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Kat Phillips spends her days in the surgical intensive care unit at UNC Medical Center treating some of the hospital’s sickest patients.
Some are on ventilators, dialysis and ECMO machines, devices that take a person’s blood and oxygenate it to bypass poorly performing lungs. When patients leave the unit alive, the nurse said, they are the exception – only about 40% improve.
And they all have COVID.
“The patients are a lot sicker than they were, they’re a lot younger,” said Phillips, referring to the differences between now and earlier in the pandemic. “And the majority of the patients we see are not vaccinated. “
The surge in COVID-19 hospitalizations in late summer – driven by the delta variant and a state’s population that remains nearly 50% unvaccinated – has put a strain on an already healthcare system overload.
That’s according to a survey of North Carolina hospitals by the NC Watchdog Reporting Network, which found that facilities are diverting patients, converting areas to COVID services and delaying procedures to cope. Hospitals say patients get sick faster and stay sick longer, extending inpatient and intensive care stays across the state.
The result: More and more hospitals are reporting critical shortages of staff to serve those in need of medical care.
“A lot of us love what we’re doing, we love the critical aspect of it,” Phillips said. “We like to treat the sick. But we are also very tired and exhausted. “
“It’s a lot of deaths and it’s the new normal, I think,” she added. “Lots of dead around here.”
Patients diverted, longer stays
In recent weeks, the number of hospitalized COVID patients has increased in North Carolina to an all-time high near about 3,800. That’s a 10-fold increase in just two months.
About 1 in 5 patients in North Carolina hospitals were infected with the virus as of Wednesday, according to data from the US Department of Health and Human Services.
People with COVID represent a greater proportion of people in intensive care. Federal data shows that 2 in 5 people in these units have COVID.
This rapid growth appears to have leveled off as the number of newly admitted COVID patients has declined, although it is too early to say how Labor Day weekend affected the spread of the virus.
To get a better idea of the impact of the pandemic on healthcare in North Carolina, the NC Watchdog Reporting Network surveyed hospitals and hospital systems representing more than 120 facilities across the state. The survey aimed to assess the impact of the current wave on access to hospital facilities, planning of elective procedures and staffing.
In the past three months, several hospitals have limited the number of new patients entering their hospitals. This includes Mission Hospital and its subsidiaries in western North Carolina, UNC Southeastern Hospital in Lumberton, UNC Medical Center in Chapel Hill, AdventHealth in Hendersonville, and Duke and Novant Health hospitals in several locations across. the state,
They did this either by reducing transfers or by diverting incoming patients to nearby facilities.
All hospitals and hospital systems have said their ability to accept new patients and transfer patients fluctuates with their capacity, largely dictated by the number of COVID patients.
“This is a fluid, day-to-day situation,” said Leigh Whitfield, spokesperson for Lake Norman Regional Medical Center in Mooresville.
At Novant Health, which has hospitals near Charlotte, Winston-Salem and Wilmington, spokeswoman Megan Rivers said they have diverted patients to their own system and other local hospitals to manage wait times. for the emergency room and other beds.
A spokesperson for WakeMed in Raleigh said it has created back-up spaces to increase the capacity to handle a high volume of patients going to its hospitals’ emergency rooms, if needed.
The volume of patients is just one of the stressors on an already strained system. Almost all of the hospitals that responded said COVID patients stay longer than patients hospitalized for other illnesses.
At the Statesville-based Iredell Health System, that’s the difference between 4.5 days for a non-COVID patient and 10 days for a person moderately ill with the virus.
“This is in part due to a five-day treatment coupled with the fact that patients continue to require much longer treatment with steroids and oxygen due to the lung damage caused by the infection with the COVID, ”Iredell Health spokesperson Meagan Kowalski said.
Within the North Carolina Veterans Health System, the average length of stay for a veteran hospitalized with COVID at Fayetteville VA Medical Center since June 1 was 20 days, compared with an average stay of five days for veterans. non-COVID patients. Veterans treated for COVID at Salisbury VA Medical Center were staying more than nine days, compared with an average stay of three days for non-COVID patients.
As of June 1, Chapel Hill UNC Medical Center has reported an average length of stay for all COVID patients of just over nine days, with more than 16 days for intensive care patients. This brought the average stay for all patients to almost six days on average, a spokesperson said.
Victoria Dunkle of AdventHealth Hendersonville said the hospital is currently receiving younger and sicker patients. Although the average length of stay for patients with respiratory infections and inflammation, which includes COVID-19 patients, is 5.66 days, Dunkle said sicker COVID-19 patients stay an average of 13 days. , some being taken care of by the hospital for a month. or more.
Many hospitals have also reported having had to delay some elective procedures at some point in the past three months, with some hospitals specifically canceling surgeries that would require an in-patient bed.
“Simply not enough staff”
In the meantime, two of the state’s largest healthcare groups are sounding the alarm bells.
The NC Nurses Association released a survey in late August that showed nurses are exhausted and reeling from the impacts of a staff shortage that existed before the pandemic, which has only worsened since.
“I am really concerned about nurses right now and I am even more concerned about the long-term impact this will have on individuals and the profession,” Association CEO Tina Gordon said in a statement. .
About 77% of nurses surveyed by the association said their facilities suffer from a severe or moderate shortage of nurses.
And this finding is supported by data from the US Department of Health and Human Services.
The number of North Carolina hospitals reporting critical staff shortages has tripled in three months, from four to 12, according to federal data.
But exactly which hospitals – or which departments – are experiencing these shortages is unclear.
Hospitals report staff information to the Federal Health Agency daily, and it is up to each facility to determine if there is a critical shortage. But that number is only published statewide. Although the government collects data on positions that are experiencing staffing problems – ranging from critical care nurses to respiratory therapists – federal officials do not provide this data to the public.
Hospitals statewide are feeling the shortage, but it’s worse in rural hospitals, according to hospital responses to the Watchdog Reporting Network survey.
“There just aren’t enough staff to care for all the patients who need a hospital bed,” said Amber Cava of Sampson Regional Medical Center in Clinton.
“Due to the shortage of healthcare workers, we are heavily dependent on travel / crisis nurses. These nurses are in high demand and we have to win the bidding war between all the other hospitals, ”Cava said.
NC Hospital Association spokesperson Tatyana Kelly said the staff shortage was a problem before the pandemic and has only worsened over the past 18 months.
“We cannot continue to welcome the waves of people who show up at our facilities,” Kelly said.
Many hospitals have had to convert additional rooms and wings of a hospital into COVID departments to treat additional patients, compounding the staff shortage, Kelly said.
The result has been delays in treating patients for injuries and illnesses unrelated to COVID and the cancellation of elective procedures, she said.
Kelly said her association’s modeling shows the wave of delta variants will likely peak by October in North Carolina depending on a host of variables, including vaccination rates and whether people continue to travel.
About two-thirds of adults in North Carolina have received at least one injection, a lower rate than about 30 other states and the District of Columbia.
Health care workers and hospital administrators all point to the state’s relatively low vaccination rate as the reason for the continued spread of the delta variant in North Carolina.
Getting the vaccine, they said, is the best way to keep people out of the hospital.
“It takes all of us to do our part,” Kelly said.
This story was jointly reported and edited by Laura Lee, Kate Martin and Frank Taylor of Carolina Public Press; Sara Coello of The Charlotte Observer; Cathy Clabby and Tyler Dukes of The News & Observer; Nick Ochsner of WBTV; Michael Praats of WECT; WRAL’s Travis Fain, Ali Ingersoll, Amanda Lamb and Ashley Talley; and Jason deBruyn from WUNC.
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