Some hospitals overflowing with patients

OPB health reporter Amelia Templeton spent a day in the emergency department at Salem Health hospital last week. The day she was there, the hospital had 540 patients, but only 494 beds.

The following transcript was created by a computer and edited by a volunteer:

Dave Miller: From the Gert Boyle studio at OPB, this is Think Out Loud, I’m Dave Miller. Back in the summer, at the height of the Delta surge, OPB’s health reporter Amelia Templeton spent two days in OHSU’s intensive care unit. As Oregon reckons with an even bigger surge now, Amelia headed back to a hospital, Salem Health, this time focusing on the emergency department. She joins us now to talk about what she saw. Amelia, welcome back.

Amelia Templeton: Thanks Dave.

Miller: Why did you go to Salem Health in particular?

Templeton: It’s a really good example of the strain that hospitals are under all over the state. It has one of the busiest emergency departments in the Pacific Northwest. It’s the only hospital serving the second largest metro area in Oregon, Salem. And the day that I was there, they broke their own record for COVID-19 patients. 122 people with COVID-19 were there last Thursday. And that was also the most of any hospital statewide that day. They told me about 70% of those were people who were admitted with respiratory symptoms, and 30% were cases they picked up because they screen every person who comes through the door.

Miller: What was the scene like on Thursday?

Templeton: It was intense. The hospital is licensed for 494 beds. So while we were there, they said the census was close to 540 patients, a surge scenario. And what that meant was that charge nurses on every floor were chatting and trying to find patients who could double up and get a roommate. Staffing-wise, the National Guard is there. There are people in fatigues throughout the hallways pushing carts.

In the emergency department, there’s kind of a rhythm to the days. When we got there at 8:30, it’s their slowest time of day, and it was fairly quiet. But, there were cots that were staged throughout the halls of the emergency department. And one of the doctors, Peter Hakim, who showed us around, explained what they were there for.

Peter Hakim [recording]: These beds right now are here because we know, as the day goes on, we will need to put people into the hallway. So even though we don’t yet have any patients in those beds, we already know as the day goes on that we’ll need to use those spaces.

Templeton [recording]: So that’s kind of staging for that moment when you have somebody who comes in, and there’s no room to put them in.

Hakim [recording]: Yeah, we are already at this point preparing for the inevitability of the day that people will need to be in those hallways, because we will be out of rooms.

Templeton: This is a really big change. He says three years ago, if he was treating people in a bed in the hallway of the ED, that would have been extraordinary. And now he prepares for it every day.

Miller: Well was he right? Did it fill up?

Templeton: By the time I left, about 12:30, there were seven or eight ambulances parked outside. I counted 13 patients being triaged in the halls of the emergency department. Many of the hallway cots had patients in them. And the waiting room out in front was also completely full of people waiting to get admitted.

Miller: How does crowding in an emergency department work? I mean, what does it mean in practice?

Templeton: Well, Hakim told me that sometimes he has a single room in the emergency department available, and five or six patients that he’s trying to evaluate or treat. And so he’ll move a person into the room to examine them, and then move them back out into the hall to wait while he wheels the next patient in. And if you think about what this means, some of his patients might have really personal medical issues that they’re dealing with. They might have a broken hip. So he might need to take somebody’s pants off. He said he’s had to take patients into the bathroom to treat them because there was no other private room available. So they’re being really resourceful. But everybody was clear, this really changes the practice of medicine.

And Salem Health is a major trauma center. So usually it takes transfer patients from smaller rural hospitals in the area. But when they’re this busy, they have to refuse some of those transfers. Hakim told me the surprising story about how his own family dealt with this.

Hakim [recording]: Last week, my mother in law had a heart attack. She was in a small rural hospital in Oregon. And they could not find a bed for her anywhere in Washington or Oregon for 24 hours. So she was sitting in this small, six bed emergency department, and couldn’t get transferred out.

Luckily, she was stable, and she didn’t have any bad outcomes because of the delay in care. But she’s fortunate in that regard. And a lot of people aren’t fortunate, and are having delays in care, and are not as lucky as she was.

Templeton [recording]: But, you had to say we don’t have room for her here.

Hakim [recording]: Even at the hospital I worked at, I could not get her here. We did not have space At that point, I think our hospital capacity was about 115%. And we had 40 people waiting in our emergency department for beds upstairs.

Miller: What does it mean in terms of the care that people get that they are stuck in the emergency department?

Templeton: I asked Dr Hakim about that. And this is what he told me.

Hakim [recording]: People often ask me as an emergency room physician what my specialty is. And I say pediatricians are trained in kids. Cardiologists are trained in how to deal with your heart. I’m trained in how to deal with today. Anything that’s happening today, I can fix, I can save your life. But how to manage your chronic conditions, that’s not my training. How to take care of you for a week, it wasn’t part of my training. So when you’re stuck here for a week, I’m actually not the person you want to see.

Templeton: And if you picture an emergency department, the lights are on 24/7. It’s never quiet. There’s always something beeping. There’s a lot of chaos all around, and it’s just a really hard place to rest or recover from any kind of illness.

Miller: I’m curious how far down the line the delays that you’re talking about are going. Are people who might have been discharged pre-COVID, are they also stuck inside the hospital upstairs for longer?

Templeton: Absolutely. Part of why there is such a traffic jam in the emergency department is because the entire hospital is full, and there aren’t beds to rotate people into. I talked about this with Sarah Weber, she’s a hospitalist and a doctor. One of her many duties is to help coordinate her patient’s discharge plans. And she told me that recently she’s had a number of patients, about half of her total panel, who no longer need hospital care but can’t find a safe bed to rehab somewhere else. Last week she said, seven or eight of the skilled nursing and rehab facilities patients would normally go to weren’t admitting anyone either due to staffing shortages, they’ve been hit incredibly hard during COVID, or COVID outbreaks. So instead of waiting a day or two to get out of the hospital, it might take somebody a week or two, or even longer, and some people essentially wind up living there.

