With Large Illinois Hospitals Filled Up, Smaller Ones Must Treat More Critical Patients
Editor’s note: This story was originally published in the Belleville News-Democrat, a news partner of St. Louis Public Radio.
Washington County Hospital in Nashville normally transfers critically ill patients to larger hospitals in Centralia, Mount Vernon, St. Louis or the Metro East almost immediately after they arrive.
But it recently took eight hours to find an Indiana hospital that could meet a patient’s needs with an open intensive-care-unit (ICU) bed and adequate staffing, according to President Brian Monsma. That’s because larger hospitals in Southwestern Illinois are struggling to meet demand due to a surge in coronavirus cases.
“We’re looking at a lot bigger circumference (for transfers), and that increases the time that our team is taking care of the more critical patients,” Monsma said Wednesday.
Washington County, which has an emergency room and 22 beds but no ICU, isn’t alone. Several small hospitals in the region report that they’ve spent more time than usual trying to find larger hospitals to accept transfers this fall.
In some cases, the small hospitals are keeping patients they would have transferred in the spring and summer, particularly those with COVID-19 and underlying health conditions that put them at greater risk of serious illness.
“We’re seeing more people coming in with COVID,” said Randall Dauby, chief executive officer of Pinckneyville Community Hospital. “We used to be able to transfer them, but we can’t do that anymore because there’s no space in bigger hospitals like Carbondale or Mount Vernon or Belleville. They just don’t have the room.”
Pinckneyville has an emergency room and 17 beds, including one wing that’s been converted into a coronavirus unit, but no ICU. As of Tuesday, there were 14 patients, Dauby said. Six had COVID-19, down from the hospital’s record of eight the day before.
Employees at Memorial Hospital in Chester also have found themselves calling around more and waiting longer to transfer some patients this fall, according to Chief Executive Officer Brett Bollmann.
“It’s not dramatically impacted anyone’s care directly, but it’s a little worrisome,” he said. “It could get worse. ... I do know that the trending is going down for hospitalizations in Region 4, so that’s a really good sign, and we’re kind of seeing that, too. We’ve been able to transfer patients a little easier.”
Bollmann was referring to the seven-county region under the Restore Illinois plan that includes Washington, Madison, St. Clair, Clinton, Bond, Randolph and Monroe counties. Chester is in Randolph County. The hospital has an emergency room and 25 beds, including two ICU beds.
Small hospitals find ways to cope
Under normal circumstances, a variety of health issues, including strokes, heart attacks and respiratory failure, would prompt small hospitals to transfer patients to larger hospitals with cardiologists, neurologists and other specialists.
The coronavirus adds another layer of complication.
Dauby gave the example of a patient with chronic lung problems who gets COVID-19 and needs a pulmonologist, which Pinckneyville doesn’t have on its regular staff. If a patient can’t be transferred, the hospital will bring in a pulmonologist from its specialty clinic to provide care, he said.
Small hospitals are finding other ways to cope as well. Some are keeping critically ill patients in emergency rooms until transfers are possible, according to Shane Watson, chief executive officer at Red Bud Regional Hospital, which has an ER and 25 beds but no ICU.
“We’ve actually been pretty fortunate,” he said. “We eventually get people placed (at larger hospitals). But over the past month, I would say that we’ve had to hold people longer to get bed placement.
“It really differs from week to week, according to what the situation is. I’d say a couple of weeks ago, (transfer delays were) definitely the case. Things seems to have leveled off, but I’m not going to say it will stay that way.”
Red Bud has reached its 25-patient capacity twice in recent months, obtaining state waivers to exceed the limit, Watson said. As of Wednesday, the hospital had 16 patients, nine who had tested positive for the coronavirus and three waiting for results.
Another practice that’s helping both large and small hospitals handle increased demand in Southwestern Illinois is regular Zoom meetings with administrators who share information and coordinate planning, Watson said.
In some cases, small hospitals have been able to help with overcrowding at larger hospitals. Washington County has accepted transfers and used its skilled-nursing beds for patients who were being treated for serious illnesses or injuries at larger hospitals but no longer needed advanced care, according to Monsma.
Flexibility is key in a fluid situation, said Watson at Red Bud.
“Our commitment is to meet the needs of our community we’re trying to make sure that we’re doing that to the best of our ability.”
Significant drop in hospital bed availability
Illinois and many other states have seen surges in COVID-19 cases this fall. Experts blame it on people moving indoors due to cold weather and getting lax on wearing masks, social distancing and following other health guidelines. That has led to tighter restrictions, including business closures and occupancy limits, to slow the spread.
Restrictions are often tied to rising positivity rates on coronavirus tests, but Illinois officials also look at hospital capacities, deeming it risky for a region to drop below 20% on availability of staffed beds, both regular and ICU.
