Facing staffing constraints while approaching patient capacity with COVID-19 hospitalizations accelerating, area doctors and health care leaders are sounding the alarm of an impending crisis as the delta variant-driven surge in the state continues and the school year approaches.
Representatives of Essentia Health, St. Luke’s Hospital in Duluth, St. Louis County Public Health and Grand Itasca Clinic and Hospital gathered for a virtual news conference Tuesday, Aug. 31, to provide updates on the spread of COVID-19 in the region and what that means for local health care facilities. Those caring for the region’s patients also used the platform to plead with the public for their help in alleviating the pressure by listening to the recommendations of trusted experts to become vaccinated, wear masks, support frontline workers and avoid delaying health care for oneself when needed.
“We have really difficult news to share. As has been reported, hospitals across our region are again very close to capacity,” said Dr. Andrea Boehland, an emergency medicine physician with Essentia Health. “This is a really big deal. We think it’s our duty to let you know about this situation. When hospital capacity becomes tight like this, our ability to care for patients with any kind of health problem is put at risk. Our capacity problems are due to an unfortunate perfect storm.”
This perfect storm, Boehland said, is driven by three factors: an increase in the prevalence of COVID-19 along with hospitalizations of severely ill patients who are mostly unvaccinated, a higher number of non-COVID patients hospitalized than at any point during previous surges and mounting staffing constraints. These constraints on staffing represent the most critical ingredient in the region’s health care systems’ abilities to provide necessary care to those who need it, Boehland said.
“What we are experiencing this time around is people are our hospital system’s most valuable resource. Not hospital beds, not ventilators, but people. Our brave frontline workers are exhausted. Some have retired, some have cut back on clinical hours. Traveling employees who helped us surge effectively last time are much more difficult to find this time around for similar reasons,” Boehland said. “We have a moral obligation to provide the best care for all our patients and this sense of duty is what leads us to share the situation with you and to ask for your help.”
Boehland said the patients she and her team are seeing are younger than in the past, including some children, and the delta variant appears to be less discriminating in its health impacts across age groups.
“This is really unsettling to me,” the doctor said. “One of my coping mechanisms over the past year and a half has been to think, ‘At least the kids are OK.’”
The number of patients with severe COVID-19 symptoms currently hospitalized across the Essentia Health system stood at 53 Tuesday, which Boehland said was an increase of 10 patients from the day before. About 15-20 of those patients were in Essentia Health-St. Mary’s Hospital in Duluth, double the number in the facility just two weeks earlier. As of Friday, Crow Wing County reported seven new hospitalizations in each of the last two weeks, representing half of all hospitalizations among county residents since the beginning of July.
Challenge upon challenge
In the Brainerd lakes area, summer is always a busy time for health care providers, said Dr. Peter Henry, chief medical officer at Essentia Health based in Brainerd, during an interview earlier this month. While visitors flocking to the region and the warmer months bringing higher incidences of trauma cases tell some of the story, Henry noted additional factors are also at play amid the second summer of COVID-19. Beyond an increasing caseload of COVID-19 patients themselves, secondary impacts of the pandemic including delayed care and mental health effects are playing a role in increased patient numbers across the board. These patients tend to be sicker as well, Henry said.
“We have seen an uptick in the severity or the acuity of the people that we see, because of the delay in health care,” Henry said. “People have postponed critical preventative health care, and so typically, the severity of the illness … is significantly higher. That makes the complexity of the care higher.”
Dr. Rob Westin, chief medical officer of Cuyuna Regional Medical Center in Crosby, as well as Tim Rice, CEO of Lakewood Health System in Staples, echoed Henry’s observations as reflected in their own health care systems.
“ED (emergency department) has been busy, the hospital has been busy. And that’s not a terrible surprise, but certainly COVID has also gone up and COVID patients tend to stay in the hospital a little bit longer for us,” Westin said. “ … It’s been hard to find beds for transferring patients out because of staffing challenges across the state and in our area, too. … So that’s been a strain. I mean, that’s multifactorial. It’s both the general volume of patients and then it’s also the staffing.
“Challenges in health care are the same as being seen across workforces all over the place. It’s just harder to find people to work the jobs that are necessary. Not that we have not been taking care of patients like we need to, I mean, I think it’s just been a really busier time this year than typical.”
