The bed shortage has reached a point where EMS searches for the closest hospital with capacity.
RICHMOND – Richmond-area hospitals are struggling to find beds for COVID-19 patients. This week, one of the biggest hospitals in the region only has 10 Intensive Care Unit (ICU) beds available.
The number of cases and deaths due to the COVID-19 virus are spiking across Virginia. There are currently 10,698 cases of COVID-19 in Richmond. Yesterday, that number grew by 140 cases.
“Our adult occupancy is 96 percent,” said Interim Chief Medical Officer at VCU Medical College of Virginia (MCV) Hospital Dr. David Lanning. “We are near capacity on the beds we have.”
Of the 10 beds available, only three are in rooms suitable for treating adult COVID-19 patients. These rooms are called negative pressure rooms.
“That’s a room that’s got ventilation such that it’s not really air going out of the room, it’s really coming into the room and up into the ventilation system,” Lanning said. “Some of the virus can be aerosolized and spread. And that’s why the air handling has to be in a way such that it gets taken away.”
Richmond Running Out of ICU Beds
VCU Medical Center isn’t the only hospital in the Richmond-area experiencing a bed shortage.
According to the U.S. Department of Health and Human Services (VDHHS), the average number of ICU beds available at Bon Secours Memorial Regional Medical Center is just 19.4. The Bon Secours St. Mary’s Hospital in Richmond has 33.3 ICU beds available this week. At Henrico Doctors’ Hospital, they have the capacity to accept another 23.7 ICU patients. At Southside Regional Medical Center, there’s an average of 6.5 ICU beds available. CJW Medical Center is doing better than most, with 57.6 ICU beds available. Virbra Hospital of Richmond only has two ICU beds free.
The Children’s Hospital of Richmond and the Bon Secours Richmond Community Hospital don’t have ICU units. Overall, the community hospital can take on 65.3 more patients this week. The children’s hospital, however, only has room for another 6.5 patients overall.
Reports by the VDHHS show that two thirds of these hospitals saw increases in the number of ICU patients admitted this week compared to last week.
Diverting Patients to Hospitals with Capacity
Regionally, the shortage of available ICU beds is leading to longer wait times for patients seeking emergency care.
“We have experienced longer waits to transfer the patients to the ER staff, due to the ER volume being high and they are waiting to transfer patients to the floors,” said Tuckahoe Volunteer Rescue Squad President John Tatum.
When hospitals are no longer able to accept ICU patients, they declare themselves on diversion status, which reroutes EMS away from their facilities. Rerouting patients could result in delays to patient care, because it can take them longer to reach an alternative hospital.
“Of course we try to use the hospitals that are in our area. If it is an emergency situation and 911 has been called, we would not want to drive pass three or four hospitals unless it is a specialty hospital,” Tatum said.
Care of COVID-19 Patients Strains Staff
COVID-19 patients in the ICU require constant monitoring. At VCU Medical Center’s Medical Respiratory ICU, one nurse cares for every two patients.
“My nurses ratio of one nurse to two patients has not changed. That’s what we were doing pre-COVID, that’s what we’ve been doing since we received our first patient, and that’s what we continued to do in the ICU setting,” said Audrey Roberson, nurse manager of the Medical Respiratory ICU.
However, according to the medical center’s own chief medical officer, that’s really not enough.
“In this case there are times where you really have to have just one nurse per one patient. And that creates strain on the nurses,” Lanning said. “There’s definite strain on our system from a hospital ICU standpoint and nursing standpoint, because these patients requiring so much really support and hands-on care.”
Most of these ICU patients can not breath enough oxygen on their own.
“They usually require some additional supplemental oxygen and sometimes that can be just what we call high flow nasal cannula, which is something that goes through their nose and it allows more oxygen to be delivered to them. Many of our patients, however, require more invasive ventilation and that requires them to be on a ventilator. To provide even more oxygen directly to the lungs,” said Roberson.
No One Is Immune
According to Roberson, the virus not only affects a person’s respiratory system. It also worsens their existing health conditions, resulting in a need for even more care and monitoring.
“Unfortunately most of these patients have more than one of those problems occuring at the same time. And so the management of a patient that has multiple problems is very complex because you can’t disrupt one problem just to make another problem better,” Roberson said.
