Mike Wolanin | The Republic Columbus Regional Health President and CEO Jim Bickel talks about recommendations by the Columbus and Bartholomew County COVID-19 Community Task Force during a press conference at Columbus City Hall in Columbus, Ind., Friday, March 13, 2020.
As the pandemic enters its third year, the local health care system finds itself contending with an unprecedented number of patients — with no clear end in sight and growing uncertainty about what the long-term implications will be on the health care system.
Hospitals across the country and state, including Columbus Regional Health, have been near or exceeding capacity as the latest COVID-19 surge continues to intensify and waves of patients whose care was disrupted during the pandemic keep rolling in.
As of Wednesday, just 10% of ICU beds in Indiana were available and a near record number of people were hospitalized with COVID-19, according to the latest figures from the Indiana Department of Health.
Locally, CRH’s staffed occupancy rate has been hovering between 85% and 95%.
But the effects of the pandemic are being felt far beyond CRH. Most hospitals, if not all, are dealing with similar sets of challenges.
Additionally, primary care offices have been swamped with patients, and long-term care facilities and nursing homes have been bogged down in staffing shortages.
“This has impacted the entire spectrum of the health care system,” CRH President and CEO Jim Bickel said. “…It’s a systemic challenge, not just unique to hospitals, though we are on the almost immediate frontline in many cases for the system.”
Staffing challenges
The rapidly escalating surge in COVID-19 infections across the U.S. has exacerbated a nationwide shortage of nurses and other front-line staff as many hospitals are dealing with double the patient surges than in the past.
Staffing is what “keeps me up the most at night,” said Dr. Tom Sonderman, vice president and chief medical officer at CRH. But shortages of nurses and other health care workers are not new.
“Even prior to the pandemic, we were dealing with a nursing shortage for over a decade,” Sonderman said. “…As far as being able to ramp up staffing immediately or in a very quick fashion, health care has some difficulties or challenges.”
Nurses require at least two years of training, Sonderman said. Other health care workers, including nurse practitioners, need as many as six years. Doctors go through at least seven years of training before they can practice medicine.
“We can’t make nurses and doctors quickly,” Sonderman said.
On top of that, hospitals are struggling to cope with burnout among doctors, nurses and other workers after two years of being on the frontlines of the worst health crisis in over a century, which has killed one CRH employee and sickened at least 238 others as of last month.
Many workers have opted for early retirement or left the profession altogether. Others have found lucrative gigs as travel nurses, fueling a bidding war of sorts among hospitals for the short supply of trained staff.
However, most workers are struggling to grapple with the emotional toll of seeing patient after patient die from COVID-19 — knowing that many of those deaths could have been prevented if the patient had gotten vaccinated — as well as what CRH officials described as “increasing antagonism” from patients and their families.
Once hailed as heroes in the early days of the crisis, local health care workers are now increasingly being subjected to violence and verbal abuse from patients and their families.
“The verbal and physical abuse that happens almost daily to some of our caregivers, on top of everything else they’re dealing with, that is very concerning,” Bickel said. “…We’ve had employees that have been assaulted, kicked, punched, spat upon, blamed for the pandemic when they’re taking time away from their families and dedicating themselves to take care of patients.”
Physical capacity
CRH also has taken unprecedented measures to make room for a once-unthinkable number of patients.
The hospital has converted a first floor main hallway into a spill-over triage area and is delaying some non-emergency surgeries to free up beds and reallocate staff after reaching 198 total inpatients on at least two occasions over the past month — the highest ever in the hospital’s 104-year history.
The spill-over triage area is separate from a overflow ICU that has been set up in the hospital’s outpatient cath lab.
But the hospital’s footprint is finite.
“When you hit that capacity, then what?” Bickel said. “Then you have to start looking at other places to care for patients.”
Most hospitals in Indiana and the Midwest are grappling with surges of their own, according to federal records. Some are far worse off than CRH.
Johnson Memorial Health in Franklin reported that just 18% of its beds were available as of the last week in December and had no empty ICU beds, according to the most recent data from the U.S. Department of Health and Human Services.
IU Health Methodist Hospital in Indianapolis didn’t have any available beds at all, and Norton Hospital, a 1,035-bed facility in Louisville, was over capacity by 20 patients.
And similar scenarios are playing in other areas country as hospital scramble to find open beds, including transferring patients out of state in a desperate attempt to find care for critically-ill patients.
One person who suffered a heart attack in Louisiana was bounced around six hospitals before finding an emergency room that could take him in, The Associated Press reported.
CRH, for its part, has received requests during the pandemic to admit patients from as far away as Virginia.
“When you have no other hospital that has any more capacity in their system to take (patients), we have no place to send patients,” Bickel said. “That’s where the concern is. …And then you start to say, ‘Well, do you start to take conference room space or other space not normally (used) for patient care?’ And that care looks dramatically different. That’s what we’re trying to prevent,” Bickel said.
Converting spaces
Converting sections of the hospital into additional patient care areas takes time, planning and resources. Complicating matters further, the sickest COVID-19 patients can linger in the hospital for weeks before they are discharged — or die.
Over the course of the pandemic, the average length of stay in the hospital for Bartholomew County residents with COVID-19 has been 19 days, while the average ICU stay has been 10 days, according to the Regenstrief Institute.
Bartholomew County residents in their 40s have had the longest average stay of any age group at nearly 23 days. Children ages 4 and under have an average stay of about 5.5 days, while residents ages 5 to 19 have an average stay of nearly 11 days.
Additionally, staff need to make sure IT systems and medical supplies are available in the newly-converted areas.
Negative airflow needs to be set up in areas where COVID-19 patients are being treated to prevent the virus from spreading.
“All of that has a domino effect,” Bickel said. “When we convert the recovery room … that has implications for the surgical program. It has an impact on the cath lab program. …Every time we make those types of changes, it requires a lot of planning and effort to get that executed.”
“It’s not something you can stand up in six hours,” Bickel said.
Despite the unprecedented strain on the hospital, CRH officials are urging people to not hesitate to seek care, get vaccinated and a booster once eligible, wear masks, get tested and avoid crowds. “We are busy, and it is an unprecedented time, but we do have the ability to care for you,” Sonderman said.
But as the pandemic enters its third year, CRH officials say that one of the toughest parts of it all is not knowing when it is going to end.
“There’s no end in sight,” Bickel said. “…It would be one thing if we saw where this is going to end. But when we start looking out over the horizon, none of us can predict where all this is going to end up.”
“What is this going to do the long-term supply of professionals in health care?” Bickel said. …I don’t know what those long-term implications are to health care professionals.”
