As COVID-19 fills up beds, patients stuck waiting in ER
Hospitals rushing to create more capacity amid surge
Houston-area hospitals are increasingly having to keep patients in their emergency rooms for longer periods while they scurry to open additional beds, the new pressure point of the relentless surge of COVID-19 cases.
Hospitals inside and outside the Texas Medical Center confirmed Friday that the lack of available staffed beds is stressing their already strapped ERs. Officials at the hospitals warned that though they have been able to find beds for patients with time, that won’t be sustainable if COVID-19 cases continue at this rate.
“If things don’t change, we’re facing a picture like New York City did,” said Dr. Esmaeil Porsa, president of the Harris Health System, the Harris County safety-net hospital network, which has been hit particularly hard by the pandemic. “That’s what scares the bejesus out of me.”
Dr. David Callender, president of the Me
morial Hermann Health System, said it’s not uncommon for hospitals to lodge patients but “not at this level.” Callender said 145 patients were in Memorial Hermann ERs waiting to be admitted to system hospitals Wednesday and Thursday.
What’s more, wait times keeps increasing. Porsa said it’s more than doubled in the last few weeks — from eight to 12 hours in late June to more than 24 hours this week. Sometimes, it’s longer, Porsa said.
It’s become much harder, Porsa added, for Harris Health to identify hospitals to accommodate transfers when it doesn’t have enough beds or health care workers. The system has sent patients to all manner of hospitals, from Galveston to Bryan, and continues to send adults to Texas Children’s, a highly unusual course of action.
The newfound reliance on emergency departments as substitutes for ICU and regular flood beds come as new Texas data Friday showed the number of hospitalizations around the state topped 10,000 for the first time. That represents a 3.2 percent increase over the previous record, set Thursday. There were 9,506 new cases in the state Friday.
The Houston-area’s hospitalization count, 3,920, also set a record Friday, its 10th in the past 14 days. Friday also marked a new high for the share of COVID-19 patients in ICUs — 48 percent. That’s more than triple what officials consider a safe level.
Medical center hospitals last week began implementing COVID-19 surge plans — adding more beds — something leaders thought might not be necessary after volumes fell far short of projections in April and May. That came as ICU levels topped 100 percent of base capacity for the first time. On Friday, ICU levels were at 105 percent.
Like many of their counterparts around the state, Houston-area hospitals have begin enlisting external staff support to respond to the spike in patients — and requesting more such help. Porsa, for instance, said he sent a request to the state health department for help but knows he’s far from alone.
A spokeswoman said the department has deployed more than 2,300 doctors, nurses and other medical professionals to Texas hospitals, staff supplied by three San Antonio companies. She said that “at this point, we have been able to support the staffing requests we are receiving.”
It is not just Harris Health and Memorial Hermann that are having to keep patients in the ER. The Southeast Texas Regional Advisory Council, which coordinates emergency medical responses, reports there were 271 ER patients awaiting regular (211) or ICU beds (60) at 12 area hospitals reporting more than minimal issues Thursday.
“It’s a big concern, ER patients having to wait for hospital care,” said Darrell Pile, executive director of SETRAC. “Even with hospitals invoking surge plans to open more beds, we are experiencing the kind of increased demand and situations we hoped would never happen.”
SETRAC’s Friday numbers showed improvement — 200 ER patients awaited such beds at 10 area hospitals. So did those at Memorial Hermann, where the number of boarded patients dropped to 50.
In a statement, HCA Houston Healthcare acknowledged a large increase in ER volumes and said it’s true some patients “have experienced longer wait times to be admitted to the hospital as we determine if we have the beds and staff to accommodate them.” The statement added that additional ER volume “creates a trickle-down effect, meaning that more beds and staff are required to care for patients.”
An HCA spokeswoman would neither confirm nor deny an NBC report that said it has been caring for dozens of patients in the ER.
Houston Methodist reported fewer than 10 ER patients were awaiting beds Friday. Dr. Marc Boom, president of the system, noted that “unlike a hotel, which can tell everyone they must check out before noon and cannot check in before 4 p.m., we have constant, somewhat unpredictable flows of patients who need beds and who get discharged.”
Methodist had 695 COVID-19 patients Friday and Memorial Hermann had slightly more than 900.
Callender said TMC hospitals still aren’t that close to implementing the third and last phase of their surge plan but could “get there in 10 to 14 days if current COVID-19 growth rates continue.”
“We’re holding our own,” he said, “but we’re not very comfortable with hospitalization trends we’re seeing. We really need the number of new cases and demand for hospitalizations to go down.”