Hospitals hit by RSV, flu, COVID and staff shortages

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When Christina Anderson’s mother started having chest pains in October, they rushed to the nearest emergency room in their hometown of Ottumwa, Iowa. Due to her mother’s diagnosis of ovarian cancer, Anderson assumed she would be seen within a reasonable amount of time. Instead, his journey became a nine-hour odyssey.

Anderson said, “When we first walked in, it was packed and packed like nothing I’ve ever seen before.” “I saw people lying on chairs; Some people turned on the people who were there hours before we arrived, and some even got frustrated and left because they couldn’t wait any longer.

Andersen’s story is not an isolated incident. Patients across the country are facing similar experiences.

Hospitals across the United States are overwhelmed. The combination of a swarm of respiratory diseases (RSV, coronavirus, flu), staffing shortages and nursing home closures has exacerbated the crisis on an already overburdened health care system. Experts believe that this problem will increase further in the coming months.

“This is not just an issue. It is a crisis,” said Anne Klibansky, president and CEO of Mass General Brigham in Boston. “We are caring for patients in the corridors of our emergency departments. There is a huge capacity crisis, and It is becoming impossible to properly care for patients and provide the best care that we all need to provide.

With the lack of beds, Klibansky said his hospital system is extremely short-staffed. The fast-paced and anxiety-inducing environment of an emergency room is a deterrent for many health care workers.

“Many people don’t want to work in hospitals,” Klibanski said. “There are other [less stressful] settings where they can work.

Klibansky said the staffing shortage goes beyond physicians and nurses, and includes technicians, respiratory therapists and other hard-to-fill jobs.

More than half a million people in the health care and social service sectors left their positions in September — evidence, in part, of burnout linked to the coronavirus pandemic — and the American Medical Association says 1 in 5 doctors within two Has been planning to leave the area for years.

The shortage has hit the health care system like a tsunami, according to Thomas Balczak, chief medical officer at Yale New Haven Health Hospital. He said that doctors, nurses and support staff have experienced a change in their dealings with the public as compared to 2020.

“When Covid first hit, there would be all these parades in front of our hospital, where people would call the health care workers heroes,” Balczak said. “Now, we’re seeing nurses who show up in scrubs and try to sign up for apartments because they’re turned down [management companies] The people who live there don’t want those who work in health care.

American College of Emergency Physicians President Christopher S. Kang said, since the start of the pandemic, health care workers have faced increasing violence.

According to the American Hospital Association, 44 percent of nurses reported physical violence, and 68 percent said they experienced verbal abuse since the pandemic began.

In October, two health care workers were shot and killed at Methodist Dallas Medical Center. Groups such as the Texas Nurses Association say hospitals are one of the most dangerous places to work.

Kang said, “I have seen nurses and doctors being subjected to both physical and verbal violence.” “It shouldn’t be a surprise when they leave an area where they are not respected.”

And the workload is tough: Kang has seen physicians evaluate patients in the waiting room at the emergency ward. Patients who need to be admitted are sometimes forced to stay in the ER because of insufficient nursing staff to move them to the inpatient floor.

“It is unfortunate because it is an uncomfortable situation in terms of privacy as well as perception,” Kang said.

Some hospitals have set up overflow tents to manage the surge in patients and have proactive transfer agreements with nearby facilities.

In the Northeast, Boston Children’s Hospital announced in November that it would postpone elective surgeries.

In October, the Johns Hopkins Children’s Center, which was running at capacity, reopened Covid triage tents initially used to manage Baltimore hospital overflow at the height of the pandemic.

In November, Colorado hospitals activated transfer protocols to help manage the overflow. The Colorado Hospital Association said the activation was due to “increased flu, COVID-19, and respiratory syncytial virus (RSV) cases, which are challenging hospital capacity, especially for the pediatric population.”

Data shows that overcrowding in hospitals leads to poor health outcomes. An analysis published in the Journal of Patient Safety found that longer wait times in the emergency room are associated with a higher chance of medical errors.

But unlike pediatric hospitals, where an explosion of RSV cases and other childhood respiratory illnesses has led to capacity issues, older patients and those in need of long-term care face a different problem: They don’t have enough time to be discharged. After that there is no place to go.

“Many patients come from a nursing home to a hospital for some type of care, and then when it comes time for them to be discharged, they can’t go back because there aren’t beds available,” said chief operating officer Kathleen Parrinello. “And then we can’t get patients into our emergency department because our beds are filled with more nursing home patients than ever before,” at Strong Memorial Hospital in Rochester, NY.

The condition of the hospital is increasing day by day. During the pandemic, 327 nursing homes were closed nationwide, displacing 12,775 residents, and more are projected to close this year.

Parrinello said the availability of nursing home beds in his area has dropped from 4,500 to 3,000 because of the facility’s closure. But most of the capacity issues can be attributed to existing nursing homes not being able to manage their capacity. “They don’t have the staff to keep beds open and take those patients,” Parinello said.

Of the roughly one million hospital beds in the United States, more than 700,000 are registered with the Centers for Medicare and Medicaid Services. Seventy-eight percent of hospital beds registered with CMS are occupied by patients, and 4 percent of those are occupied by Covid patients, according to data from the Department of Health and Human Services.

And the number of occupied beds is expected to rise as the United States moves into late fall and winter as the coronavirus season precedes the onset of flu cases.

Influenza cases continue to rise, with the latest data from the CDC showing that there have been 23,000 hospitalizations and 1,300 deaths from the flu so far this season.

About 146 million doses of the flu vaccine have been administered. And 31 million people age 5 and older have received the updated coronavirus booster vaccine. But vaccines haven’t been enough to fix the crumbling emergency room infrastructure.

In November, the American College of Emergency Physicians and 35 other health care associations sent a letter to President Biden urging the administration to address ER staffing shortages and burnout. “Shift work, scheduling, risk of infectious-disease exposure, and violence in the emergency department can all affect the mental health and well-being of physicians and nurses,” they wrote.

Many of these long-standing issues were exacerbated by the pandemic, and the assumption was that when the coronavirus surge subsided, things would return to normal. but Klibansky, Mass. General Brigham said, “There is no more general.”

“Everything has changed, and now all the issues at the forefront are moving more and more over time,” Klibanski said.

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