COVID surges are stressing capacity — here’s what we’re doing

The increasing number of COVID patients admitted to our hospitals has had a dramatic impact on non-COVID care that Asante delivers. The most recent peak in COVID-positive patient admissions was Dec. 28, with 13 admissions in 24 hours. Our average daily census is approximately 47 COVID patients. In addition to increased admissions, we are also seeing a decrease in hospital discharges. This results in a net increase to our usual census and a bottleneck in patient throughput within our hospitals.

Capacity constraints are currently a compromise to the safe delivery of care. Increased capacity demands have resulted in extended patient stays (boarding) of inpatients in our emergency departments, delayed discharge from our inpatient units, brought more daily admissions than discharges, and caused delays or cancellations of non-emergent and non-urgent surgeries and procedures.

Boarding

Patient boarding has had serious consequences. On average, Asante has 45 patients waiting for external placement. This means we have 45 patients in the hospital who no longer need acute-care services but have nowhere to go, taking up beds that should be used for other patients needing our care. Longer stays also put patients at risk for poorer outcomes and increased risk of a hospital-acquired complication.

Boarding is also an issue in our emergency departments, where we are experiencing anywhere from 10 to 30 patients at any given time who are awaiting placement in an inpatient bed. These boarders occupy emergency department rooms, which reduces the number of rooms available to care for other patients needing emergency services. This results in longer wait times, people leaving without being seen and potential for delayed diagnosis. People who cannot access critical care services in a timely manner face a potential increase in morbidity and mortality.

Surgical and procedural cases

Secondary to our hospital capacity constraints, we have also been forced to delay and cancel non-urgent and non-emergent procedures and surgeries. To date, we have delayed or canceled more than 100 cases across the Asante system.

Many of these procedures have lifesaving implications, including open heart surgery and other cardiac procedures, and vascular, lung and cancer surgeries. Other more elective cancellations have included spine, total joint, hernia, thyroid, colon and bariatric surgeries.

Capacity management and patient surge planning

ARRMC serves as the regional resource hospital for the Oregon Health Authority, and with OHA’s support, will implement a distribution protocol after exhausting resources within the health system. Until then, we are taking several steps to address the surge, including aggressive and proactive management of our non-urgent procedural services and focused efforts on patient throughput.

We have also worked to optimize our resources across the system and will continue to load-balance and cohort medical-surgical COVID patients at AACH, ATRMC and ARRMC.

In addition, we have prepared to expand critical care capacity. At ARRMC, we are preparing to open a Cardiac Stepdown Unit on the Heart Center. This will help increase capacity in our critical care units. We have also added critical care beds at ATRMC by converting six beds from the Cardiovascular Recovery Unit and Sleep Lab to critical care rooms to create an additional 12 critical care beds. (Six are existing IMCU beds).

That said, our ability to expand and fully use these newly created resources is limited by our clinician staffing. There are critical staffing concerns across Asante secondary to exposures to COVID-19 and seasonal illness. These absences have escalated rapidly in critical care and are complicated by the complexity of our patients requiring acute care. We continue to look for solutions to meet the demand.

Call to action

The situation caused by the pandemic and the conditions under which our teams are working reinforce the need for the community to remain vigilant in following safety precautions, including physical distancing, wearing a mask, avoiding large gatherings and washing hands frequently.