Patients being transferred halfway across the US as ICU bed shortage nears crisis point

Patients are being flown across states and time zones as short-staffed hospitals scramble to find open ICU beds

Sheila Flynn
in Denver
Sunday 29 August 2021 21:15 BST
ICU nurse calls on community to step up to fight Delta variant
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One patient was transferred by air from Oklahoma to Connecticut – a full time zone, eight states and a 23-hour drive away, even by the shortest estimates. Another went from Washington to Idaho. Still another was critically ill in Texas with gallstone pancreatitis, a condition usually fixable in a matter of hours, as his doctor desperately tried to find an ICU bed to take him.

That patient, a 46-year-old veteran, wasn’t as lucky as the others transferred out of state. Despite his doctor’s best efforts, his transfer came too late – and he died.

An ICU bed shortage is further plaguing patients and medical staff across the country as the Covid pandemic continues to ravage America – literally from coast to coast. According to the latest statistics from the Department of Health and Human Services, more than 77 per cent of staffed ICU beds across the United States are currently occupied.

Covid patients are taking up more than 50 per cent of ICU beds in at least four states - Alabama, Georgia, Florida and Mississippi, according to data.

During the peak at the beginning of the pandemic in New York, nurses and doctors were flying in from around the country to help. Now, however, the rest of the nation is facing shortages – not just in ICU beds but in staff trained to care for the most serious cases.

Hospitals shut down operating rooms and other departments at the beginning of Covid to make room for patients infected with the virus - but that has changed and the situation has consequently become more dire, said Dr Greg Martin, professor of pulmonary critical care at Emory University and president of the Society of Critical Care Medicine.

“It is worse” than when Covid first hit, Dr Martin told The Independent.

“We’re trying to - without expanding or without shutting down other areas ... we’re trying to continue providing more balanced care to make sure we’re caring for everything,” he said.

“Let’s say, for instance, half of the ICU beds are dedicated to Covid. That creates a real problem, because there’s - particularly for critical care - there’s often very little additional capacity in the systems. For instance, most hospitals don’t have a huge excess of ICU beds because ICU beds are expensive and they require staffing to go with them.

“Most hospitals have their ICUs running at somewhere between 80 and 90 per cent capacity - and particularly in urban areas, higher than that,” he told The Independent. “That means if you add an additional group of patients, like Covid patients, you have to figure out how to balance that and how to take care of the other patients - because they don’t just go away ... It becomes a bit of a game of dominoes, or a game where you have to move one piece - when you have to move the next piece, it becomes almost gridlock.”

In Connecticut, a spokeswoman told The Independent that Hartford Hospital on Saturday accepted a patient transferred from Oklahoma.

“Hospitals across the country are reaching out to Hartford HealthCare and we are helping out whenever possible,” she said.

On the other side of the country, Washington health authorities were expressing their desperation this week.

Dr Steve Mitchell, medical director of the emergency department at the Harborview Medical Center in Seattle, said at a press conference with state health officials that a “patient who was severely ill ... did pass away in this small hospital when, after eight hours of trying, we were unable to find an ICU bed that could help sustain her life at that point.”

He said that another patient had to wait six hours for lifesaving surgery, and one patient had to be transferred to a hospital in Idaho that had a bed available, CNBC reported.

“Sadly for large periods of time now, we have reached a point where there are actually no critical care beds that are able to accept those patients throughout our entire state,” he said this week.

That dire situation is being mirrored in states all over the country. In Colorado, health officials said that ICU bed availability and contingency plans were beginning to falter as the Delta variant sweeps the population, particularly among the unvaccinated.

Larimer County Health Director Tom Gonzales on Thursday told The Coloradoan that the county hospitals have “progressive care unit beds they’re able to use when ICUs reach maximum capacity. But all 24 of those beds are already” filled, the newspaper reported.

“The problem is we don’t really have the capacity to go to (medical) surge,” Mr Gonzales told the paper. “We’re going to have to exceed the ICU, exceed the (progressive care unit), find nooks and crannies, put beds wherever we can. They can. They’ve done that before.”

Sara Quale, a spokeswoman for Banner Health’s Northern Colorado hospitals, added: "We are working hard to hire contract labor and deploy extra resources where they are needed. The current surge is impacting hospitals across the nation, so we are all trying to hire from the same pool."

The failure to provide staff and beds lead to disaster, even for those who are vaccinated and/or present with other emergency conditions – such as Texas veteran Daniel Wilkinson.

“I’ve never lost a patient from this diagnosis, ever," Dr Hasan Kakli, the emergency room physician at Bellville Medical Center who treated him, told CBS This Morning.

"We know what needs to be done and we know how to treat it, and we get them to where they need to go. I’m scared that the next patient that I see is someone that I can’t get to where they need to get to go.

"We are playing musical chairs, with 100 people and 10 chairs," he said. "When the music stops, what happens? People from all over the world come to Houston to get medical care and, right now, Houston can’t take care of patients from the next town over. That’s the reality."

Dr Kakli told CBS This Morning that he’d called multiple facilities about their ability to take his patient - only to be told “sorry.”

"Then I’m at my computer and, I’m just like, scratching my head, and I get this thought in my head: I’m like, ‘What if I put this on Facebook or something, maybe somebody can help out?’ One doctor messaged me: ‘Hey, I’m in Missouri. Last time I checked, we have ICU beds. We can do this, call this number.’ The next guy messages me, he’s a GI specialist, he goes, ‘I’m in Austin. I can do his procedure, get him over.’ I said, ‘Okay great, let’s go.’ He texts me back five minutes later: ‘I’m sorry. I can’t get administrative approval to accept him, we’re full.’"

It’s a tragic reality being repeated across the US; one Kansas family, for example, says that 44-year-old Kansas man, Robert Van Pelt, went in for a routine procedure under light sedation – only to flatline and ultimately die because nowhere had the facilities to adequately treat his emergency situation.

“There are a lot of people who don’t believe the hospitals are full,” family spokeswoman Liz Hamer told local station KWCH. “That’s really hard to listen to when one of my friends’ husband was lying in a hospital dying because he couldn’t get the treatment he needed because the beds were full.”

Like Houston’s Dr. Kakli, doctors in Kansas desperately tried to find any equipped facility to care for Mr Van Pelt, the family said.

“The family will never know if having an open hospital bed or open neuro ICU beds, specifically in any of the 20 states, could have found urgent care,” Ms Hamer told the station. “They’ll never know if that could have kept him ere. And that’s something that’s extra hard for them to carry right now.

She added: “People need to understand this is a real present danger for families. Car accidents happen, heart attacks happen, trauma happens, and there may not be care for you in the hospital if we can’t get this under control.”

Dr Martin, who hears from doctors all over the country through his SCCM job, said the attitudes of providers have changed along with the availability of beds since the beginning of the pandemic - as doctors scramble to find ICU places across the country for patients with unaffiliated and serious problems.

“This is really remarkably different,” he told The Independent. “And it’s not something that I think anyone would have anticipated years ago - and our health systems aren’t really built for this.

“Finding the next available bed can be a real challenge, and that’s one thing that I know a lot of providers are struggling with, if they’re ... beyond their ability to provide care [and] their capacity is way down ... then spending time trying to find that next available bed is really difficult.”

That search not only takes time away from treating other patients but also eats into the morale of doctors and nurses, he told The Independent.

“The provider knows that what they’re dealing with is almost wholly preventable,” he said, adding: “We recognise that these people that are otherwise young and healthy are coming in with this preventable disease - and it’s really more of an acute choice, because they could have gotten the vaccine.”

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