Hospitals
declined to share specific surge-planning documents with The Courant. But based on interviews with officials, here’s what we know about how local hospitals plan to survive a long COVID-19 winter.
Reallocating staff
Unlike in the spring, when the biggest struggle for hospitals was a shortage of personal protective equipment, this time officials say they face a different bottleneck: staffing.
Because most of the country is experiencing a COVID-19 surge simultaneously, local hospitals can’t borrow staff from other states, as they did in the spring. Because the virus is now distributed across the state, instead of confined largely in its western half, they can’t pull staff from less-crowded facilities. And because non-coronavirus hospital traffic hasn’t declined the way it did in the spring, it’s difficult to focus resources on COVID19 patients.
Hospitals could free up staff by postponing some elective procedures, but officials fear the ramifications of doing so — both on patient health and on hospital finances. While Massachusetts Gov. Charlie Baker said Monday hospitals there will “curtail” elective procedures, Connecticut hospitals have resisted that step.
The result is widespread concern about staffing levels.
“We don’t have the deep bench that existed in April where you had a lot more traveler nurses that were willing to move to a given location,” said Dr. Syed Hussain, the regional chief clinical officer for Trinity Health of New England, which operates three hospitals in Connecticut. “No doubt, staffing is stretched, nationwide.”
“Our staff would say ... what we need is relief. We either need more staff — and you can’t create staff overnight — or we need fewer patients to be coming in.”Marna Borgstrom, Yale New Haven Health System CEO
That means hospital systems are left to reassign staff from some areas of care to others. Hussain said any medical worker could, theoretically, be reassigned to work with coronavirus patients. For example, he said in the spring the hospital system reassigned an anesthesiology group to care for patients in the emergency department.
Flaks said this type of shuffling isn’t ideal but may become necessary at Hart
ford HealthCare as well.
“Wecanmove nurses who work in home care today into hospital settings,” he said. “We can move rehabilitation physical therapists into school settings. We move all levels of staff within our medical offices into hospital settings. We can move physicians who have critical care airway management kind of skills that work in surgery centers today — they can be moved into critical care settings.”
The Yale New Haven Health System has similarly begun to shuffle staff. Marna Borgstrom, CEO of the system, mentioned one nurse who had experience in the intensive care unit but had moved on to conduct research in another part of the system. As COVID19 has surged, he has been shifted back to the ICU for a four-week redeployment.
“He spent a couple of days kind of honing his skills, learning the newest procedures in the MICU, and the medical intensive care unit staff were thrilled to have him,” Borgstrom said.
Still, Borgstrom said, hospitals have only so much staff to reallocate.
“Our staff would say ... what we need is relief,” she said. “We either need more staff — and you can’t create staff overnight — or we need fewer patients to be coming in.”
Moving patients
The state’s hospitals will not all reach capacity at the same moment — they are filling up at different rates depending on geography
and a variety of other factors. That means as one hospital becomes stretched, another might still have room for more patients.
When this happens, hospitals can begin to shuffle patients to spread the burden of care.
Borgstrom said officials across Yale New Haven’s Fairfield County hospitals communicate daily to manage moving patients and equipment so that no single facility is overburdened.
Flaks said the Hartford HealthCare system, which includes seven acute care hospitals, is designed for this kind of “load balancing.”
Hartford Hospital pulmonologist Dr. Patrick Troy said that the hospital system also accepted patients from the Yale New Haven Health system in the spring, when Fairfield County was crushed with coronavirus patients early on in the first wave of the pandemic.
“It’s almost like a state network,” Troy said. “COVIDhas demanded that of us.”
Troy said there may be some risks to patients when they’re transferred, which could be a stressful process for some. But moving patients to a facility where they will receive the care they need is worth the risk, Troy said.
“We cannot decentralize certain elements of our care. The sickest of the sick, [the] most critically ill patients, really need to be housed in one area,” he said. “We think that that value is literally lifesaving for them and outweighs the potential downside.”
Hussain said that, in the Trinity hospital system, patients can also sometimes receive telehealth treatment from providers in different hospitals, without actually needing to be transferred.
For instance, a patient admitted to Johnson Memorial Hospital in Stafford Springs — which doesn’t have as many resources — could be treated both by an on-site physician and, through telehealth visits, by a specialist based at St. Francis Hospital and Medical Center in Hartford.
It comes down to “howdo we utilize technology … with limited manpower,” Hussain said.
Auxiliary sites
During Connecticut’s initial COVID-19 wave last spring, hospitals set up various ancillary sites to treat patients, from tents in parking lots to overflow hospitals at the Connecticut Convention Center and other large venues.
Though some of these sites went unused in the spring, when Connecticut’s outbreak peaked somewhere short of hospitals’ worst-case scenarios, they could become necessary this winter if hospitalizations continue to climb.
Hartford HealthCare officials say the convention center site isn’t currently necessary but that they’re in communication with the state and prepared to reassemble it if necessary.
“We’re in pretty regular contact trying to figure out if it’s necessary and the timing of it,” said Dr. James Cardon, Hartford HealthCare’s chief clinical integration officer. “We’re constantly reassessing it. If we need it, it’ll be stood up.”
The convention center site would be available not just for Hartford HealthCare patients but also for those from hospital systems across the state.
Borgstrom, on the other hand, said Yale New Haven will open large auxiliary treatment sites, such as one at Southern Connecticut State University that was assembled but not used in the spring, only in a truly dire situation.
“What the spring showed us is that we can provide better care if we are not trying to staff a completely separate remote location,” Borgstrom said.
She said it will be “more appropriate” to instead free up capacity within the system’s existing hospitals and that the system had received an emergency increase to its bed licensure.
Michael Holmes, senior vice president of operations at Yale NewHavenHospital, said the hospital has a multitiered process for creating capacity for COVID-19 patients, using areas across its two campuses.
“Based on our COVID census, we use one tier up, and once that’s used up we flip to the second tier, and once that’s used up we go to the third tier,” he said.
With more than 200 COVID -1 9 patients currently, the hospital is now into the third tier of its plan, Holmes said.
Hussain said that Hartford’s St. Francis Hospital hasn’t yet needed to convert any non-care spaces into coronavirus units. In the spring, the hospital prepared its large auditorium to hold patients but ended up not needing to use it.
This t i me around, Hussain said the hospital is instead preparing to use mobile field hospitals and other temporary spaces to vaccinate Connecticut residents — not to treat them.
“We feel very comfortable given where we are ... that we will be able to take care of patients if there’s a surge on top of a surge,” Hussain said.