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This year, hospitals aren’t just battling the coronavirus; they’re treating more people with other health issues and dealing with staffing shortages. Hospitals are delaying procedures and diverting patients.
George Morris, a doctor in the CentraCare health system in Minnesota, offered a one-word reply when asked if the system’s hospitals are at capacity.
“Beyond,” he said.
Morris is the physician incident commander for CentraCare’s COVID-19 response. CentraCare operates eight hospitals across central Minnesota, and those hospitals are packed with COVID-19 patients.
Emergency departments and critical care beds are full at CentraCare and throughout Minnesota. Hospitals are regularly diverting patients and delaying surgical procedures that aren’t urgent or require overnight stays.
Minnesota officials say they aren’t simply postponing knee or shoulder surgeries. Hospitals are postponing heart procedures in some cases, officials say. They stress that urgent surgeries are still being performed, but hospital officials said they are postponing procedures they wish they could perform.
Hospitals have been battling the coronavirus for nearly two years, but this new wave of COVID-19 cases is testing healthcare organizations yet again. Some health officials said this year’s wave is more difficult to handle.
Healthcare systems are dealing with staff shortages, in nursing and other areas.
Hospitals aren’t just dealing mostly with COVID-19 cases like they were a year ago. This year, systems are seeing more patients for other reasons, such as influenza, respiratory viruses and car crashes now that people are driving more often. Hospitals are seeing more people who delayed treatment for other health issues and need treatment.
“This year is definitely worse than last year,” said Rahul Koranne, president and CEO of the Minnesota Hospital Association.
Koranne said part of the reason it’s worse is because healthcare workers have been pushing so hard for so long. As dedicated as they are, Koranne said hospital workers are “bone tired, exhausted.”
“Our healthcare heroes have been running on this relentless ultramarathon that just doesn’t stop for 22 months,” Koranne said in a phone interview.
This week, nine Minnesota healthcare systems took out advertisements warning residents that hospitals are filled and their ability to provide care is being threatened. The full-page ad in newspapers carried a stark headline: “We’re heartbroken. We’re overwhelmed.”
Other states are struggling with the latest coronavirus surge and are taking steps such as delaying non-essential procedures. As of Thursday afternoon, 41 states and the District of Columbia have seen increases in COVID-19 hospitalizations over the previous two weeks, according to The New York Times.
While COVID-19 remains a national crisis, Minnesota offers an illuminating window into how the coronavirus is challenging hospital systems.
Minnesota’s seven-day average of COVID-19 hospitalizations tops 1,400, according to the U.S. Centers for Disease Control and Prevention. That’s less than the peak of 1,639 in November and December of 2020.
But Minnesota hospital officials said staffing shortages and the uptick in patients with other health woes are making it tougher now.
Like elsewhere, Koranne said Minnesota hospitals are seeing shortages of nurses, nursing assistants, respiratory therapists, surgical technicians and other healthcare workers.
Nationwide, roughly 1 out of 5 healthcare workers have left their jobs, according to an analysis by The Morning Consult. Some have left due to burnout, family responsibilities or because they wanted to do something else, hospital officials say.
“We are in a true workforce crisis,” Koranne said.
Morris doesn’t hesitate when comparing the difficulties with the current wave of COVID-19 hospitalizations.
“This cycle is hitting harder,” he said.
James Hereford, president and CEO of Fairview Health Services, also said this spike of COVID-19 hospitalizations is more challenging.
“Our overall volume is higher,” he said in a phone interview. “We’re also seeing labor shortages in skilled and unskilled positions.”
Allina Health, which operates 11 hospitals in Minnesota and western Wisconsin, is struggling with high patient volume and staffing shortages. Hsieng Su, Allina Health’s senior vice president and chief medical executive, said “the great resignation” has been seen at Allina and other healthcare organizations.
“It’s a perfect storm,” Su said in a phone interview. “Coupled with shortages in staffing, it’s a storm that has worsened compared to last year.”
At CentraCare, Morris said the staffing challenges make handling the new wave of COVID-19 patients much more difficult. Like other healthcare systems, CentraCare has lost nurses who have left the profession or have shifted into more lucrative careers as traveling nurses.
“There are only so many critical care nurses around,” Morris said.
Long stays, delayed surgeries
CentraCare is facing difficulties with having enough staff and space to treat COVID-19 patients.
“We’re treating critical care level patients in non-traditional critical care level spaces,” Morris said.
Hospital systems such as CentraCare are seeing younger patients with COVID-19 this year. Some are in their 40s and 50s, and some in critical care beds are as young as their 20s and 30s.
Those younger patients are staying in the hospital longer and requiring more staff, adding to the strain on the system, he said.
