A nonprofit publication of the肯塔基州公共服务新闻中心

更多的sick staff, fewer beds in rural hospitals as COVID-19 continues spread through region


由Corinne Boyer.
Ohio Valley ReSource

临床总监柯克塔克博士,阿登纳人Health Systems in Chillicothe, Ohio, said a week before Thanksgiving that the health system’s three hospitals in southern Ohio were bombarded with coronavirus patients. But it isn’t just the patients testing positive. The virus has also sickened 65 of his fellow caregivers.

Recently, Tucker said, a doctor there in his 60s tested positive for COVID-19 and died the same day of a sudden cardiac event.

“This physician, to my knowledge, did not feel bad,” Tucker said. “As a matter of fact, I saw him the day that this happened.” Tucker said one of the many dangerous things about COVID-19 is that the virus is prothrombotic, meaning it can cause blood clots.

RN Marcia Alverson,Rith和Amy Richardson,右边,拟合在Bailey Adamson的动力空气净化的呼吸器套装,然后在艾伯特B.钱德勒医院与Covid-19患者一起使用的员工室内进入患者房间。(照片由英国Mark Cornelison)

“When you draw blood on some of these people, it no sooner than gets into the blood container, than it starts to turn to jello.”

Tucker说,在怀孕8个月怀孕后,八个月怀孕,经历了“失败的呼吸健康”,被转移到另一医院。几天后,Tucker说护士是“挂在那里”。

“我分享这些故事,因为人们需要了解这是多么可怕,”Tucker说。

感恩节前的一天,4,449名Covid-19患者在俄亥俄州住院治疗 - 在过去的11天内增加了1,400多名的数字。11月,国家波动波动的总医院容量的68%至78%。

“And the weird part about this wave is usually we watch what happens in the major urban centers like Columbus to our north, and we will sort of follow their surges,” Tucker said. “This time, it was the reverse. We had the first surge.”

Chillicothe is a city of just over 21,000 but, like many parts of the Ohio Valley, it is experiencing a rural surge of coronavirus that has gone far beyond major cities and isolated outbreaks in jails and nursing homes. That is straining the smaller hospitals and health centers that serve those rural communities and small towns. As Dr. Tucker’s experience shows, it’s not just a question of available beds — hospitals could face staff shortages as more fall ill or face quarantine amid the uncontrolled spread of the virus.

“这个Covid-19绝对粉碎,粉碎了这些医院的农村临床工作人员,”国家农村卫生协会首席执行官Alan Morgan表示。“我不能强调这一点,就有有限的能力来制造错误,基本上,一旦你减掉10到15名护理人员,你就会失去一些你的初级保健医生,你是危机模式。”

住院能力

农村医院已经面临大流行前面临的能力和人员配置问题。摩根说,他不确定农村医院如何在接下来的几个月内票价,但他认为更多农村医院将关闭。

“简单地说,农村美国是一个最需要医疗保健服务的地方,摩根说,莫根说。“它只是农村美国的化妆,农村美国年纪较大,病情,较贫穷,它具有更高的老年人,许多慢性健康问题。”

Chillicothe’s Adena Health System’s three hospitals serve nine rural counties. As the hospital system COVID-19 unit filled up, medical staff reached out to larger cities to arrange transfers.

“我们已经达到了几天,我们已经叫做哥伦布,辛辛那提,代顿,没有那些医院可以服用Covid患者 - 他们已经满了,”Tucker说。

俄亥俄州医院协会总监John Palmer尚未达到能力,俄亥俄州医院协会总监报道说,一些国家的八个地区有很少的ICU床。

Elsewhere in the region hospitals are beginning to take measures to absorb the expected growth in demand. The University of Kentucky’s Chandler Hospital in Lexington announced it will close five of its operating rooms beginning Monday, Nov. 30. “UK HealthCare’s COVID-positive patient numbers continue to grow and during the last week, the total COVID census has increased above 70 patients daily,” according to a UK HealthCare press release.

