On many days the emergency room doctor arrives for a shift and finds the madness has already started. Sick patients may be stuck in the ER, cleared for admission but waiting for beds to open up in the higher floors.
So they wait for hours and hours, sometimes lying on stretchers, and as the day flies the line grows, to 20, 30, maybe 40. They’re cared for by frazzled nurses meant for ER care, not trained to handle severely-ill patients who belong in wards over long stretches.
“You just put patients in hallways,” said Dr. Josh Mugele, of Northeast Georgia Medical Center in Gainesville. “You start decreasing your nursing ratios. So instead of a nurse seeing five or six patients, they’re seeing eight or nine patients.”
Doctors order tests and medicines. But if there aren’t enough nurses to administer them, those wait, too.
Over the past week, similar scenes have played out in emergency rooms in several parts of Georgia.
Major hospitals including Grady Memorial, Wellstar Kennestone, Emory University and Augusta University were going on and off diversion last week, meaning ambulances bringing in more patients had to be turned away. On Thursday afternoon the Georgia Coordinating Council had 17 Georgia hospital emergency departments marked as overcrowded, six of them classified as “severe.”
That’s not the scariest part. The predicted dark winter of the pandemic hasn’t even started, yet some Georgia hospitals are already running out of room for patients. That leaves Georgia in a dangerous position before the expected surge of coronavirus infections from Thanksgiving gatherings hits.
Credit: Courtesy of Josh Mugele
Credit: Courtesy of Josh Mugele
“The fuller a hospital gets, the worse the staffing ratios,” Mugele said, expressing concern for care across the state. “The fewer resources we have, then patient care begins to suffer and so people will die more.”
The situation already: The Georgia Department of Public Health, which tracks hospital capacity on a regional basis, reported Friday that the areas surrounding Marietta, Carrollton, Dalton and Milledgeville were all above 90% full for intensive care beds, and the regions around Athens and Valdosta were both at 97%, each with just two ICU beds remaining. Those numbers may be optimistic when it comes to individual destination hospitals.
Two hospitals in Augusta and midtown Atlanta said late last week they had no space to accept any referred patients: not ER space, not in the ICU, not in their regular hospital wards.
Several hospital administrators who spoke to The Atlanta Journal-Constitution said that the patient levels they’re seeing mirror past years’ numbers for peak flu season — before flu is even being seen in high numbers here.
As the patient pipeline clogs, problems compound.
The pandemic is raging at even higher levels in other parts of the nation — CNN reported Monday that 26 states set hospitalization records at the end of November, based on data from the Covid Tracking Project. The surge is forcing some hospitals into painful decisions, including lowering their levels of patient care to “crisis standards.”
That may mean physicians allocate limited resources based on the likelihood a patient will survive.
In part, the situation is the result of a shortage of health care workers. Doctors and nurses are getting worn out from the endless pace of work, while traveling contract nurses, who can earn top wages, are being siphoned away from the local job market.
CEOs from Albany to Atlanta confront hourly wage prices for precious workers that have nearly doubled, from $60 or $70 per hour up to $120 or $130 per hour.
Hospital executives calling up temp agencies are told to get in line.
Evans Memorial Hospital saw its hired, onboarded group of 18 new workers crumble to six, as people suddenly left or never even showed.
“We’ve had three no-shows. I mean these are professional, experienced nurses,” said CEO Bill Lee. “We upped dollars and threw money at that, and we still cannot get workers.”
Credit: Jenni Girtman for the AJC
Credit: Jenni Girtman for the AJC
An unending battle
Some Georgia hospitals have become so overwhelmed, members of the administration are being forced out of their offices and back into scrubs.
Sheila Bennett, executive vice president of Floyd Medical Center in Rome, is preparing to suit up and work again as a nurse. Last weekend she had scheduled time off for a holiday break, but she worked every day, fielding calls about nursing shortages in the hospital and calling other departments to see where she could poach.
Floyd Medical was among the first to see the spring surge, and it had a July surge too. But the one right now is the biggest, Bennett said. One thing different this time, she said, is that Floyd nurses keep testing positive or having someone in their household test positive, requiring them to quarantine.
“We’re asking so much from people that are tired,” Bennett said. “They’ve been in this battle close to a year now and we don’t know when we’re going to see the dip again and things feeling more back to — not normal, just manageable.”
Even with an extra 20 beds in an outside mobile unit provided by the state, and even with added intensive care beds, her hospital is still overflowing, with staffing short.
