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Hospitals still under strain as COVID-19 surge subsides

Mail Tribune / Jamie LuschAsante Rogue Regional Medical Center remains under strain as the COVID-19 surge subsides because of a backlog of deferred care, including surgeries.
Rogue Valley hospitals face backlog of non-COVID-19 patients

Although the summer and fall COVID-19 surge is subsiding, Rogue Valley hospitals remain under strain as they work through a backlog of non-COVID-19 patients whose care was delayed during the surge.

“Although you see these COVID volumes coming down, we still are limited on our precious resources — our hospital beds,” said Amanda Kotler, vice president of nursing for Asante Rogue Regional Medical Center and Asante Ashland Co mmunity Hospital.

For weeks, the number of open intensive care unit beds in Jackson and Josephine County’s four hospitals have been dangerously low, often dipping to no beds or just a few, according to hospitalization data.

Hospitals are still treating COVID-19 patients in their intensive care units, although those numbers are now lower, but other types of patients are filling the ICU beds.

“When you think about all the patients waiting for care, it’s really sad, but we’re doing our best to prioritize them and work them through the system,” Kotler said.

During the surge, local hospitals had to cancel all but the most urgent surgeries as COVID-19 patients overwhelmed hospitals’ abilities to care for everyone. Even people who needed surgery for cancer or to treat heart conditions had operations put on hold.

Kotler said hospitals are working through the highest-priority cases first.

“We’re really focusing on surgeries like cardiac surgery or cancer surgery or neurosurgery where the patient will have negative consequences if they don’t have the surgery within a certain time frame,” she said.

The medical community is constantly weighing who gets surgery and who has to keep waiting.

“It weighs heavily on us and we do our best to understand the patient’s clinical condition and get them in as soon as possible. That’s what adds to the complexity of all this. It requires prioritization and re-prioritization. We just really want to be here to serve our community,” Kotler said.

Patients who need surgeries to reduce pain, such as knee replacement surgery, are continuing to see delays. Bariatric surgeries to treat obesity are also among the surgeries being postponed, she said.

People who delayed seeking care during the COVID-19 surge are now showing up in emergency departments. Their conditions often grew worse while they waited, Kotler said.

Many patients who need to be admitted into the hospital still have to wait for beds to open up. Hospitals are continuing to board patients in emergency departments as they wait, Kotler said.

Whether a patient comes to the hospital with COVID-19 or some other illness or injury, the most acute patients are getting beds first, she said.

On Saturday, Asante’s three hospitals were treating 38 COVID-19 patients, 84% of whom were unvaccinated. There were seven COVID-19 patients in intensive care unit beds and three COVID-19 patients on ventilators. All the COVID-19 patients in intensive care and on ventilators were unvaccinated, according to Asante.

During the surge, the vast majority of hospitalized COVID-19 patients in regular and ICU beds have been unvaccinated, and almost 100% of COVID-19 patients on ventilators have been unvaccinated, Asante data shows.

Hospitals are still using alternative spaces to house their various patients.

“We continue to use our cardiovascular recovery unit for an overflow critical care unit. That is still in place despite the COVID volume going down,” Kotler said.

Patients are also often boarding in surgery recovery units, she said.

More patients are flowing into hospitals than are leaving, straining capacity.

“The patients who are seeking care currently are sicker than they ever have been before. So they have longer lengths of stay in the hospital. Those patients are taking longer to discharge,” Kotler said.

The struggle continues to find nursing and rehabilitation centers that can take patients who are ready to be discharged from hospitals. Centers often have open beds, but many say they face labor shortages, low reimbursement rates for patient care, regulations and other challenges that make it hard to operate at full capacity.

In September, the state government funded eight COVID-19 recovery units at nursing homes around the state to help ease the nursing home bed crunch, which has persisted throughout the pandemic.

“We continue to see support from the state and we’re really grateful for the support they’ve provided. Unfortunately, the volume is exceeding the beds that are available in the community. It’s still a crisis for us in terms of discharging those patients despite all the efforts to help,” Kotler said.

Asante’s hospitals currently have 60 patients who are ready to be discharged, but are waiting for openings in nursing homes or rehabilitation centers, she said.

Although Rogue Valley hospitals remain under strain, she said people shouldn’t delay seeking care.

“We want patients to receive care when they need to receive it. I don’t want to by any means discourage patients from coming in. We really want them to be treated and we do everything we can to support making sure they get the care they need,” Kotler said.

The state of Oregon is urging people to avoid unnecessary trips to hospital emergency departments and to seek care at a doctor’s office or urgent care clinic for less serious problems.

When it comes to staffing, Asante said it isn’t seeing major impacts from Gov. Kate Brown’s mandate that health care and school workers get vaccinated against COVID-19 by Oct. 18 or get a religious or medical exception.

“All our essential services continue to be provided to patients. There may be some delays, such as the turnaround time for non-critical lab test results or preparing a hospital room for the next patient, but in each example, we’re only talking about one or two hours longer, not days or weeks,” said Asante spokeswoman Lauren Van Sickle.

She said Asante hospitals faced staffing challenges long before the mandate. They’ve been operating at or near their maximum capacities since the start of the pandemic.

Some people predicted the vaccination mandate would prompt an exodus of health care workers at a time when the nation is still dealing with the pandemic and has a shortage of medical workers. Oregon adopted its own mandate, and a federal mandate affecting workers at businesses with more than 100 employees goes into effect in November.

Asante, which operates three hospitals in Medford, Ashland and Grants Pass plus other medical facilities, has more than 6,000 employees.

“We were hopeful that every employee would choose to stay. However, a small number of employees, fewer than 60, resigned citing the mandate. About 3% of our workforce is currently on leave without an exception. We anticipate they will end their employment on Oct. 31,” Van Sickle said.

Even with the governor’s mandate, she said the desire to work at Asante remains high. Asante set a new record in October for recruiting and has more than 100 new hires joining Asante across all areas of the organization. Asante began ramping up recruitment efforts more than a year ago to accommodate growth in services it’s bringing to the community, including a new regional cancer center in Medford and an expanded cancer center in Grants Pass, Van Sickle said.

“As of Oct. 18, our patients are assured that every employee they come in contact with in an Asante medical facility is vaccinated. This includes contracted labor such as traveling nurses who must follow the state’s vaccination mandate in order to work for Asante. We’re incredibly grateful for all our employees who are committed to offering this high level of reassurance to the community,” Van Sickle said.

Reach Mail Tribune reporter Vickie Aldous at 541-776-4486 or valdous@rosebudmedia.com. Follow her on Twitter @VickieAldous.