Hospitals are straining
Facilities are conserving beds for sickest patients
As COVID-19 hospitalizations soar in San Antonio with no end in sight, hospitals are making moves to conserve beds for the sickest patients and stretch beyond their normal capacities.
Health care systems across the city have activated their surge plans.
University Hospital is limiting the number of trauma patients it receives, instead directing them to Brooke Army Medical Center. Hospitals are curtailing nonessential surgeries and converting specialty care areas into COVID units. More medical staff are headed to San Antonio to assist with the emergency.
As one of the area’s two Level 1 trauma centers, University typically works in tandem with BAMC, accepting an equal share of people hurt in car crashes, shootings and accidents.
But as it works to maintain enough intensive care beds, the public hospital has requested that all transfers from other hospitals in the region be directed to the military medical center.
University still is accepting patients who are directly transported from the site of their injuries, as well as pediatric trauma and burn cases.
In a statement, BAMC said the move will
help “ensure that the regional trauma system remains intact in the face of the pandemic.”
“We are grateful for the leadership at BAMC who readily assumed this extra number of civilian patients,” University said in a statement. “This allows for loadbalancing to optimize the regional COVID surge response while also maintaining high quality trauma care and access.”
The arrangement also was used for about two months over the summer to lessen the burden on the public hospital during the city’s first major coronavirus surge.
“This is a well-documented, proven process to help us with surge capacity at University,” said Eric Epley, executive director of the Southwest Texas Regional Advisory Council, which coordinates emergency services for Bexar and 21 surrounding counties.
City in crisis
The temporary change to how the county handles trauma patients comes as San Antonio faces its most extensive coronavirus crisis yet.
Across San Antonio, a record 1,318 people were hospitalized with COVID-19 as of Tuesday. The city blew past the previous high of 1,267 patients who were treated in July, during the city’s first major surge. People infected with the virus accounted for 33.6 percent of all hospital patients.
The city continues to average more than 1,000 new infections and 100-plus COVID-19 admissions a day, outstripping the number of patients hospitals have discharged.
To free up beds, hospitals are discharging patients to long-term acute care and specialized nursing facilities whenever possible.
Last month, transports by San Antonio Fire Department paramedics returned to levels commensurate with the summer surge, said Woody Woodward, a department spokesman.
In the past month, there have been more than 1,000 emergency transports suspected of being related to COVID-19, city data indi
cates.
The situation in local hospitals is expected to get worse before it improves.
Hospitalizations could reach or surpass 1,700 coronavirus patients before the surge relents, Epley said. Fewer than 500 staffed beds were available across the city’s hospitals as of Tuesday.
“The situation right now is pretty heavy with respect to our demand, but it’s manageable,” he said. “I think that the numbers will continue to increase incrementally, as they have done for the last three to four weeks.”
‘Better off in a hospital’
Over the past eight weeks, the number of staffers brought in to work in San Antonio’s hospitals under state contracts has increased five-fold, totaling more than 1,000 nurses and respiratory therapists. Another 300 health care workers are expected to arrive by Monday, and STRAC may submit additional requests for staffers as needed, Epley said.
The additional medical personnel are helping to staff beds in pediatric and surgical areas to accommodate the influx of COVID-19 patients.
San Antonio’s hospitals are so busy that they’re going on diversion with greater frequency — temporarily routing ambulances elsewhere as they contend with overcrowded emergency rooms.
While ambulances still are able to drop off patients, Epley said there could be delays at times in bringing them into hospitals during the surge.
At times, patients may be held in ERS for longer periods of time until a bed becomes available, a practice called “boarding” that can happen during busy periods — such as the height of flu season.
Beds have been set up at Freeman Coliseum, but it’s not yet staffed. Epley said all measures will be taken to expand traditional hospital capacity before officials resort to opening the facility, which lacks laboratory, imaging and pharmacy services.
“I’m still a full believer that you’re better off in a hospital,” he said.
Should Freeman be opened to patients, Epley added, it likely would serve less-ill coronavirus patients who are almost well enough to be released.
With more than 450 patients, Methodist Healthcare is caring for
more than a third of all coronavirus patients in San Antonio. The system has assembled advisory committees to help determine which surgeries can proceed during the crisis.
Like University, it is limiting some elective procedures — as is Baptist Health System.
Dr. C.J. Winckler, an assistant clinical professor of emergency medicine with UT Health San Antonio and deputy medical director of SAFD, said paramedics have been relying on a new telemedicine program to free up emergency responders for the most urgent calls.
Instead of always sending an ambulance, callers who may have COVID-19 but don’t appear to be in distress are transferred to a clinical dispatcher, who assesses their symptoms and helps connect them with testing.
Winckler also has been overseeing the operations of an infusion center at Freeman, where monoclonal antibody treatments are being administrated to COVID-19 patients at a higher risk of developing severe complications.
Since it opened Nov. 30, more than 500 patients have received infusions, including 56 on Tues
day.
“One way to decrease the strain on the hospitals is to try to keep people out of the hospital,” Winckler said.
Slow-burning surge
In some ways, this surge has been less challenging, Epley said.
Over the course of June, area hospitals scrambled to open units and bring on extra staff as COVID-19 hospitalizations rose by nearly 1,000 percent. The latest round of hospitalizations has risen more gradually, doubling over the course of a month instead of a week. That has allowed hospitals to more effectively bolster their capacities, Epley said.
Doctors, nurses and respiratory therapists now are well acquainted with the progression of COVID-19 and have more options for treating it. Far more residents are able to access testing and receive a COVID-19 diagnosis before they’re sick enough to need medical care. Fewer patients are being admitted to ICUS and placed on ventilators to breathe.
“All those things combined make this a little bit easier to deal with this time, although the numbers are going to be higher than the summer,” Epley said.
Even so, nearly a year into the pandemic, health care workers are weary. Hospital staffers are confronting a new flood of patients as they try to cope with exhaustion, burnout and trauma exposure. They’ve grown frustrated with residents who ignore public health advice and act as if the pandemic is over.
Through STRAC, San Antonio has benefited from a unique level of coordination and communication among its hospitals and emergency services providers, Winckler said.
But having deployed to overwhelmed hospitals in Eagle Pass, where facilities were in danger of running out of supplemental oxygen, he is acutely aware that every system has its breaking point.
“If you just have too many sick patients, then you’re going to be overrun,” he said. “There’s no amount of planning that can help in certain circumstances. You mitigate, but you can’t exactly fix it.”