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As COVID ICU beds fill, dominoes fall through hospitals

12 October 2021 – The filling of the beds of the intensive care unit of the country has been headlines for months now. As waves of COVID-19 swept across the country, hospitals were driven to their capacity.

You can read the headlines about a lack of ICU beds, but it can be difficult to imagine exactly what they look like. How does this affect patient care throughout the hospital? How is it for staff? And what about getting resources from the right people?

Here is a snapshot of the domino effect of a system in crisis.

From normal to overflow

To understand the impact of ICUs that are full or over capacity, it is important to understand what is going on in these important units of the hospital.

“Before the pandemic, ICUs usually care for patients with respiratory distress, sepsis, strokes or serious heart problems, ”explains Rebecca Abraham, a critical care nurse who founded Acute on Chronic, which provides assistance to patients navigating the healthcare system. “These are people who are very ill and need constant care.”

The allocation of nurses to these units is generally recommended in a ratio of 1 to 1, or sometimes 1 to 2. These are patients who need specialized equipment, such as not elsewhere in the hospital. fans, bed dialysis, specialized cardiac catheterization machines, and drains among others.

These patients also require multiple laboratory measurements, taken regularly per hour, and rapid changes in medication. “Their conditions change quickly and frequently, so you do not want to miss a review,” says Abraham. ‘But if we have to expand our nurse-to-patient relationship, we can not monitor patients as we should.

Today, ICUs are now full of very sick COVID patients, in addition to these ‘normal’ critically ill patients, with serious consequences. “The relationships had to expand far beyond the standard,” Abraham explains. “You may have four to six nurses involved with one patient.”

COVID patients, for example, often have to be placed upside down by staff. To do this properly and safely, a complete team must be available to prevent tubes and lines from coming out of the patient’s body. And if sick COVID patients need it intubation, nurses, doctors, respiratory therapists and others should be involved. All of this pulls these essential staff members away from their other duties and normal care activities.

Complete ICUs also require nurses and other staff who are not specifically trained and certified in critical care. “These nurses also take care of other patients,” says Abraham. “If a patient gets stuck and the nurses are not trained for it, the quality of care suffers.”

Where ICUs once had an inpatient nurse available and a place for a new patient, it would be a luxury, says Megan Brunson, a critical care nurse at Medical City Dallas Hospital who works on behalf of the American Association of Critical-Care Nurses spoke. “Everyone is hoping not to get a new admission on their shifts,” she admits.

There was already a shortage of nursing before the pandemic, and the strain that ICUs place on health care is only exacerbating the problem.

Brunson says the devastation of COVID has reached a national crisis.

“More important than the conversation about how many beds are available is how many nurses we have,” she says.

Abraham agrees.

“As the ICUs get busier and thinner, so does the care,” she says. “That’s not what nurses want, or why they’re in the field.”

A survey by a healthcare staffing company Vivian found in April that 43% of nurses are considering quitting during the pandemic, including 48% of nurses on ICU.

It’s not just nurses. Doctors are also considering leaving the professional. April study published in JAMA network open found that 21% of all health workers “moderately or very seriously” consider leaving the workforce, and 30% consider reducing their hours.

Outside the ICU

As ICUs become full, the effect increases throughout the hospital. “One thing no one talks about is the fact that our pantry has been wiped out,” Brunson said. ‘We’re trying to fix it. Our ration also still PPE [personal protective equipment], after all this time. “

Every 4 hours, Brunson says, staff at her hospital work together to determine where resources should be sent. “In a triag situation, you can do just as much with what you have,” she explains. “We can only meet the priority needs.”

Abraham says that emergencies today often have to house critically ill patients. “Emergency care does not stop there,” she says. ‘The patients are still coming in. There is less monitoring, less titration [adjusting meds]and in some cases sending ambulances to other hospitals. ”

The bottom line, according to Abraham, is that complete ICUs require hospitals to bypass all of their standard procedures.

“It’s never a good thing because it leads to delays in care,” she says. “Critically ill patients go to the floor without specialized staff, and mistakes can happen.”

In addition, nurses and other staff are being burned out.

“Nurses quit or go to less stressful environments,” Brunson says. “Many become traveling nurses because they can make a lot of money in a short period of time and then take a break.”

Brunson says that according to her, it is most important to have the right nurse for the right patient. “I’m in an adult unit, but had to see a pediatrician the other day,” she says. “She learned quickly, but is still limited by her training.”

Despite everything, Abraham and Brunson are hoping for a better future in the country’s hospitals.

“I hold my breath, but I’m optimistic,” Brunson said. “I have been hoping for three years, but we need to eliminate new nurses for the system, people who are vaccinated, and a long-term strategy.”

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