For 20 hours Wednesday, the delta variant put the University of Cincinnati Medical Center at capacity, and word went out to the emergency responders and other regional hospitals that UCMC had to limit emergency intake to patients with trauma, burn or stroke.
The alert lifted at 7 p.m., but Wednesday was the third time in a month that the academic health center declared itself “at capacity” as caseloads from the fourth surge of the novel coronavirus pandemic strained weary doctors, nurses and caregivers at Cincinnati-area facilities.
The warning also served as an acute exercise of Surgenet, an online tool within the Ohio Department of Health that hospitals across the state have used for more than a decade to track beds, supplies and other necessities. Surgenet was built for one-time crises, when an incident overwhelms a hospital with patients, then subsides.
But through the nearly 18 months of pandemic, hospitals have adapted Surgenet as a key daily count of beds, ventilators and supplies, and where they are. Last winter, during the peak of the pandemic, those vitals were taken several times a day. Now, it’s done once before dawn. With those readings, hospitals can balance the load of patients by directing ambulances to go to emergency rooms that aren’t as busy, said Dr. Dustin Calhoun, UC Health’s medical director for emergency management.
When hospitals must caution emergency services about which patients to bring, “It isn’t the system failing, it’s the system self-balancing,” Calhoun said. “It’s the system balancing itself to maintain ability in the right places.”
Surgenet is so detailed, “I know how many slots in a morgue I have,” said Christa Hyson, spokeswoman for the nonprofit Health Collaborative, which has coordinated the region’s pandemic response. Hyson also minds Surgenet for the Cincinnati area.
“People hear Surgenet and they say, oh, no, something’s happened,” Hyson said. “But basically, it’s just the way you can give a hospital’s status a definition to make the best routing decision possible.”
The Health Collaborative features some Surgenet data on its daily dashboard. Friday, for example, Surgenet counted 2,424 patients in the region’s 40 hospitals, with 490 in intensive care beds. The dashboard reports those numbers are putting a “moderate to extreme strain” on staffing. Another 197 admittances would force the hospitals to create more bed space.
Access to Surgenet, hosted by the state Health Department, is restricted to hospital and public health officials. Hyson said the system does not call for “diversion” of ambulances. Instead, a hospital declares itself “at capacity,” meaning the emergency department is backed up, and it's a long wait for care. Calhoun, who worked overnight Friday morning, said three or four patients waited for care. The overnight before, there were 50.
Calhoun has been at UC Health for more than 10 years, “and in the whole time I’ve been in UCMC, we’ve been at capacity almost never. Most of our hospitals almost never are, and now we’re on our third time in the last couple of months.”
UCMC was at capacity July 27 for a few hours in the evening, Aug. 12 overnight and Aug. 24 at 11 a.m. until Aug. 25 at 7 p.m., or 20 hours, said UC Health spokeswoman Amanda Nageleisen. When at capacity, UCMC alerted the Hamilton County communication center to tell emergency responders that the hospital could only handle trauma, burns and stroke. UCMC is the area's only Level 1 trauma center, handling the most serious cases.
Sometimes, being at capacity is "a perfect storm of circumstances,” Calhoun said. “Maybe a hospital has a decreased number of discharges, or several patients who had surgery and were expected to go home immediately stayed overnight.”
Calhoun said if a patient in an ambulance flat out insists on going to UCMC, the crew will comply, "or else it's kidnapping." But they will also warn, “if they show up at a hospital that’s extremely busy, it takes longer to offload their patient.”
The increased caseload of COVID-19 patients, almost all of whom are unvaccinated, and the rise of other respiratory viruses are tipping the balance in the past month at UCMC and other hospitals. But Hyson said an even larger factor in the tight conditions is the staff. Normally, a nurse, even in an ICU unit, has more than one patient to attend on a shift. But COVID-19 patients often require one-on-one attention throughout a hospitalization, meaning fewer nurses are available overall.
“Staffing shortages are affecting our ability to flex up,” Hyson said. “People are getting a bit frustrated, a year and a half into a pandemic. … And none of those things are going away super quickly. We have the potential to see more of it, or to continue to see it periodically.”