Hospitals still teetering on full capacity

Sierra View Medical Center reached capacity on Sept. 4, Kaweah Health is 130 nurses short of full staff and Adventist Health Tulare calls in help from the state

TULARE COUNTY – Three weeks after Kaweah Health instituted its two-day code triage, it was Sierra View’s turn to bear the brunt of the highly contagious delta variant of coronavirus.

On Sept. 4, Sierra View Medical Center’s emergency department (ED) experienced its largest surge of the pandemic, holding 25 patients in its 18-bed ED and reaching capacity in its ICU. The Central California Emergency Medical Services Authority (CCEMSA), which oversees Tulare County ambulance providers, put the hospital on diversion, a situation where a hospital ED is unable to provide care for additional non-emergency patients and redirects them to other hospitals nearby. While the emergency diversion lasted less than five hours, ending at 9 p.m. on Sept. 4, it resulted in at least two patients being transferred out of the South Valley to Sutter Health’s Memorial Medical Center in Modesto.

“As we continue to navigate the realities of this surge and the stress it continues to cause, our health care teams continue to provide our patients with the care they need,” SVMC posted on its Facebook page on Sept. 4.

CEO Donna Hefner did not know how many patients were diverted on Sept. 4, but did say they worked closely with the Medical Health Operational Area Coordinator (MHOAC), a position in each county to make and respond to mutual aid requests from other counties. Imperial Ambulance in Porterville and American Ambulance in Visalia responded by offering employees to assist hospital staff in both the ED and COVID units. Overall, the ambulance companies provided a “Strike Team” of five paramedics and six Emergency Medical Technicians (EMTs) to increase the staffing at the hospital for 10 to 12 hours. On Sept. 5, COVID-confirmed ICU patients reached an all-time high during the pandemic of 30 and ambulance providers sent another team of six registered nurses and one certified nursing assistant.

“We have not experienced surges like those in August and September,” Hefner said. “Our health care professionals are pulling many long hours and extra shifts. Clinical Leaders and other licensed leaders are caring for patients directly day and night shift to adjunct our patient care needs.”

Kaweah Health, the county’s largest hospital, did see some patients from the Porterville area during the brief diversion, but it was less than significant in the scope of its current high patient volume in the emergency department. Laura Florez-McCusker, director of media relations for Kaweah Delta, said the Visalia hospital’s ED is seeing 230 patients per day, driven by unvaccinated patients with COVID which is taking up beds for patients with other issues.

“We have more people needing care, both COVID and non-COVID related,” Florez-McCusker said. “The resources are limited and we are stretching them the same as we did in the winter.”

Fortunately, Kaweah Health now has full use of its expanded ED, which is allowing the hospital to hold more patients for admission in actual beds instead of in the waiting room and the hallways. Similar to the winter surge, this now fourth surge of the pandemic is still defined by the number of beds the hospital can staff and not simply the number of beds. Kaweah Health has 550 open positions including more than 130 RN positions. The hospital continues to recruit travel nurses and other travel staff, and is working with the state to bring additional resources and offering incentives to recruit both existing and new staff to work additional shifts.

“This has been an incredibly difficult 18 months for our team, but throughout this pandemic, our team has remained committed and persevered through their struggles,” Florez-McCusker said. “They have served on the frontlines caring for others despite the risks. They have shown us what the human spirit is all about and blown us away by their dedication and their personal calling to help others.”

Despite the national shortage of nurses exhausting those who aren’t quarantining, taking time off or have left the industry, Adventist Health Tulare said the winter surge helped the hospital prepare for the next surge, which is happening now. Amanda Jaurigui, communications manager for Adventist Health Tulare, said Adventist has not had to divert any patients, has yet to reach capacity and said there is no indication the situation will get bad enough to ration care.

“During this wave, we have found ourselves to be better prepared based on our learnings from the previous wave. We have the staff in place and are now able to care for more COVID positive patients,” Jaurigui said.

As of Monday, SVMC was still in a precarious situation as it only had no ICU beds available. Staffing shortages continue to be an issue nationwide and Hefner said many of the Porterville hospital employees are on quarantine, caring for family members quarantining or suffering from other illnesses and simply taking some much deserved time off.

“We are trying to get employees time off to rest and recover and monitoring this closely,” Hefner said.

Adventist Health Tulare had 23 patients, as of Sept. 17, of an available 30 in med/surge and six to eight in ICU. The state provided the Tulare hospital with three traveling RNs to assist in caring for the high number of patients.

“The employees are tired, but continue to fulfill our mission of living God’s love by providing health, wholeness and hope,” said Amanda Jaurigui, communications manager for Adventist Health Tulare.

Kaweah Health offered a glimmer of hope for the current surge noting patients are spending less days in the hospital than they did during the winter surge. Florez-McCusker said the length of stay for COVID patients is three to four days shorter than it was in December and January.

“We have more people being admitted, but they stay a shorter amount of time,” she said. “We do not have a shortage of personal protective equipment or testing capacity.”

There are also far fewer deaths from COVID, there is no shortage of personal protective equipment, ventilators or testing equipment.

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