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Healthcare systems in urban and rural areas face similar problems: too many patients, staff shortages and unprecedented stress.
Rahul Sharma recalled the early stages of the pandemic.
Sharma, emergency physician-in-chief for New York-Presbyterian/Weill Cornell Medical Center, described the experience of treating the first coronavirus patients two years ago.
“In 2020, we were paving the road while we were driving on it,” Sharma said in a conference call with reporters in January.
Two years later, hospitals continue to deal with waves of COVID-19 patients. With the highly transmissible Omicron variant, the nation saw COVID-19 hospitalizations reach a peak of more than 160,000 in January.
Hospitalizations have started dropping, notably in the Northeast, but some states in the South and West are seeing more COVID-19 patients requiring treatment in hospitals.
Healthcare systems have much more knowledge in treating COVID-19 patients than they did two years ago. But hospital leaders from across the country said the recent weeks have been the most challenging of the pandemic.
Hospitals have dealt with waves of COVID-19 patients, but this winter they have encountered additional challenges, including a labor shortage affecting systems around the country. Nearly 1 in 5 healthcare workers have walked away from their jobs during the pandemic, according to a Morning Consult report.
“Today we have a much larger staffing shortage than we did in two prior surges,” Sharma said.
Healthcare systems have endured additional difficulties this winter. They’re seeing more patients for reasons other than COVID-19. Some are there due to emergencies, while others have held off on treating lingering health complications and now they can’t wait anymore. Faced with so many patients, hospital leaders around the country have pleaded with residents to get vaccinated to ease some of the stress on their staff.
Hospitals have also struggled financially. They’re dealing with higher labor and supply costs. Many systems have postponed elective or non-urgent surgeries, reducing another source of income.
Rick Pollack, president of the American Hospital Association, said hospitals and healthcare workers need relief.
“For over two years now the relentless battle against COVID has strained our workforce like never before,” Pollack said.
For those on the front lines in hospitals, “Their health and wellbeing is on an unsustainable path.”
More than two years after the first diagnosed case in the United States, the COVID-19 pandemic is anything but a memory for those working in hospitals.
Earlier this week, the American Hospital Association scheduled a conference call to publicize its push for an additional $25 billion in COVID-19 relief from Washington. The AHA also invited hospital leaders from different areas to talk about their struggles in the pandemic.
The leaders faced some problems that were very different, and some that were very similar.
‘We know them’
Ruby Kirby is the chief executive officer of West Tennessee Healthcare’s Bolivar and Camden hospitals. She shed light on the pandemic’s toll on rural areas.
In some respects, her rural hospitals endured many of the same challenges as the largest urban medical centers. They were packed with COVID-19 patients and had difficulty transferring them, since nursing homes were filled, too.
But healthcare providers experienced different levels of stress. In those rural hospitals, the COVID-19 patients requiring treatment weren’t strangers.
“Many of the patients that come through our doors, we know them,” Kirby said. “They’re our families, they’re our friends.”
She said staffing has been a big challenge. Some registered nurses have left to take jobs at staffing agencies that can offer better pay. The AHA and members of Congress have asked the White House to investigate staffing agencies to determine if they are engaging in price gouging. They said some agencies are charging far more than they did before the pandemic.
Respiratory therapists have also resigned to work at staffing agencies.
“We cannot compete with the salaries they’re offering,” Kirby said.
The number of nurse vacancies continues to be a daunting challenge. Without adequate nurse staffing, “you start to experience more negative outcomes,” she said.
The system has received ample quantities of personal protective equipment, something that was in short supply across the nation earlier in the pandemic.
But Kirby said the system is dealing with more staff vacancies than at any time she can recall in her career.
“We are appreciative of the help we are receiving but we are really struggling in the rural communities,” Kirby said.
‘Many are burned out’
The largest of New York City’s five boroughs in geography, Queens is often hailed as the most diverse region in the country. More than 130 languages are spoken in Queens.
Bruce Flanz, president and CEO of MediSys Health Network in Queens, described the pandemic’s toll on his safety net organization. The system manages two hospitals and an ambulatory care program. More than 80% of the system’s patients are on Medicare or Medicaid.
Queens was the “epicenter” of the pandemic’s beginning, Flanz said. Then the Omicron variant brought another wave of COVID-19 patients into the system.
“The cumulative effect on our staff cannot be overstated,” Flanz said. “They are understandably tired, exhausted and many are burned out.”
Even before the surge of COVID-19 patients with the Omicron variant, Flanz said the system had high admission levels “as patients had been postponing their care.”
As if that weren’t enough, MediSys operates the busiest Level 1 trauma center in New York City.
“That responsibility doesn’t stop because of COVID,” he said. “We continue to see gunshot victims. We see people who have suffered motor vehicle accidents.”
The system did curtail non-urgent procedures. Flanz said those with the Omicron variant generally required less time in the hospital before they could be discharged. The sickest patients were those who were unvaccinated.
He also pointed to one advantage with this wave of COVID-19 patients.
New York state began requiring healthcare workers to be vaccinated in September, so 99% of the system’s employees were vaccinated. Fewer employees were getting COVID-19 and being forced to isolate.
“We believe that this helped tremendously during this current wave,” Flanz said. He estimated 3% of the staff were out due to COVID-19 this winter. (A federal order recently upheld by the U.S. Supreme Court will require most of America’s healthcare workers to get a COVID-19 vaccine by the spring.)
Flanz said the system needs additional support from the federal government to support the system.
‘A serious toll’
The Henry Ford Health System operates six hospitals and 250 affiliated healthcare sites in Detroit and southeast Michigan. The region was among the first to see record peaks in hospital admissions due to the Omicron variant.
In late January, hospitalizations began falling. Still, COVID-19 cases and hospitalizations remain high, said Wright Lassiter, president and CEO of the Henry Ford Health System.
The drop is “not yet a sign for celebration,” he said.
About 20-30% of the beds in the system’s hospitals are filled with COVID-19 patients, Lassiter said last week. Coronavirus patients are filling a quarter to a third of the ICU beds.
Lassiter said the stress on the staff can’t be overestimated.
There’s been a 600% increase in staff requesting support from the system’s employee assistance program.
“COVID is taking a serious impact, a serious toll on our staff,” Lassiter said.
Labor shortages are adding to the system’s problems.
The system has 1,000 vacancies for nurses out of a pool of about 9,000 he said. Henry Ford is recruiting a cohort of nurses from the Philippines, who are expected to arrive this summer.
Early last week, Lassiter said 75 beds were closed due to staffing concerns. A month earlier, 150 beds weren’t available. And the lack of staffing has limited non-urgent procedures.
“We have delayed about 400 procedures over the last 30 days related to staffing, related to lack of staffing,” Lassiter said.
In addition, the system is losing millions on what Lassiter termed “crisis labor spend.” The system is spending an enormous amount on nursing staffing agencies to cover shifts, he said.
A military medical team has been assisting Henry Ford Wyandotte Hospital, just south of Detroit. Lassiter said he’s grateful for the help.
“Our organization continues to bear a significant burden,” he said.