‘No place for the patient to go ’ — As a new COVID wave hits, hospitals struggle to find open beds
On a recent evening, as Dr. Thomas Tobin tried to transfer a patient from Grand Junction, he called every hospital equipped to offer a high level of care within a 500-mile radius.
“There was just no place for the patient to go to,” said Tobin, chief medical officer for Community Hospital. “No one had any beds.”
One finally did open up about 24 hours later — in another state — and Community was able to transfer the patient. The key is to just keep calling other hospitals, Tobin explained, and hope you're the lucky one on the line when a bed finally becomes free.
There doesn’t seem to be any sign of things letting up for the hospital, either. At one point this week, Community was caring for 56 hospitalized patients, even though it only has 54 beds.
“We're full on a daily basis,” Tobin said.
The situation at Community Hospital is one that is happening at hospitals all over Colorado. As large numbers of mostly unvaccinated COVID-19 patients are hospitalized, it’s putting stress on the state’s entire health care system. Scott Bookman, director of Colorado’s Division of Disease Control and Public Health Response, said that the state historically sees about 68 percent of ICU beds occupied at any given moment.
As of Thursday, that number was hovering around 90 percent.
“That means that we have approximately 120 ICU beds available across the entire state,” Bookman said during a press conference with the governor Thursday.
He called COVID-19 “the pandemic of the unvaccinated.”
State data show that areas with high vaccination rates have much lower rates of hospitalizations. Gov. Polis explained that in cities like Eagle, Boulder and Broomfield — where the vaccination rate is around 80 percent — the rate of hospitalization is just a fraction of that in counties with low vaccination rates, many of them small and rural. Those hospitalizations don’t just stay in those lower-vaccinated places, however. Patients often end up moved across the state or region, as health care workers try to fit the puzzle pieces together, trying to find care for everyone.
All the while, hospitalizations in Colorado continue to climb. Bookman, who’s also the incident commander for the state’s COVID-19 response, said all kinds of hospitalized patients are being affected by the decreasing capacity at the state’s hospitals.
“Brain surgeries, heart surgeries are being delayed because of a lack of availability to provide care to those patients because of the impact that COVID hospitalizations are going to have,” he said.
If things were to get worse, the state’s hospitals could even move to the most urgent medical approach: crisis standards of care. “I'm in regular discussion with all of our providers with regard to when, or if we need to re-institute, those crisis standards of care,” Polis said. The guidelines set out how to make the most grave medical decisions, as the crisis potentially overwhelms hospitals, and resources get scarce. Those standards would help determine who gets care and at what level.
Hospitals in other western states like Wyoming, Idaho, Montana, Utah, and Alaska have all either activated their own crisis standards or have come close in recent weeks.
Bookman stood with the governor in asking everyone who’s not vaccinated to take that step, to get their first shot, and for vaccinated people to get a booster shot when they are eligible.
“Our health care workers on the front line deserve that from all Coloradans so that we can get back to our way of life,” he said.
But the vaccine remains a tough sell, even among health care workers, in many of Colorado’s more rural, lower-vaccinated communities.
At Montrose Memorial Hospital, 10 employees have chosen to quit rather than take the vaccine or ask for an exemption. Chief Executive Officer Jeff Mengenhausen said that another 30 or 40 unvaccinated staff members — about 5 percent of its workers — have not told the hospital what they’re going to do yet, even though the vaccination deadline for Colorado health care workers is Nov. 1.
“Unfortunately, we're not dealing with science,” Mengenhausen said. “We're dealing now with emotion and beliefs and, and it's a very polarizing issue and I'm trying to walk a very fine line supporting our caregivers and also supporting the vaccine and believing in the vaccine.”
He explained that he’d rather have “great, valued caregivers” taking care of patients than have to close down beds. He worries that the vaccine mandate might push more employees to leave. His hospital has had to hire traveling nurses to help fill the gap, and their average salary nationally is $200 an hour.
All of this comes as his hospital is seeing an unprecedented number of patients. In August, Montrose Memorial’s emergency room had its busiest month ever, though it wasn’t due to COVID, just typical accidents and ailments. Each month since has been just as busy or even busier — and now that a new coronavirus wave has hit, that has also added to the strain.
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“It was just, boom! One day we’re getting busy with COVID,” Mengenhausen said.
For the last two weeks, he estimates the hospital has been running at 105 to 110 percent capacity, and that this Monday was the hospital’s “worst” day in its history. At one point this week, seven of the hospital’s eight ICU beds were taken up by COVID-19 patients.
The hospital has been able to stay nimble, however, Mengenhausen explained. They’ve been able to triage and add hallway beds in the emergency room. And despite the shortage of health care workers, they’ve been able to staff each one of their beds.
But Montrose Memorial, like all hospitals in Colorado right now, remains in a precarious spot, especially when they need to transfer a patient. In the past, if the hospitals on the Western Slope were all busy, there was usually a facility in Metro Denver willing and able to take their patients.
“But right now, it’s everybody,” Mengenhausen said.
As a result, his hospital has had to turn to another unexpected place to search for places to send patients.
At one point this week, after his hospital kept searching and searching for another facility to take a patient, it finally found one with space — in Kansas.
CPR’s John Daley contributed to this report.
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