But it’s not only those with underlying conditions who get the virus. According to Roberson, people with seemingly perfect health can end up in the ICU with COVID-19.
“We have seen them very young, we’ve seen them on the older end of the spectrum. We’ve seen patients that really have no history, medical history prior to being admitted. So it is definitely a full gambit of different types of patients from different walks of life,” said Roberson.
No Space for More COVID-19 Patients
The ICU specializing in the treatment of respiratory emergencies where Roberson works is currently completely full. All 28 beds have occupants, but according to Roberson, that’s not unusual for this time of year.
“For my ICU, this time of the year we usually see a lot of flu. So that’s another type of patient population that we see a lot of. And this is flu season,” Roberson said.
She says what’s changed is the condition of her patients. Overall, they’re more sick.
“What the virus has done really is made the care of the patient more complex and the patient sicker. But we are still providing very similar care for our patients,” said Roberson.
Combatting Staffing Shortages
Due to the increasing need for medical care in their ICU and emergency care departments, VCU Medical Center’s administration is reassigning its staff to provide care where it’s most needed.
“You might be a doctor that works in neurology or in nervous conditions. And you might get, so that we have enough doctors to be able to cope with the virus, you might get kind of redeployed if you’d like to help out in the emergency room or help out in some of the clinical care or ICU units,” said Dean of the VCU School of Medicine Peter Buckley.
The students and professors of VCU’s School of Medicine staff VCU Medical Centers Hospital as practicing doctors and residents.
“That’s very different. And we’ve done the same thing with our more junior doctors in training, our residents. So we’ve been very smart in how we’ve utilized this precious workforce to the best, and to marshall ourselves to be able to work as strong as we can against this virus.”
Expanding Capacity to Keep Up with COVID-19
In addition to redirecting staff normally assigned to non-essential departments, hospitals are expanding their capacity by converting additional hospital beds into ones capable of delivering intensive care.
“If our existing ICU becomes full, we are equipped to transition other areas of the hospital to increase our ICU capacity should the need arise,” said Associate Vice President of Communications at HCA Healthcare Jeffrey Caldwell.
Henrico Doctors Hospital, in addition to several other Richmond-area hospitals, are owned by HCA Healthcare.
According to representatives of VCU’s Medical Center Hospital, they have plans to expand their capacity by converting other areas of the hospital to house ICU patients with COVID-19.
“We have, I think, about a hundred and eleven total negative pressure rooms with some, some of which are operating rooms that we could convert to negative pressure rooms,” Lanning said.
MCV’s COVID-19 Contingency Plans
The medical center is also making contingency plans for the future, in cases of the virus continue to climb in the region. These plans include converting one of the medical college’s dorms in downtown Richmond into an ICU.
“We even have the honors dorm, which used to be a hospital, then it was converted to a dorm on the academic campus. We’ve now basically made it essentially ready to revert back into a hospital,” said Lanning. “That’s also probably one of the last resorts because that would mean moving them further away from the medical campus. But it does have beds and a hospital-like setting if we need to use that.”
The hospital also has a plan to convert the Richmond Coliseum into a mass ICU unit if necessary.
“At one stage we were getting ready to help the Virginia Department of Health to staff and support setting up kind of a mass COVID unit in the Richmond coliseum. Because we thought that we were going to be overwhelmed with the number of patients,” Buckley said.
Experts say cases of COVID-19 will continue to rise throughout Virginia over the next few days and weeks.
With such a limited number of beds, the possibility that Richmond hospitals will become overwhelmed by a surge in patients is a real concern. According to Lanning, VCU’s Medical Center at least thinks it can respond without a delay in providing care.
“I don’t anticipate a delay. We certainly have prepared for mass casualty events pre-COVID and even now,” said Lanning. “It certainly may be a challenge.”
According to Lanning, the best thing anyone can do to help VCU Medical Center and other regional hospitals is to adhere to social distancing guidelines, wear a mask, and avoid social gatherings.
“If you look at the curves the number of people getting infected and the spread is overwhelming. It’s really triple, in many respects, what it was in the Spring. So people, if they could adhere to that guidance, that’d be incredibly helpful. And then certainly when the vaccine becomes available, please, we strongly encourage people to take it,” Lanning said.
Meg Schiffres is Dogwood’s associate editor. You can reach her at firstname.lastname@example.org.