As of Thursday, Region 4 had 12.9% of regular hospital beds and 14.5% of ICU beds available at its hospitals (three-day rolling average), according to the Illinois Department of Public Health. That represents a significant drop from September and October:
- Sept. 3: 31.2% availability on regular beds and 49.5% on ICU beds
- Sept. 10: 30.5% regular and 38.3% ICU
- Sept. 17: 31.4% regular and 44.1% ICU
- Sept. 24: 39.3% regular and 60.7% ICU
- Oct. 1: 30.2% regular and 38.4% ICU
- Oct. 8: 27.3% regular and 43.1% ICU
- Oct. 15: 27.1% regular and 44% ICU
- Oct. 22: 31% regular and 51.1% ICU
- Oct. 29: 25.8% regular and 41% ICU
- Nov. 5: 28.8% regular and 38.9% ICU
- Nov. 12: 22.2% regular and 38.6% ICU
- Nov. 19: 14.9% regular and 22.4% ICU
- Nov. 26: 13.4% regular and 16.9% ICU
- Dec. 3: 13.5% regular and 17.1% ICU
In late November, Randolph County Health Department issued a statement asking the public to follow recommended COVID-19 health guidelines to help alleviate the strain on hospitals in the largely rural county.
“Our local hospitals are reporting difficulty in transferring patients who are in need of a higher level of care,” it read. “Larger regional hospitals are reporting a higher than normal census and will not accept transfers from the smaller rural hospitals. This means that individuals who are ill and need of a higher level of care will remain in the rural facility until a bed is available.”
It’s unclear whether health department officials believe the circumstances have improved. Administrator Angela Oathout didn’t return calls for comment.
Staff shortages part of the challenge
Beyond transfer delays, the COVID-19 pandemic has caused both small and large hospitals to face staffing issues. Employees who test positive for the coronavirus or discover through contract tracing that they’ve been exposed outside of work must quarantine under U.S. Centers for Disease Control guidelines.
That means schedules have to be reorganized and shifts covered by fewer people, a challenge for an industry that was already facing shortages in some specialties, such as nursing.
“Our census has gone up, and we have a core staff to meet those needs,” said Monsma of Washington County. “But what has really challenged us since the end of October is that as the positivity rate goes up ... We’ve now had close to 10% of our (150 employees) infected, and we had a few weeks where multiple departments basically had half the staff not available.
“So that’s been our biggest challenge. The good news is, they figured out how to cover the hours with less people. Our team works together well.”
Washington County serves portions of Regions 4 and 5. The seven-day rolling average positivity rates on coronavirus tests, which are considered good indicators of community spread, were 14.5% in Region 4 and 12.4% in Region 5 as of Wednesday, according to IDPH.
Memorial in Chester also went through a rough patch a few weeks ago with a significant number of its 240 employees forced to quarantine, Bollman said, but most are now healthy and back on the job.
Small hospitals also aren’t immune to the national problem of doctors, nurses and other staff being physically and mentally exhausted after eight months of working extra hours and dealing with the onslaught of serious illness and death.
“It places a lot of stress on health-care workers,” said Watson of Red Bud. “I think we’re very aware of it because we see it day after day. It’s not just here. It’s across America. We’re learning about this disease. We were all scared when it started. We’ve adapted pretty quickly over time, but just the sheer volume of it ... It’s had a big effect on people.”
Educating without alarming public
Some administrators of small hospitals say they’re trying to avoid overstating challenges related to COVID-19 because they don’t want to discourage people from seeking help in case of illness or injury, knowing that minutes can make a difference in emergencies and ignoring problems can cause them to get worse.
Dauby insists all hospitals, including Pinckneyville, are safer than many other public places due to mask requirements, regular cleaning and sanitizing and employees who are trained on how to protect themselves and others.
Bollmann describes potential transfer delays of a few hours as concerning but not cause for panic by would-be patients.
“They’re going to get good quality care (at Memorial in Chester),” he said. “We’ll find a place for them, and if we have to wait a little bit, we’ve got a capable medical staff to take care of them and meet their needs until we do find a place.”
Monsma noted that all hospitals have faced a big learning curve with the coronavirus because of inexperience and lack of information in the beginning.
Washington County expanded with telephone and video consults, experimented with evaluation and testing in the parking lot and converted its auxiliary space, which wasn’t being used, into a intake room for suspected COVID-19 patients.
“Everybody in health care has learned a lot about how to treat this more effectively,” Monsma said. “The length of stays are shorter. People are recovering faster.”
Some of the administrators see educating the public as part of their jobs, considering that coronavirus spread in local communities could lead to bigger problems for hospitals.
Washington County has done a good job handing seven or eight patients a day during the pandemic instead of the usual four or five, Monsma said, but things could get tricky if that increased to 14 or 15 without additional staff.
Pinckneyville is in Perry County, which is part of Region 5 under the Restore Illinois plan. The county had an 18.4% seven-day rolling average positivity rate on coronavirus tests as of Wednesday, according to IDPH. Dauby has noticed that many people don’t sanitize properly, wear masks or social distance in public.
“If everybody wears their mask and self-protects and isolates and does what they need to do, your numbers are going to go down in your community,” he said. “And that’s going to help. It will keep so many people from having to come for emergency care or be admitted to the hospital for COVID.”
Teri Maddox is a reporter with the Belleville News-Democrat, a news partner of St. Louis Public Radio.