As COVID-19 strains Houston hospitals, small facilities scramble to transfer patients out of state

LUMBERTON – Over the past week, Brooke Hale has been told ‘no’ about 80 times a day. The executive assistant at Altus Lumberton Hospital spent her shifts on the phone in a windowless office, repeatedly asking the same question of other facilities within an 800 mile radius: Can you take one? of our COVID-19 critical patients?

Thursday, there were three of them. They needed intensive care, and without it they could die. Hale tried hospitals in Texarkana and Tyler, Lubbock and Lufkin, Oklahoma, Louisiana and Mississippi. None had room.

“I feel helpless,” Hale said through his green N95 mask. “I feel like I can’t help patients the way I need to. “

The same scene is repeated across Southeast Texas, as rural hospitals and free-standing emergency rooms scramble to send critical patients to other regions and states because Houston medical centers, filled with COVID-19 patients refuse to accept transfers.

For small facilities, what was once a routine transport to local hospitals has become a frantic process of cold calling and coaxing health care providers in hopes of getting an open bed. In the meantime, patients who need intensive care languish in places unable to provide it.

As of Thursday afternoon, 543 patients in the Houston-anchored 25-county hospital region were awaiting staffed hospital beds, according to the SouthEast Texas Regional Advisory Council; 62 others were awaiting admission to an intensive care unit. The traffic jam is also spreading to ambulance teams, who wait longer outside overcrowded emergency rooms to admit patients.

And health officials predict hospitalizations linked to COVID-19 in the region, which have since increased three consecutive weeks at over 2,500, will swell further through August.

The result is a strained healthcare system that is more dangerous for anyone in need of acute care, from a critically ill COVID-19 patient to a victim of a car accident that requires surgery. And like last summer’s wave, researchers fear this wave could lead to an increase in non-COVID-related deaths, attributable to delays in care caused by the pandemic.

“Typically, it takes less than an hour to find a bed,” said Dr. Swapan Dubey, chief medical officer at the Texas Emergency Care Center, which has two stand-alone emergency rooms in the Houston area. “Today in my own centers we hear cases that last 30 to 50 hours. “

Finding beds to transfer patients is now more difficult than the previous two COVID-19 outbreaks in Texas, small facility administrators said. On paper, the Houston hospital region reports 93 available intensive care beds, but that figure does not take into account the ability of hospitals to staff them.

Darrell Pile, CEO of SETRAC, said the region “is reaching a crisis” due to a nursing shortage exacerbated by the state health department’s decision to no longer provide additional staff to hot spots in the country. virus, as had been the case in previous outbreaks.

“A hospital is able to increase its capacity quite quickly, and they intend to do so,” Pile said. “But we never anticipated a complete loss of this additional staff.”

Harris County safety net hospitals Ben Taub and Lyndon B. Johnson are short of 250 nurses, limiting their ability to treat existing patients, let alone accept transfers. The better resourced Texas Medical Center hospitals, including St. Luke’s and Houston Methodist, say they remain able to staff all beds.

Altus Lumberton is the only hospital in Hardin County, east of Houston, and has 51,000 residents. Although there is no intensive care, it serves as a nearby emergency room where local patients can be stabilized and transferred to a larger facility for intensive care.

This system is broken. As of 9 a.m. Thursday, the three critical COVID-19 patients had been stranded in the emergency room for 96, 72 and 36 hours. Staff found beds in New Mexico and North Dakota for the two patients who waited the longest, but airlifting the fragile man and woman proved too expensive.

Dr Adriano Goffi does with it, improvising along the way. He does not have respiratory therapists or advanced breathing apparatus like an intensive care unit would. It has orthopedic pillows, which staff use to support patients in positions that allow them to breathe more easily. Yet the level of care is lower than what they would receive elsewhere.

“These patients, in order for us to feed them, they have to remove a mask that keeps them alive,” Goffi said. “Thus, fatigue sets in, dehydration and starvation. … We sit down with them and see if we can just put bread on for a second and then replace the mask. “

Richelle Blackburn, administrator of Lumberton, is concerned about the hospital’s ability to accept many more COVID-19 patients. The highly transmissible delta variant has caused an explosion of new infections across Texas, and only 26% of Hardin County residents are fully vaccinated, well below the state average. Lumberton serves many communities in its eastern Texas strip of forest.

“If people can’t come here, they’re at a dead end,” Blackburn said.

The transfer problem extends beyond patients infected with the virus. Dubey, of the Houston Autonomous Emergency Department, said he faces long waits to transfer two patients with appendicitis and one with a ruptured bowel.

At Bayside Community Hospital in Anahuac, staff have been trying for 10 days to transfer an elderly woman with severe heart and lung disease. Nurse Felicite Louviere said that because Texas currently does not have a central database of beds available at all hospitals, she recently found an online directory and started calling Oklahoma hospitals at random. , without success.

Bayside CEO William Kiefer said he had an affiliation agreement with a Pasadena hospital, but that facility refused transfers, citing its own patient overload. Kiefer said even if he could get a bed out of state, the trip could be too expensive for a patient or their family.

“When we have needy patients in rural Texas, if we were to send them away, how could they come back? Kiefer said. “Transportation is in quotes ‘covered’ … but the same is not true for the return trip.”

The lack of available beds has aggravating consequences: patients across the region wait longer to be transferred from emergency rooms, leaving ambulances outside waiting longer to deliver new ones.

So far in August, Houston fire crews have reported waiting an average of 29 minutes to drop patients off at hospitals, 10 minutes longer than in June and longer than any other month in the pandemic. Four crews waited more than two hours on Thursday, said Dr David Persse, the city’s health authority.

In Lumberton, Hale continued to work on the phone. Dallas said no. Austin too. Tiny Cuero, near San Antonio, offered to take patient information in case a bed opens.

As 4 p.m. approached, a breakthrough: A hospital in Beaumont called to say it had a temporary opening. The staff prepared the woman for the transport and crossed their fingers.

An hour later, an ambulance arrived. In a few minutes she was gone. Goffi and the emergency room staff cheered and applauded. Upstairs, Hale exhaled in relief.

Two days earlier, the patient was about to need an intubation. Now, said Blackburn, she has a better chance of surviving.

“She’s going to get the care that we can’t provide,” Blackburn said. “Bringing her out – that’s a big accomplishment right now. “

The woman had been in the Lumberton emergency room for 104 hours.

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About Linda Stewart

Linda Stewart

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