eyes to the coincidence.”
The intensive care unit of the Alabama hospital has been overflowing for six weeks, with 16 patients with viruses on ventilators in a hospital that only had 10 breathing machines a year ago. “You can see the stress in people’s faces and in their body language. It’s just that people can wear them a lot, “Smith said.
“Only the fatigue of our staff can affect the quality of care. “I was encouraged that we were able to maintain a high quality of care,” Smith said. “You feel like you’re in a very precarious situation where mistakes can happen, but fortunately we’ve been able to stay on top of things.”
Hospitals say they follow high standards of patient care, but experts say the spikes compromise many normal medical practices. Overcrowded hospitals may be forced to mobilize makeshift intensive care units and hire staff without critical care experience. They may run out of sedatives, antibiotics, intravenous or other consumables they rely on to keep patients calm and comfortable while on ventilators.
“It’s really scary and mentally taxing. You do 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 Nurses.
In Oklahoma City, OU Medicine’s chief medical officer, Dr. Cameron Mantor, said that although vaccines were promising, hopes still seemed low as intensive care cases continued to rise. The number of COVID-19 hospitalizations at OU Medicine has dropped from more than 100 a day in recent weeks to 98 on Wednesday, Mantor said.
“What stresses everyone,” Mantor said, “looks week after week, the week doesn’t go off, it doesn’t know there’s a break, it doesn’t see the proverbial light at the end of the tunnel.”
Associated Press authors Marion Reno of Rochester, Minnesota, Nomaan Merchant of Houston and Ken Miller of Oklahoma City.
The Associated Press’s Department of Health and Science receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.