Rural hospitals stretched by surge
Many nearing capacity and are short-staffed
With an influx of new coronavirus patients slamming rural Ohio hospitals, many report they are nearing capacity and short-staffed, and some are close to having to ration care.
Rationing health care is the process of making decisions about who a hospital can provide with full care and who they will be unable to provide support. The term became more commonly known as a wave of COVID-19 cases hit places such as New York City earlier this year and the country of Italy before then.
Many Ohio hospital leaders have warned that they could be forced to ration care, though they hoped to avoid
such a situation. But, with a record 5,060 Ohioans hospitalized as of Monday, some southern Ohio health systems are near the point of having to do so, said Dr. Kirk Tucker, chief clinical officer for Adena Medical System.
Adena Regional Medical Center in Chillicothe had 38 coronavirus patients as of Monday, and it has the capacity for 40 COVID-19 patients. With eight of 14 hospitals in the region not taking any transfer patients right now, Adena is working on a backup plan to house up to 60 COVID-19 patients in an auditorium in the PACCAR Medical Education Center in Chillicothe.
“When we need to, we overflow into other areas of the hospital, but it requires the hospital to call in emergency staffing,” Tucker said. “It’s really not been, at least to date, a bed-capacity issue, it’s been a staffing issue, having adequate nursing staff and position staff to care for an ever-growing demand of patients with COVID.”
The worst surge in COVID-19 patients to date has been since September as people “further let down their guard,” and students returned to school and colleges, Tucker said.
Tucker said that several times a week when he is in the COVID unit, a patient will be dying of coronavirus and going through the grieving process with family while being pulled from the ventilator for the last time.
Three patients were on ventilators as of Monday morning, said Tucker, and the hospital usually fluctuates between three and six.
Seven nurses and three doctors are off work with coronavirus, with 59 caregivers total out of rotation due to the disease, Tucker said. Adena peaked with 14 nurses out “at one point in time,” he said. One employee has become sick enough to be hospitalized.
Every hospital system throughout the state is “being destroyed by this surge,” Tucker said.
“You hear the governor plead,” he said, “And I don’t want to be the guy who says, ‘It’s too late,’ but at this point if you haven’t gotten COVID yet, this is like a tornado warning. The sirens have gone off and it’s time for everyone to get in the basement.”
Dr. Lucy Bucher, senior director of medical affairs at Ohiohealth’s O’bleness Hospital, said the COVID-19 surge was taking its toll but that as of Tuesday the Athens hospital was managing it.
The hospital recently added more beds to deal with the increase in COVID-19 patients. O’bleness has benefitted from being part of Ohiohealth, which Bucher said it can lean on if needed.
“If there are resources that we just don’t have because of the size of our hospital, we have the opportunity to work with (other) Ohiohealth hospitals,” Bucher said. “I feel very fortunate. … I really worry about the small hospitals that don’t have that resource backing of an institution like Ohiohealth.”
Further north, Wooster Community Hospital has been able to keep its other services open through recent surges.
The hospital, located in Wayne County, has 29 beds available for COVID-19 patients on its second floor. It also can accommodate more COVID-19 patients in other select rooms, with the goal to keep the cohort of COVID patients together.
The hospital has taken in patients from other area hospitals in the northeast central Ohio region to help with their surges. It has been able to maintain its capacity and used its clinical team to help in areas stretched by the increase in COVID-19 patients.
“We had one point where our COVID area was pretty full,” said Ryan Mcbeth, the clinical manager for Med/ Surge at Wooster Community Hospital. “We extended to what we anticipated early on. We hadn’t seen to that extent.”
Pomerene Hospital in Millersburg has seen “spurts” of high capacity and had to rely on other area hospitals such as Aultman in Canton; Aultman Alliance; Aultman Orrville; Union Hospital in Dover; and Wooster Community Hospital to take its patients. CEO Jason Justus also spoke of issues finding beds for people who need “higher tertiary care.”
Staff at both Wooster and Pomerene have picked up extra shifts to maintain their expected levels of patient care. Justus said a concern moving forward is maintaining that consistency with providers and staff members in case the area sees an uptick in hospitalizations and infections.
“It’s much more difficult to replace staff and additional providers,” Justus said.
Licking County saw a more than 62% increase in hospitalizations due to the novel coronavirus Monday.
Heather Burkhart, vice president of acute care services at Licking Memorial Hospital, recently said the hospital’s current designated COVID units hold 49 patients. But the hospital’s capacity is being adjusted in real-time, she said.
“It’s important to communicate that, at any time, we can make adjustments to accommodate any additional surge in patients,” Burkhart said. “Our current capacity of 49 COVID beds is not a static number. It’s what we currently have in place based on recent surge numbers.”
Fairfield Medical Center in Lancaster has two COVID-19 units and the hospital can hold 26 COVID patients in the unit. However, FMC has the capacity to hold more COVID patients in other areas of the hospital if need be.
The number of COVID patients or those who are suspected of having the virus changes by the hour, spokeswoman Michelle George said. She said that causes the admissions to fluctuate during the day.
George said the hospital has seen an increase in the number of COVID patients from what it experienced at the start of the pandemic, but did not supply any numbers.
Though rural hospitals are bearing the brunt of the patient surge first, some hospitals in Ohio’s big cities are already taking action to free up beds and staff should they become overwhelmed.
On Monday, UC Health started to only perform medically necessary surgeries and procedures. The move, made because of the physical and emotional toll on workers as COVID-19 cases keep rising, also included inpatient services, emergency cases and outpatient elective cases that do not require a hospital stay.
UC Health’s move came after neighboring Butler County saw a 64% drop in available adult medical-surgical beds, a 55% drop in ICU beds and a 21% drop in airborne infection isolation beds, an analysis from The Enquirer shows. The drop in medical-surgical bed availability is 21 points worse than in neighboring Hamilton County.
In the opposite corner of the state, Akron-based Summa Health has suspended all elective surgeries and procedures, both same-day and those that require a stay at its hospitals.
Procedures and surgeries for traumas and cancer patients still are being performed. The procedures for “the folks that don’t absolutely need to be in the hospital” right now – such as for hernias and elective joint replacements – are being postponed, said Dr. David Custodio, president of Summa Akron campuses.
The hospital system also moved all obstetrical services and deliveries of babies scheduled for Barberton Hospital to its Akron City Hospital campus – a move Summa made in April during a previous COVID-19 surge.
“As it was earlier this year in April, this is a temporary decision and all services will return on the Barberton Campus at the conclusion of this crisis,” said Dr. Michael Hughes, president of Summa’s Barberton campus.
Gannett Ohio reporters Céilí Doyle, Anne Saker, Terry Demio, Betty Lin-fisher and Michaela Summer contributed to this story. mfilby@dispatch.com
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