How are Vermont's hospitals faring? In mid-January 'things are getting tight'
Vermont hospitals have reached their highest rates of admitted COVID patients throughout the pandemic– exceeding 100 each day for much of the past week.
As cases continue to climb, it’s possible that hospitalizations will exceed capacity in the coming days, but not a guarantee, according to hospital and state officials.
Amid high patient volumes, staffing continues to be a challenge. The University of Vermont Medical Center announced an emergency staffing plan this week as nearly 5% of its workforce is out due to COVID-19 protocols.
Reinforcements have arrived from the federal government: health care workers from the Federal Emergency Management Agency (FEMA) have proved “tremendously helpful” for Vermont hospitals in recent days, though it’s uncertain whether their contracts will be extended.
In the past week, VPR’s Lexi Krupp spoke separately with Dr. Stephen Leffler, the chief operating officer at the University of Vermont Medical Center in Burlington, Meg Oakes, a nurse leader and senior director of quality and safety at Rutland Regional Medical Center, and Dr. Trey Dobson, the chief medical officer at Southwestern Vermont Medical Center in Bennington. Their responses are below and have been edited for clarity.
VPR: How have things been in the past week?
Meg Oakes (Rutland Regional Medical Center): Things have gotten tighter in terms of staffing, and staff being COVID positive or having family members who are and needing to stay home. And in terms of just overall patient volume in the hospital going up, as well as COVID patient volume going up. We've got more COVID patients than I think we’ve ever had in house.
Dr. Stephen Leffler (UVM Medical Center): Our staffing challenges have gotten greater. We started to enact an emergency staffing plan in certain key areas to make sure we can staff and keep those services fully functioning.
Dr. Trey Dobson (Southwestern Vermont Medical Center): We're sort of yellow light. Some days, we do turn red — certain hospitals will turn red. And they send a note out, we try to figure out, how can we support each other? But yellow is not a good place to be. You want to operate when you're green, offering all the services the community needs.
What do we do when the volume exceeds our capacity? Basically what it does mean is that care standards would have to be modified. And that's not something that most health care professionals in Vermont have had to face before.
How are staff doing?
Oakes: There's very much a domino effect from what happens with schools, and how schools are handling all the cases, and potential exposures. And then, our ability to provide services, whether it's testing, or effects our employees, because, of course, we're also community members.
Dobson: The angst is certainly present among our staff, concerned that we have finite resources and finite staff. And we've done all that we can to prepare for an increase in hospitalizations. But the angst comes about, what do we do when the volume exceeds our capacity? Basically what it does mean is that care standards would have to be modified. And that's not something that most health care professionals in Vermont have had to face before.
Does it seem inevitable that patient volume will exceed capacity?
Dobson: No, it’s not a feeling that it’s inevitable. We do have treatments that help keep people out of the hospital, although unfortunately those treatments are in very short supply right now. And then there's also the hope that we have such a vaccinated and boosted population that the increase in hospitalizations will not keep continuing.
Leffler: There's so much COVID in the community right now, we expect [patient volumes] to get a little higher over the next five to seven days. But we don't know for sure.
We have two adolescent patients who have been in the E.D. (emergency department) for more than 10 days. That is not good.
Are you having problems discharging patients?
Leffler: We have more than 40 people here in the hospital that are ready to be discharged to a nursing home. But the nursing homes either have their own COVID issues, their own staffing issues, or other problems that are not allowing them to accept people in a normal fashion.
Oakes: The usual problems are amplified. We have two adolescent patients who have been in the E.D. (emergency department) for more than 10 days. That is not good. It's not the best environment for the patients in terms of it being therapeutic.
How sick are the COVID patients you’re seeing right now?
Leffler: People who have COVID really fall into three buckets. There's people who have COVID, and are very sick because of COVID — about half of the COVID that we're seeing right now falls into that bucket. Then there's people who have other health conditions — maybe congestive heart failure, or emphysema— and COVID has made that worse. Then we are seeing some people right now who have COVID, but it really is not causing them any symptoms.
And even if they’re not very sick, how are COVID patients burdensome on the hospital?
Leffler: Whether you’re here because of COVID — and you're very sick from COVID — or you're here with appendicitis and have COVID, you're still a patient who's very labor-intensive to care for. You still need specific kinds of isolation, extra PPE and require numerous extra steps of care.
What’s the status of elective surgeries?
Oakes: We're still able to do them. Most of the elective surgeries that are happening today [Monday, Jan. 10] will be people who can go home the same day. So those surgeries are not taking inpatient beds. As far as physical materials, inpatient beds are the thing we're shortest on at the moment.
As far as physical materials, inpatient beds are the thing we're shortest on at the moment.
Leffler: We are still doing a fair number of elective procedures. We're trying to do more elective procedures where people go home, so they don't need a hospital bed. And deferring some, where someone might need admission.
Has staffing support from FEMA helped out?
Oakes: We've got some FEMA nurses and paramedics here. And a couple more on the way. And that's making a big difference.
Leffler: They're absolutely helping us.
Dobson: It's really helped morale so that you're not toeing the line all by yourself. You’ve got some additional resources there. And you get that collegiality and camaraderie of having folks there.
Will that support continue?
Dobson: Unfortunately, every two weeks they are renewed and reassigned to areas of most need. We are going to be likely losing many of our FEMA individuals at the end of this week.
Leffler: I can't tell you exactly how the government is deciding. I'm cautiously optimistic that they'll keep helping. When we've told them we could really use them for another cycle, to this point, they've been responsive.
Lexi Krupp is a corps member for Report for America, a nonprofit national service program that places journalists in local newsrooms to report on under-covered issues and regions.
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