该医院有32岁或多,如果总Covid患者增加到90岁,则可能更接近。

Pikeville Medical Center首席执行官Donovan Blackburn呼应了医院服务的东肯塔基社区的同样担忧。自10月以来,二十二人从Covid-19死亡。在感恩节之前,医院的ICU的周末几乎处于容量。

“但是将发生的事情是,我们将不得不开始在我们自己的地区,我们自己的服务区内下降我们自己的患者,”布莱克本说。“而那些患者将在国家的不同部分或可能在另一个州最终结束。”

随着假期接近的,冠状病毒患者在肯塔基州的390张,390家中占据了超过1,650张的医院床。在上周的一封电子邮件中,与肯塔基州的健康和家庭服务柜台的苏珊Dunlap表示,1,713张ICU床有员工,但该州总计2,066张ICU床可以使用是否有工作人员。

在西弗吉尼亚州,501名Covid-19患者周三在ICU床上住院了144名患者。据华盛顿大学的卫生指标研究所介绍,西弗吉尼亚州的医疗床铺有超过3,000家医院床,并没有接近能力的危险。然而,该州拥有196张ICU床,IHME模型预测,在圣诞节前一周内,该州对州的ICU床的需求可能超过国家的供应。如果目前的住院趋势继续,IHME数据显示肯塔基州和俄亥俄州也可以缺乏ICU床铺。

生病的员工

随着较多的医疗工作者生病,医疗工作者的供需变得越来越直接,而不是医院的能力问题。农村环境中的保留保健工作人员一直是一项挑战,但情况恶化。

在Pikeville Medical Center,Blackburn表示,医疗人员可以在12到16小时的时间内工作。除了长期的工作日外,医院的ICU单位的患者还是“非常生病”,他说。到目前为止,一些员工对病毒进行了阳性,并已住院,但没有一个病例危及生命。

为了解决Chillicothe的Adena医院的人员配置差距,Tucker表示护士从业人员与自己的做法被要求在其医院工作,几个已经这样做了。

“One of them is working seven days a week, seven days a week, she hasn’t had a day off now in I think three or four weeks,” Tucker said. “Some of them work a full day shift in their office, and then leave their office, change into scrubs and then work on the floor at night.”

护士和医生采取关键步骤来照顾病人,并努力简化关心努力减少文书工作的紧急努力。

“We have dialed back on what is required of nursing staff to document in the computer to streamline their jobs and get them at the bedside more but that only lends itself to some improvement,” Tucker said. “You can’t really safely take a nurse and ask him or her to care for 10 or 15 critically ill people, and these people that are on the COVID unit are not well.”

A pedestrian bridge outside of the Shriners Hospital for Children Medical Center in Lexington. (Photo by Corinne Boyer, Ohio Valley ReSource)

昂贵的替代品

Across the board, the U.S. needs medical workers, and oftentimes, hospitals rely on staffing agencies to find nurses.

“Earlier in this pandemic, we could simply redeploy clinicians into these rural communities from their larger health systems or from other states, we don’t have that ability anymore,” the Rural Health Association’s Morgan said.

通过代理商的费用提供了哪些护士的资金更多。

肯塔基州医院协会总裁Nancy Galvangi表示,他们不得超过四到500%的任何地方支付超过四到500%的人。“这是因为肯塔基州与其他州的竞争,其他能够支付更多的国家。”

Across the Ohio Valley, hospitals anticipated $2.7 billion in losses associated with the pandemic. Galvagni said the additional costs of agency supplied nurses will increase Kentucky hospital losses.

“And I think we’ve testified to the fact that these COVID patients are sick — if you look at a COVID wing, they require more staff than the average patient, they require a lot more PPE, they require a lot more therapy,” Galvagni said.

这种成本增加在Pikeville Medical Centre等农村卫生设施中特别困难。几个月前,CEO Blackburn表示,ICU护士可能在该中心每小时售价68至78美元,但今天成本可能是165美元和每小时200美元的费用。Blackburn说,在支付更多的支付之上,它可以让护士到达一个新医院。

Although Kentucky hospitals received some CARES Act funding, Galvagni says more is needed.

“我们很乐意看到额外的联邦救济基金,”她说。“所以我认为这是我们与[肯塔基]参议员McConnell密切合作的事情,以确保肯塔基州获得这些救济基金,因为你知道,我们确实有这些损失在那里。”

俄亥俄州谷资源得到了公共广播公司和我们的合作伙伴的支持。

Corinne Boyer covers health issues for WEKU in Richmond. Previously, she covered western Kansas for the Kansas News Service at High Plains.


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