ICU STAFFING AT LIMITS AS PATIENTS FILL BEDS
Hospitals seek relief from state nurse-to-patient ratios to meet increasing demand
San Diego County set a fresh single-day coronavirus case record Friday as it became increasingly clear that local intensive care capacity is stretched much thinner than bed occupancy numbers suggest.
The county health department’s daily COVID-19 update includes 2,867 additional cases, besting the previous record set on Dec. 4 by 580. An additional 23 coronavirus-associated deaths appeared in the report, and total hospitalizations senting 4,627 total nearly patients 21 hit percent 965, in repre- of beds the across the region Thursday.
The situation is most severe in intensive care units.
Friday’s report indicates an occupancy rate of 82 percent of all ICU beds in the county. However, Dr. Wilma Wooten, the county’s public health officer, indicated Wednesday that this number is a bit misleading. Not all of those beds that remain open have enough staff available to be filled at state-mandated nursing ratios.
On Wednesday, when 20 per-cent of ICU capacity remained, Wooten estimated that just 6 percent of that larger number had staff available if patients were put in them. No updated figure was avail-able Friday evening, though total ICU occupancy, including COVID-19 and non-COVID-19 patients, climbed from 544 Wednesday to 564 Thursday. Patricia Mays ent, chief executive officer of UC San Diego Health, which operates major medical centers in La Jolla and
Hillcrest, said Friday that a conference between local health care leaders Thursday showed that there was little breathing room left in many units.
“Yesterday, we were down to dozens of (staffed) ICU beds left in the whole region,” Maysent said. “It’s tight.”
UC San Diego Health, she said, has been coping with the surge by rescheduling complex surgeries that tend to keep patients in intensive care after pro
cedures are complete. Doing so, she said, has increased the danger for many patients who can ill afford to wait for treatment. In one case, she said, a liver transplant was delayed because it would occupy ICU resources.
“Today, this very day, we have had to make decisions to postpone cases of very sick patients who need lifesaving treatment,” Maysent said.
Scripps Health reported that many of its ICUs are quite full.
Scripps Memorial Hospital La Jolla was 98 percent full while 96 percent of the intensive care beds at Scripps Mercy Hospital Chula Vista were occupied. Scripps Memorial Hospital Encinitas checked in at 150 percent, having converted some nonICU space for intensive care use to help meet increasing demand.
Sharp Healthcare, the region’s largest health care system, did not provide specific numbers, saying in a statement only that it is “actively engaged on a real-time basis in making adjustments, such as moving patients within our system and delaying less urgent cases, to ensure we have sufficient ICU capacity for COVID and non-COVID patients.”
The current situation puts relentless pressure on California’s system of care for its sickest patients. By law, intensive care units throughout the state must provide critical care nurses at a 2-to-1 ratio — that’s one nurse for every two patients.
But meeting that ratio will clearly become untenable as the overall number of patients increases and nonICU beds are converted for intensive care use. More than 175 hospitals across the state, including several in San Diego County, have already acknowledged that fact by requesting special permission from the state to violate ratios when forced to do so by COVID-related patient increases.
The state requires hospitals to do all they can to contract with nurses outside their health care systems before assigning more patients to individual nurses than the ratios allow.
All Scripps hospitals, for example, have received waivers. Palomar Health recently requested and received dispensation for the 12-bed intensive care and intermediate care unit at its hospital in Poway. The waiver, Palomar officials said in a statement, allows one nurse to treat one ICU patient and two patients with intermediate needs at the same time.
Palomar, Scripps and Sharp all said Friday that, while staffing per bed has been tight in some of their facilities, the situation has not yet gotten severe enough to start assigning patients to nurses in numbers that violate ratios.
But just the idea that such a trend might soon begin was enough to generate a protest from members of the California Nurses Association at Palomar Friday.
Joanne Meza, an intensive care nurse at Palomar Medical Center Poway and a 13-year veteran of the inland North County medical provider’s workforce, said the idea that ratios will be violated felt like a slap in the face, especially since there appears to be no reduction in the amount of recordkeeping and other non-bedside work that nurses are expected to perform.
It’s a problem, she said, because some COVID-19 patients require regular checks and chart updates as frequently as every 15 minutes.
Caring for COVID-19 patients, she added, simply takes longer due to required layers of personal protective equipment that must be put on and taken off very carefully to avoid infection.
Having the workload ratchet up after nearly 10 straight months handling the sickest pandemic patients, Meza said, is extra cruel as the holidays arrive.
“Unfortunately, people think it’s not going to happen to them, but then it does,” she said. “We are stuck in a very hard place, and we are going to do whatever we have to do for our patients, because that’s what we always do.”
paul.sisson@sduniontribune.com