“We’ve got an extra 15 beds for ICU patients and it’s full,” Bennett said. “On the other side of the hospital with less acutely ill patients, it’s full. In our negative pressure rooms that we’ve got scattered across the hospital, they’ve got Covid patients in them.”
The result, she said, is that at that moment they had six patients “holding” — patients who’ve been seen in the ER and need to get a bed, but are lying in the ER and waiting because there’s no bed for them.
Northeast Georgia Medical Center also has one of the state’s 20-bed mobile units, with the state supplying more than 130 additional nurses, physicians, respiratory therapists and other frontline workers through its arrangement with staffing agency Jackson Healthcare.
“The fuller a hospital gets, the worse the staffing ratios. The fewer resources we have, then patient care begins to suffer and so people will die more."
That has helped but hasn’t solved the problem, with the hospital running at around 95% capacity last week, according to Dr. John Delzell, the vice president of medical education who’s leading the hospital’s incident command center. Northeast Georgia stopped taking more patients in its medical-surgical and intensive care units, but wasn’t turning ambulances away from its emergency department.
For the surrounding counties, and even some in North Carolina and South Carolina, the hospital is the closest facility for patients suffering strokes, heart attacks or traumatic injuries.
“All of the hospitals are full,” Delzell said. “All of the ICUs are full. Diversion becomes a bit of a moot point. Everyone’s trying to work together to take care of the patients that are sick and finding a way to do that.”
Credit: Jenni Girtman for the AJC
Credit: Jenni Girtman for the AJC
Looming crisis
Yet hospitals are bracing for things to get worse, as the population continues to contract and spread COVID-19.
“December and January and February are going to be rough times,” CDC Director Dr. Robert Redfield warned in remarks to a business group Wednesday. “I actually believe they’re going to be the most difficult time in the public health history of this nation, largely because of the stress that it’s going to put on our health care system.”
Dr. Zachary Taylor, director of the state Department of Public Health’s North Health District, said that since even before Thanksgiving, people all over have been getting together for small parties with people outside their immediate household. All it takes is for one person to be infected.
“That’s one of the reasons we’re concerned about what we’re going to see in the next week or two following the Thanksgiving holidays,” Taylor said, “where we’re going to see another surge in cases from people being exposed at these gatherings of friends and family over the holiday weekend.”
Credit: Alyssa Pointer / Alyssa.Pointer@ajc.com
Credit: Alyssa Pointer / Alyssa.Pointer@ajc.com
Already, West Georgia’s Tanner Health System is out of space. The system has 360 beds across five facilities, including hospitals in Carrollton and Villa Rica. All those beds were full last week, with 57 patients waiting for rooms.
During past flu seasons, the hospitals have learned to shift staff to emergency departments so that patients in waiting can get the same level of care they would in inpatient units, Chief Medical Officer Benjamin Camp said.
But CEO Loy Howard said he has no silver bullet to handle the expected Thanksgiving surge, along with the issues that keep the hospitals busy in normal times.
“The vast majority of our patients just need care. They’ve got cardiovascular disease issues. They have diabetes issues,” Howard said. “That’s the struggle — you can’t tell them to stay home, because they need that care. And we are seeing more of those patients coming in, non-Covid.”
Credit: Jenni Girtman for the AJC
Credit: Jenni Girtman for the AJC
No easy solution
To handle the predicted surge, a spokesman for Governor Brian Kemp told the AJC last week there is the option of reopening the pop-up hospital at the Georgia World Congress Center, which can hold up to 200 patients.
But hospital executives, meeting with Kemp at the state Capitol on Tuesday, told the governor that the big issue is staffing.
“We have the space right now — we even have ICU beds,” said Candice Saunders, CEO of Wellstar Health System and its 2,700 hospital beds. “But it’s a continuous effort, daily, on the staffing.”
Emory Healthcare has gone from 100 of those top-dollar temp workers to 500. “It’s unsustainable,” Bryce Gartland, hospital group president for Emory Healthcare, told the governor.
On Monday, Dr. Mugele retweeted a photo of a tent set up on the parking lot of the Mayo Clinic Hospital in Phoenix. “We’ve had tents in our parking lot for months now,” he posted. “Tents are meaningless if you don’t have the nurses to staff them.”
Mugele described the sinking feeling of having patients stacked up in the emergency department, then seeing an ambulance roll in from out of state.
“My guess is that nobody in our region is any better off than we are,” he said. “We’re basically operating on pretty thin margins.”
