Under a record number of COVID-19 patients, hundreds of the country’s intensive care units are running out of space and supplies, competing to hire temporary travel nurses at sky-high prices. Many of the facilities are grouped in the south and west.
An Associated Press analysis of federal hospital data shows that the proportion of U.S. hospitals approaching the breaking point has doubled since November. More than 40% of Americans now live in areas that run out of ICU space, where only 15% of beds are still available.
Intensive care units are the last defense for the sick of the sick, patients who are almost suffocated or facing organ failure. Nurses working in the most stressed ICUs, changing IV bags and monitoring patients on breathing machines are exhausted.
According to data through Thursday from the COVID Tracking Project, hospital admissions are still high in the West and South with over 80,000 current COVID-19 hospital patients in these regions. Encouragingly, it seems that hospitalizations are either plateau or downward trends in all regions. It is unclear whether the relief will continue with more infectious versions of the virus occurring and hanging in the rollout of vaccines.
In New Mexico, a growing hospital system brought in 300 million out-of-state temporary nurses at a cost of millions of dollars to deal with overcrowded ICU patients being treated in remodeled treatment rooms and operating suites.
“It’s been awful,” said Dr. Jason Mitchell, Chief Medical Officer of Presbyterian Healthcare Services in Albuquerque. He is comforted that the hospital has never activated its plan for rationing life-saving care, which would have required a triage team ranked patients with numerical scores based on who was least likely to survive.
“It’s a relief that we’ve never had to actually do that,” Mitchell said. “It sounds scary because it’s scary.”
In Los Angeles, Cedars-Sinai Medical Center encountered a shortage of oxygen tanks to be taken home, which meant that some patients who might otherwise go home were kept longer and made the necessary beds. But the biggest problem is competing with other hospitals for travel nurses.
“Originally, when the COVID waves hit part of the country at a time, travel nurses were able to go to areas that were hit harder. Now that almost the entire country is rising at the same time, “hospitals are paying two and three times what they would normally pay for temporary travel nurses,” said Dr. Jeff Smith, the hospital’s operations manager.
Houston Methodist Hospital recently paid a $ 8,000 detention bonus to prevent staff nurses from signing up for agencies that would send them to other hot spots. Payment for travel nurses can reach $ 6,000 per person. Week, a temptation that can benefit a nurse but can act as poaching for hospital leaders who see nurses leave.
“There are a lot of these agencies that are out there that charge absolutely ridiculous sums to get ICU nurses in,” Boom said. “They’re traveling to California, which is in the middle of a wave, but they’re crawling some ICU nurses there, sending them to Texas, where they charge disproportionate amounts to fill gaps in Texas, many of which are created because nurses in Texas left to Florida or back to California. ”
Space is another problem. Augusta University Medical Center in Augusta, Georgia, treats adult ICU patients under the age of 30 at the Children’s Hospital. Recovery rooms now have ICU patients, and if things get worse, other areas – operating rooms and endoscopy centers – will be the next areas to be transformed into 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 at their local hospitals.
“It’s a model that I think will not only survive the pandemic, but will also flourish after the pandemic,” said Dr. Phillip Coule, Augusta Hospital Chief Physician.
Hospitals are asking their communities to wear masks and restrict gatherings.
“There just hasn’t been much respect for the disease, which is disappointing,” said Dr. William Smith, Chief Medical Officer of Cullman Regional Medical Center in Cullman, Alabama. He sees that it is now changing with more people who personally know someone who is dead.
“It has taken many people,” he said of the virus, adding that the death toll – 144 people in six months in a county of 84,000 – “has opened their eyes to the coincidence of this.”
Alabama Hospital’s ICU has been crowded for six weeks with 16 virus patients on ventilators at a hospital that a year ago had only 10 of the breathing machines. “You can see stress in people’s faces and in their body language. It’s just a lot for people to carry around, ”Smith said.
“Only the fatigue of the staff can affect the quality of care. I have been encouraged that we have been able to keep the quality of care high, ”Smith said. “You want to be in a very insecure situation where mistakes can occur, but fortunately we have managed to stay on top of things.”
Hospitals say they meet high standards of patient care, but experts say surges compromise many normal medical practices. Overwhelmed hospitals may be forced to mobilize temporary ICUs and staff them with staff with no critical care experience. They may run out of sedatives, antibiotics, IVs, or other supplies they rely on to keep patients calm and comfortable while in 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 American Association of Critical-Care Nurses.
In Oklahoma City, OU Medicine Chief Medical Officer Dr. Cameron Mantor, while the vaccines provide promise, hopes it remains weak as ICU cases continue to mount. The number of COVID-19 admissions at OU Medicine has dropped from more than 100 daily in recent weeks to 98 on Wednesday, Mantor said.
“What stresses everyone out,” Mantor said, “looking at week after week after week, the tooth does not go out without knowing there is a pause, and does not see the proverbial light at the end of the tunnel.”
Associated Press authors Marion Renault in Rochester, Minnesota, Nomaan Merchant in Houston and Ken Miller in Oklahoma City contributed.
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. AP is solely responsible for all content.