Rice said similar factors are affecting Lakewood, adding the system’s long term care and assisted living facilities are also at capacity.
“Having safe and quality care is always our No. 1 concern, and we want to make sure we’re doing that. That is what our providers and employees think about every day, that they want to make sure we’re really caring for our patients and our residents,” Rice said. “But just the whole issue of the workforce, that’s our other worry. We have all this demand, both on the hospital, the clinic, and the care center side, but yet, do we have enough workforce to cover that demand? … If we get more demand than we have for people, how do we address that?”
Improved knowledge, better outcomes
While local health care systems can’t outrun the mathematics of patient-to-staff ratios nor the rise of those in need of critical care, in many ways, health care workers are better prepared than ever to combat COVID-19. Eighteen months of accumulating knowledge about the disease caused by the novel coronavirus has led to effective treatments lessening the most severe symptoms and better outcomes for hospitalized patients as best practices for providers evolve. Access to vaccines is widespread in the U.S., providing protection against the worst effects of COVID-19 while also alleviating squeezes on staffing experienced last autumn when potential exposures kept large numbers of employees home.
“How do we keep people out of our hospital? Two ways. We know the vaccine is exceedingly effective in doing that and preventing serious illness, hospitalization and death,” Henry said. “But the other thing that could be beneficial to that is monoclonal antibody therapy, and we have been following the CDC (Centers for Disease Control and Prevention) recommendations, FDA (Food and Drug Administration) guidelines in regard to modification of the therapy to make sure that it’s meeting and consistent with what the circulating variants are and we have the most up to date. We have enough supply of that medication to be able to give it to individuals and now we’re looking at making sure that we have appropriate access for that therapy.”
Westin of CRMC said one of the lasting impacts of pandemic-era health care he hopes to see into the future is the improved collaboration with other regional health care systems.
“Collaboration between organizations, both regionally and statewide, as far as sharing best practice, sharing protocols, even sharing staff and what’s worked and what hasn’t worked, and communication with all the work that we had to do for the pandemic for PPE (personal protective equipment) supply chains and treatment — that certainly has been inspiring and also, I think, something that hopefully we can carry forward,” Westin said.
Rice said Lakewood’s employees have shown an incredible ability to adapt, which bodes well for future crisis situations.
“They worked in different areas, they were flexible. We developed contingency plans that allowed us to look at different ways of best distributing resources,” Rice said. “ … I think we gained experience from that. All the way through the system, are our contingency plans that we put together before, do they fit what’s going to be happening now and in the future? And we’re busy relooking at those right now.”
Supporting burned out employees
All three local leaders said supporting their employees by ensuring they’re appreciated and have access to resources for their own mental health amid increasing burnout risk are key to keeping morale buoyed.
“We’ve done a lot of work on what we call our well-being team during the COVID pandemic, that we’re actually going to continue to extend throughout our system and bring this on a continuous basis outside of the pandemic, recognizing that health care is a very difficult job,” Henry said. “It’s 24-7-365 and it doesn’t go away on holidays, it doesn’t go away at night. And that can be very fatiguing, and we know that our facilities, especially here in Brainerd, this is our busiest time of year.”
Rice said it’s important for leaders in the organization to be cognizant of the challenges employees are facing and to give them a voice.
“This has been a long haul. People are tired, and they just need support that way. It’s just knowing and understanding what they’re going through,” Rice said. “The other part is we try to do a lot of education. We’re continually trying to provide input, we’re trying to keep our employees informed what’s going on at all times within our organization but also what’s the most current information regarding vaccinations and what information do we have. So us, availability and education are definitely the two key things we’re working on.”
Westin pointed to several staff appreciation events at CRMC and daily practices to support employees as ways to combat pandemic fatigue. These include personal thank you notes to staff as well as campuswide messages of support, along with messaging surrounding mental health breaks, physical activity and fresh air.
“It seems like that makes a big difference for staff morale,” Westin said. “Even though … the market is such that pay scales are elevated and things like that, sometimes it just isn’t enough to say, ‘Hey, you get paid more money, therefore you can work harder.’ A lot of people aren’t motivated by that as much as just knowing that they’re caring for folks and that they’re appreciated. So I think that’s what really motivates the work we do, and hopefully patients can feel that as well.”