Strained hospitals delaying surgeries
The delta variant surge of COVID-19 cases across Oklahoma quickly maxed out hospitals, exhausting health care workers.
For patients – even those without COVID-19 – that can mean long waits for a bed to open up when they need to be admitted. It can mean delayed surgeries. And sometimes, it can mean having to be transported far from home for an open bed.
Hospitalizations of COVID-19 patients across the state have begun to decline, though numbers are still high, and hospitals are still at or near their capacity, leaders have said.
On Friday, there was a three-day average of 1,381 COVID-19 patients in hospitals across the state, and 386 of those patients were in intensive- care units. That’s about 200 fewer hospitalizations than in late August, but numbers now still mirror what Oklahoma saw in January during the winter surge.
Internal reports from the Oklahoma Department of Health show Oklahoma patients have been sent to Colorado, Texas, New Mexico, Kansas, Illinois, Minnesota, Arizona, Iowa and Nebraska just to find an available bed. Some facilities are now declining out- of-state patients, the according to the latest report.
Now, it’s a struggle to find transportation options for patients who need to come home after being sent out of state.
The documents, weekly reports sent to state leaders in emergency management and public health, aren’t released to the public but are considered unclassified, so the Health Department shared them with The Oklahoman in response to a request for records.
Reports over the last two months show a worsening picture of the strain on hospitals – and a bleak outlook, even as hospitalizations appear now to be slowing and new COVID-19 cases have been declining.
“It is expected that the staffing shortage situation will continue to deteriorate as this wave progresses,” the latest report, from Sept. 13, read. “Facilities reporting critical staffing shortage has shown no improvement” in the last week.
And as the fall brings more large gatherings – sporting events, fairs and festivals, that’s causing “increased concerns for medical facilities already at or above max capacity,” according to the report.
Patti Davis, president of the Oklahoma Hospital Association, said this week that hospitalization numbers were beginning to level off, but hospitals don’t feel they’re “over the hump yet.”
“We still have patients waiting for ICU beds, and we would very much like to see the trend go down in terms of demand,” she said. “Given Labor Day activities, I think that all health care providers have their fingers crossed and are hoping for the best but not assuming that will hold.”
Pausing surgeries
To deal with an influx of COVID-19 patients, some hospitals have had to delay scheduled elective surgeries. But “elective” surgeries may be a misnomer. The term doesn’t mean those procedures are optional or unimportant – and they can’t be delayed indefinitely, health leaders said.
“Let’s be very clear, sometimes when you put things off, the condition deteriorates to make it an emergency,” said Davis, of the hospital association.
At Mercy Hospital Ardmore, all inpatient elective surgeries have been suspended for the past four weeks in an effort to keep up with a surge in COVID-19 patients.
They can encompass surgeries like hip or knee replacements, a colon resection, urological surgeries and more, said Daryle Voss, the president of Mercy Hospital Ardmore. Some neurological cases have also been rescheduled, he said.
The hospital got to a point where there were so many patients being held in the emergency department waiting for beds to open up in the hospital that there weren’t enough beds to reserve some for patients with surgeries scheduled, Voss said.
Earlier this week, there were 14 patients being held in the hospital’s 17bed emergency department.
“There’s absolutely no way we can do elective cases when … you have 14 people waiting in the ER for a room upstairs,” Voss said. “We cannot reserve them for elective inpatient cases.”
Some patients have waited in the ER anywhere between two to four days to get a room upstairs, he said. Patients have been treated in hallways and in curtained-off sections of the hospital lobby, Voss said.
“It’s hard on the patient. It’s hard on the families and visitors. It’s hard on the staff,” Voss said. “It’s not ideal, but it’s happening across the state – across the country.”
Delaying surgeries, too, is tough on patients. It’s difficult to mentally prepare for a surgery date – to arrange time off of work, to find a ride home from the hospital, “not to mention just the stress of not being able to move forward with your life until the surgery is complete,” Voss said – only to have it put on hold.
Some surgeries that would otherwise be put on hold have been able to go ahead as outpatient surgeries, meaning patients will be sent home the same day.
Over the past month, that leaves about 20 patients still waiting on a call to have their surgery rescheduled, Voss said.
Dr. Woody Jenkins, a physician in Stillwater, described a similar struggle at Stillwater Medical Center, where overflow tents were set up and the mayor declared a local state of emergency in response to the surge of COVID-19 hospitalizations.
“At one point, we had 22 ICU patients in our hospital, and we only have a seven-bed ICU. We are still under the crisis standard of care,” he told reporters this week on a Healthier Oklahoma Coalition call.
Non-emergency surgeries were also canceled at the hospital in Stillwater, Jenkins said.
‘Net negative’ beds
In other facilities, surgeries have been delayed or rescheduled on a case-by-case basis. An OU Health spokeswoman said non-emergency procedures at both Oklahoma Children’s Hospital and OU Medical Center had been delayed because of capacity issues.
Some surgeries have had to be delayed at Mercy hospitals in Oklahoma City and Ada, a spokeswoman said. An Integris Health spokeswoman said the system hasn’t had to make cancellations across the board, but staffing and bed availability are taken into account when hospitals are scheduling surgeries.
SSM Health St. Anthony hospitals have also had to delay some surgeries but preserves slots for people with time-sensitive surgery needs, chief medical officer Dr. Kersey Winfree said.
“We really feel an obligation that we have to block times for at least a certain minimum number of patients,” he said. “We’re balancing that against a very unpredictable volume of COVID-19 patients that require multiple levels of care.”
COVID-19 patients can require some of the highest skilled nursing staff – the same nurses that are needed to run surgeries, Winfree said.
Another wild card: Some COVID-19 patients can be so sick that they, too, require surgeries to secure feeding tube access or breathing tubes or address collapsed lungs, he said.
“We have to kind of balance, a very busy schedule, a very busy list of planned procedures against some of the unknowns that come up with emergencies and some of the needs for the COVID patients,” Winfree said.
Within the health system, Winfree said hospitalization numbers are plateauing but haven’t declined yet.
“As a state or as a metropolitan area, we’re probably still at a net negative for beds,” he said. “You look at the ERs across the metro, and at any given time when you check in with them, you find out that they’re holding patients waiting for beds.”
Health leaders are still asking for Oklahomans to do their part to ease the burden of this wave of the pandemic on the health care system: to get vaccinated and take other precautions to slow the spread of the virus.
“Hopefully, as we begin to achieve a critical mass of people that have been vaccinated, we’ll start to see our cases go down,” Winfree said, “and we’ll get back to business as usual.”