Dr. Jeff Hersh
Q: Last week you noted that the COVID-19 crisis is not over. But at least hospitals are back to normal, right?
A: Unfortunately, just the opposite. Across the country hospital beds are in short supply, with available beds more limited now than at almost any time except during the height of the COVID-19 crisis. On average, about 80% of hospital beds are full, an increase of almost 10% over the last several weeks. And it’s even more pronounced for pediatric beds.
Although the pandemic continues to contribute to the short supply of available hospital beds — with about 6% of hospital capacity being for COVID-19 patients — the disease itself is not the only driving factor:
- Respiratory Syncytial Virus (RSV) and the flu are also major contributors, which is why COVID-19 plus RSV plus the flu is now being called the “tripledemic.” The tripledemic is just one factor leading to what’s now a 2.5-per-100,000-person hospitalization rate, which is even more pronounced at almost 7 per 100,000 for people over age 70. We’re still early in the flu season, and unfortunately there’s always the risk of yet another problematic variant of COVID-19 occurring.
- Patients “catching up” on care that was delayed or limited for them during the COVID-19 crisis is also placing a demand on hospital beds.
- In addition, there are not enough health care workers (discussed in more detail below).
The present health care staff shortage is a big issue; nationally, more than 225,000 health care workers have quit in the past year. Right now, almost 10% of hospitals are noting a “critical” level of staff shortages, including nurses, physicians, physician’s assistants, nurse practitioners and/or other health care staff (for example respiratory, radiology and lab technologists, physical and occupational therapists, social workers, pharmacists, dieticians, nurse’s aides and many other health professionals).
There are many drivers of this, but burnout from the last several years is definitely a contributing factor. For example, the baseline of the approximately 10% annual nursing turnover rate doubled to almost 20% last year. Even more worrisome is that the present capabilities in the U.S. to train new, skilled health care workers (including nurses and physicians) is not enough to address this trend. Add to this that demand for health care is increasing as the average age of our population increases; this will predictably increase the overall need for health care as older people in general have more health issues and require more care.
The shortage of available pediatric beds is even more pronounced. As with most issues, there are many contributing factors to this, but one huge one is simply economics. Hospital/clinical reimbursement for pediatric care is much less than for certain other high-volume, high-reimbursement medical conditions, such as cancer care, certain orthopedic care and many others. In addition, some pediatric beds were converted to adult beds during the COVID-19 crisis.
One of the many ramifications stemming from the limitation of available hospital beds is an increase in “boarding” of patients in the emergency department (ED). Boarding occurs when patients who are seen in the ED and who need to be admitted simply have no bed available, and so they stay (are boarded) in the ED until a bed becomes available.
One study noted that, on average, patients admitted from the ED are now waiting about seven hours before a hospital bed becomes available. Of course, this practice has a trickle-down effect, as it overwhelms resources in the ED, both in terms of physical space and in the ability to care for boarded patients. This in turn leads to increased ED wait times for patients to be seen, and predictably an increase in patients “giving up” and leaving the hospital without ever being seen (the rate of patients leaving without being seen doubled from about 1% in January 2017 to over 2% in December 2021).
So what can we all do to help? First, only go to the ED for emergencies, and instead see your primary care provider for less urgent things. Second, get your flu and COVID-19 booster shots and take care of yourself to minimize your chances of needing to be hospitalized.
Jeff Hersh, Ph.D., M.D., can be reached atDrHersh@juno.com