“They’re spending a long, long time in those critical care beds,” Morris said. Virtually all the patients in those critical care beds are on ventilators.
“It is the story of why we are full,” Morris said.
With so many beds filled with COVID-19 patients, CentraCare has stopped performing many non-urgent surgeries.
Procedures are being done if they can be handled on an outpatient basis. But CentraCare is postponing elective procedures that require an overnight admission.
“Anything except for a truly emergent procedure is not happening at our hospital,” Morris said.
He stressed that some of these delayed surgeries aren’t minor procedures.
“It’s delaying a lot of cardiac procedures, a lot of neurosurgical procedures, a lot of abdominal procedures,” Morris said.
CentraCare and other health systems said they are trying not to delay treatment in cancer cases. At times, surgical procedures for cancers have been moved to alternate sites.
Allina Health has also postponed non-urgent procedures that require an overnight stay in order to free people and resources to care for COVID-19 patients.
“We are at capacity,” said Su. “Every day, we are trying to think about ways to increase that capacity and there are days we are at more than capacity.”
Across Minnesota, hospitals are delaying surgeries, including heart and abdominal procedures, said Koranne, the head of the state’s hospital association.
Those postponed procedures are obviously affecting patients profoundly. Hospitals are also losing revenue when they can’t offer some of their surgical services.
“All these canceled surgeries are impacting the finances of the hospitals and healthcare systems,” Koranne said.
CentraCare’s emergency departments are regularly forced to divert patients.
Morris said it’s not uncommon to divert 15-20 patients per day, simply because the system doesn’t have the capactiy.
“We've had to tell our region, we can’t take your patients,” Morris said. “Please find somewhere else. This is a problem throughout the state of Minnesota.”
Koranne said emergency departments around the state have been forced to divert patients. He said the state’s 140-plus hospitals have regularly collaborated to help each other when some facilities are full.
“Sometimes, the patient may need to get transferred from their loved ones and community,” Koranne said.
Fairview Health Services also diverts some patients temporarily, Hereford said. He said it is usually only for a short time, for a simple reason.
“There’s nobody else in the region who has capacity,” Hereford said. “We’re all facing the same challenges.”
‘Just plain exhausted’
Minnesota’s hospital workers are getting worn down by the crushing demand of another wave of COVID-19 patients.
Since the first pandemic cases emerged in March 2020, Morris estimated there has been about one hour of one day where CentraCare didn’t have a patient in the COVID-19 unit.
“Our critical care staff are tired,” said Morris. “Emotionally, it’s really hard to do this day in and day out.”
Like other health systems, Allina Health has developed wellness programs and offered bonuses to staff workers, Su said. A walk through Allina’s hospitals would show that everyone is doing their very best.
Still, the pandemic has been hard on physicians, nurses and the entire healthcare team, Su said.
“Everyone is just plain exhausted," she said.
Now, hospitals and healthcare systems are about to begin their third year of dealing with COVID-19.
When asked if COVID-19 cases and hospitalizations are close to peaking in Minnesota, Su and others said it’s difficult to predict.
The emerging Omicron variant, which is now present in most states, adds another complicating factor. Plus, it remains to be seen if cases rise again after more people travel and attend gatherings around Christmas.
“It just seems never-ending,” Su said.
Because some COVID-19 patients are spending such a long time in the hospital, with stays lasting several weeks in some cases, doctors and nurses get even more attached to the people they are treating.
“You get to know them,” Morris said. “And it becomes even harder.”
Some of the emotional exhaustion comes in treating younger COVID-19 patients, including patients in their 20s and 30s, who are on ventilators.
Now picture having end-of-life conversations with the families of patients in their 20s and 30s who aren’t going to recover.
“To try and do that in a family of people in their 20s, 30s, small kids, young kids, that’s hard,” Morris said. “The toll that’s taking on the staff is adding up.”
At the same time, staff are still stepping up, holding the hands of patients when families can’t be there, he said.
“I still get buoyed by the fact that our staff keep coming,” Morris said. “Every day they come to deliver that hope or deliver that care and it’s just amazing to see them do it.
“It just is a long haul.”
Su said it’s difficult to talk about capacity challenges at hospitals without returning to the fact that the public could help healthcare workers by getting vaccinated.
“If there’s anything I would like to spread, it’s the importance of unity, unity of the community in fighting this,” Su said. “Health systems can shoulder a lot but they can’t do it alone.”
The ad from Minnesota hospitals represented a desperate plea for residents to get vaccinated, or get their boosters, and to take steps such as wearing masks.
“We’ve called it a crisis, we’ve called it a catastrophe,” Koranne said. “We’re running out of words to describe what is happening. It’s important for the community to understand everyone needs to do their part.”