Sarah Webber [recording]: Hospitals are not ideal places for rest, recovery, for strengthening, and our staff is already so stretched thin that they don’t really get the rehab that they need. There’s exposure to potential illnesses and infections, increased risk of pneumonias. And there’s many documented bad outcomes to staying in the hospital for too long. So I actually think it delays and potentially decreases a patient’s ability to become independent again, the longer that they stay here.

Templeton: This is a statewide problem. I looked at the data this morning, and about 10% of the hospital beds in Oregon have somebody who’s ready to leave but can’t find a place to safely rehab or recover.

Miller: As I mentioned, you came on to Think Out Loud this past summer, after you spent two days at the intensive care unit at OHSU talking to a lot of nurses there in particular. That was during the Delta surge. What’s similar and what’s different from the hospital’s perspective when you compare these two surges?

Templeton: I think the biggest thing that’s different is really simple. It’s just the cumulative impact of how long this pandemic has stretched on. This is now the fifth or sixth wave depending on how you count. The health system as a whole is just fragile and exhausted. What’s similar: medically, the people who are at greatest risk and with the worst outcomes are unvaccinated people. Most people in Marion County, about 60%, have had two doses of the vaccine. A majority of the people hospitalized with COVID-19 at Salem Health are unvaccinated. And if you are vaccinated, you can still wind up getting sick enough that you end up in the ICU on a ventilator. Peter Hakim, the ED doctor, really objected to the way that Omicron is framed as milder.

Hakim [recording]: A lot of people think Omicron is very mild. And if you’re vaccinated, and especially if you’re boosted, it generally is. But if you’re unvaccinated, you’re still coming in very sick. And people don’t understand that. They say “On the news, they told me it wasn’t that serious. They told me it was mild.” And that’s as I’m putting them on a ventilator.

Templeton [recording]: When did you most recently ventilate a COVID patient?

Hakim [recording]: On my last shift. Every day, we are still seeing very, very sick COVID patients.

Templeton: But other staff said that, when you look at the patient population as a whole, the impact on the hospital as a whole, this wave does seem milder. They’re less concerned about running out of intensive care resources. Patients still need care for pneumonia, but they don’t need the same level of oxygen support.

I spoke with Jackie Williams, a respiratory therapist, who said she thinks she’s seeing a difference.

Jackie Williams [recording]: I feel like I am seeing more patients live. And that has been really awesome. And I was thinking about it yesterday actually. I can think of like three patients that I know of that were very, very sick, and we all were pretty sure that they were going to die. They were young. And they’re discharged. They were here for months and months and went to rehab and they’re better. And I feel like we are seeing patients now that aren’t getting as sick as they were with the previous wave. So that feels really good. It’s like a little glimmer of hope.

But what we’re seeing in addition to that is other consequences of COVID. And it might not be breathing problems, but it’s alcoholism, it’s suicide, it’s traumas, it’s all these other things that are what the world is dealing with after coming out of two years of a pandemic. And those are critical illnesses too.

Miller: Amelia, misinformation has been one of the hallmarks of this pandemic from basically the beginning. Did any of the folks you talk to mention what they’re encountering now during this latest surge?

Templeton: Yeah, they are still encountering people who are asking for treatments that don’t work. Things like Ivermectin, or even I was told, sometimes trying to sneak it in themselves. There’s also some new misinformation that’s circulating. Sarah Weber, the doctor we heard earlier, said that some of her patients have started refusing Remdesivir. It’s one of the first drugs that was approved for COVID-19. It’s a really standard treatment. and Weber is struggling to figure out how to establish trust with her patients who don’t trust vaccination or the really standard courses of treatment for this infection.

Weber [recording]: And it’s been really hard to be at a patient’s bedside who’s really sick, and there was a potential way to prevent it. It’s really hard to, over and over and over again, feel helpless, like we had an answer, but people chose not to take it. And then they want me to fix it, and I can’t. And that’s a terrible feeling, as a physician and a health care provider.

But even worse, that people come to the hospital sick and they want me to help them, but they won’t trust me over the basics of how to help them, or how to prevent it.

Miller: So given all of this, how are staff doing?

Templeton: You know, it’s just such a difficult environment to work in, even as resourceful as all of these people are. One described the situation as an accumulation of small traumas. They said the Delta wave broke a lot of people and they’ve left medicine entirely. The people who are still here are bending.

And it’s really hard to manage work and family, feeling like the stress of work isn’t something they’re just shouldering themselves, but that it spills over to affect their kids, their spouses. One nurse talked about how difficult it is for her to face the day before her shift starts at 6:30 in the morning. This was emergency department nurse Heather Gadget.

Heather Gadget [recording]: I drink my tea. Kind of scroll through, look at my emails, pack my daughter’s lunch. And then when I drive to work, I call my mom. My mom’s like my cup of coffee on the way to work. I know it’s gonna be a long day. I’m very close to my mom. She kind of is like my cheerleader, tells me “you’ve got this, you’ve been doing this a long time.”

I kind of have to mentally psych myself up for what I’m walking into. Almost a little panic before I come to work. And then the funny thing is I clock in, I walk in the break room, I look around, and I’m like, “It’s good. These are my people, this is my team.” And it feels safe again. But that little time before work is kind of stressful in the morning to be honest. I feel like I should be used to it by now,

Miller: Amelia, what do the doctors and nurses you talked to say about the future?

Templeton: Well, they expect that this wave is peaking or will peak soon, and they want to hope that they’re going to get a breather. But I think they’re also realistically bracing for being there for whatever the pandemic throws at them next.

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