Hospitals are grappling with staff shortages as federal Covid funds run out

“We had to pick up the slack and then try to figure out, ‘Are we protecting people or are we letting them go when we’re not in a hurry?'” said Julie Hirschhorn, director of molecular pathology at the Medical University of South Carolina. in Charleston. “The increases are far enough apart that I don’t know what to do … it’s a difficult new normal.”

The current wave of new hospitalizations for Covid-19 has increased 40 percent It has also put new stress on facilities in the last month as federal funding to respond to the pandemic runs out, leaving some with less flexibility to hire more staff if needed.

In March, a financing deal will cover the portion The White House’s $22.5 billion request It collapsed because Democrats in Congress objected to the reuse of unspent funds promised states during the pandemic earlier, while Republicans said Accounting was required $6 trillion Congress appropriated for pandemic relief before approving new money in past funding bills.

“There’s a growing concern that that money has run out,” said Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association. “It really doesn’t get enough attention.”

As of July 22, hospitals in nearly 40 states are reporting Shortage of critical personnelWhile hospitals in all 50 states said they expected it within a week.

Several states with increasing numbers of Covid-19 cases have large and growing problems, although factors beyond Covid are involved.

In California, for example, only eight hospitals described staffing shortages as critical as of July 22, but 118 are expected within the week. In Louisiana, only one hospital reported a critical shortage last week, but 46 are expected to have one this week. More hospitals also expected shortages in Alabama, Florida, Kentucky, New Mexico, Tennessee and West Virginia — all states with rising cases.

“While we’ve had staffing shortages before, we’re acutely aware of staffing shortages in virtually every position in the hospital right now.” Foster said. “If we have a large influx of Covid patients, it will be much more difficult to meet these demands than ever before.”

Chronic hospital staffing shortages remain a long-term problem, administrators say, because even vaccines that have been shown to be highly effective in preventing serious illness don’t keep everyone out of the hospital. There is also growing resistance among Americans to mitigation measures such as social distancing and masks and Reluctance of public officials Sounding the alarm during a wave in which fewer people get sick and die than in the past.

Hospital ICUs are not flooded with Covid-19 patients as they were in previous waves and The average daily death rate is up to 350According to the Centers for Disease Control and Prevention, there are far fewer than the thousands of Americans who die each day from past outbreaks.

But serious strain on the health care system remains without these horrendous bills.

“I don’t think people appreciate the consequences of allowing us to transmit the virus almost willy-nilly,” said David Wohl, an infectious disease expert who leads the Covid-19 response at UNC Health in North Carolina. “If there are supply chain issues, if there are delays in getting services, or if people are saying, ‘Well, I’m understaffed, I can’t do this,’ it’s because of the pandemic.”

“Robbering Peter to Pay Paul”

Hospital staffing shortages—from nurses to doctors to medical lab technicians—existed before SARS-CoV-2, a result of both an aging health care workforce and an aging population in general, which increases demand for care.

The pandemic has created a kind of domino effect in the medical community, said Sherry Polhill, associate vice president of hospital laboratories, respiratory care and pulmonary function services at UAB Medicine in Birmingham, Ala.

This forced older workers to leave their jobs earlier and created a boom in the lucrative travel medical professional industry, which drove people away from staff jobs.

“You have a vacuum of vacancies to fill, and you can’t do that easily,” Polhill said, adding that it could take years to fill open positions in his labs.

The shortage has hit hospitals — and their patients — in a number of ways, as BA.5 has proven able to evade immunity and has become the dominant strain in the country.

North Carolina, where cases have increased almost 20 percent For the past two weeks, UNC Health has been struggling to meet increasing patient demand for monoclonal antibody treatments.

Hospitals are still treating the antibodies with drugs that may interact negatively with the simpler therapy, paxlovide.. Unlike paxlovide, a pill that can be taken anywhere, monoclonal antibodies are given by infusion, a time-consuming process that requires careful infection control to treat patients in infusion centers that also treat immunocompromised individuals.

To make it work, Woll said, the hospital would have to pull staff from other departments.

“We have to rob Peter to pay Paul,” he said. “If you have people who work in an infusion center who do this, what was their day job like before Covid? Some of them worked in the emergency department. Some of them worked in the operating room. You just can’t pull people out of these other critical functions and always work somewhere else.”

In neighboring South Carolina, staffing shortages at the Medical University of South Carolina have already forced the hospital to suspend all inpatient testing for Covid-19, as it had previously done during the pandemic.

The facility received money from the Covid-19 Relief Act Congress passed in March 2020 to bolster its testing capacity with new equipment and staff.

Now that money has dried up, and Hirshhorn has had to cut shifts and staff. His lab, one of them in a hospital, had 44 employees and contractors at the peak of the pandemic, but today only 10 full-time. his Covid-19 testing capacity has been reduced from about 3,500 to 1,500 per day.

The decision to suspend routine testing for Covid has helped prevent the lab from being overwhelmed. Despite a 34 percent increase in the number of people hospitalized with Covid in the past two weeks in South Carolina. But Hirshhorn said it’s embarrassing to know he no longer has the resources to step up if needed.

“We’re all trying to understand what our lab looks like now and what we can do to prepare for the next wave because we know we won’t have the same staff that we had in other operations,” he said. . “We’re flying blind.”

Pandemic fatigue

That anxiety is common in hospitals, where the pandemic has exacerbated staffing shortages that preceded it.

“Medical laboratory scientists are unhappy right now,” said Susan Harrington, a microbiologist at the Cleveland Clinic and chair of the American Society for Clinical Pathology’s Laboratory Worker Management Committee. “They work very hard and work very long hours.”

“What is the end of it?” he asked. “I really don’t know the answer.”

While hospital labs are generally much better prepared to handle this wave of cases than they were in 2020, the Medical University of South Carolina is not alone in not being able to complete testing all patients for Covid-19 due to staff shortages, Jonathan Miles said. Chair of the Council on Government and Professional Affairs, College of American Pathologists.

A lack of local testing options poses a greater risk to patients and the community, he said, especially in rural facilities that operate in economically disadvantaged areas. “They’re working on a shoestring,” he said. “If you limit testing to rural areas, you exacerbate disparities in care.”

Large urban hospitals may be better positioned to juggle peak transmission periods, but with more staff calling in sick and more patients testing positive, they are also under pressure.

In Los Angeles County, where no Patients are hospitalized with Covid-19 It increased sharply after May, regardless of the area High vaccination rateHarbor-UCLA Medical Center had to find ways to manage.

“People are getting Covid left and right,” said Anish Mahajan, the facility’s executive director and chief medical officer.

So far, the hospital has dealt with that uptick, he said, with longer wait times in the emergency room due to staff shortages and more patients. The hospital may again have to prioritize emergency cases if the condition worsens.

The only real way to end the uncertainty is to stop the virus, by vaccinating and taking measures to stop its spread, he said, like re-fitting masks when transmission is high.

“The more viruses that enter our world, the more likely we’ll see future generations of variants,” Mahajan said. “Maybe this option doesn’t cause as many people to get sick in the hospital.” But we don’t know what the following options might do. “

Hospitals are grappling with staff shortages as federal Covid funds run out

Source link Hospitals are grappling with staff shortages as federal Covid funds run out

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