• Thu. Aug 11th, 2022

Rising number of coronavirus patients in Oregon prompts joint hospital efforts, delayed medical treatments

Oregon Governor Kate Brown on Monday announced a new strategy to create more desperately needed hospital capacity for a growing number of coronavirus patients, including joint operations by hospitals in the Portland metro area, the delay of elective medical treatments and the search for an additional capacity of patients in non-hospital parameters.

The effort will bring together Oregon Health & Science University, Providence, Kaiser Permanente and Legacy Health under a joint command to maximize their ability to handle the influx of patients expected in the coming weeks.

“Metropolitan hospitals will act as one large, unified hospital system for the treatment of COVID-19,” Brown said at an afternoon press conference. “We will increase bed capacity by adding more beds in non-hospital settings.”

Related: Oregon orders all restaurants and bars to restrict access, bans groups over 25

Hospitals in Oregon are cutting back on elective surgeries and releasing patients who can recover safely at home in a bid to free up beds for a possible increase in the number of patients infected with the coronavirus.

Dr. Renee Edwards, chief medical officer at Oregon Health & Science University, told reporters that postponing elective medical procedures would be an important part of increasing hospital capacity for COVID-19 patients.

“All of our facilities are looking at which surgical procedures or clinical interventions make the most sense to tell our patients, ‘it can wait’,” she said.

Oregon has 6,601 staffed hospital beds. Edwards said Oregon may need 1,000 additional hospital beds, including 400 additional intensive care unit beds, to cope with the expected influx of COVID-19 patients.

Hospitals across the country are facing a shortage of beds and life-saving equipment. According to data from the Kaiser Family Foundation, the average number of beds per person was 2.4 per 1,000 in 2018. And the number of hospital beds is steadily declining, to about 3 per 1,000 in 2000.

Oregon, in particular, faces an uphill battle. Oregon has the lowest number of hospital beds per person in the country: just 1.6 beds per 1,000 people.

Oregon and Washington rank last among all states in hospital beds per person

With fewer than two beds per 1,000 people, Oregon and Washington each have less than half the capacity of the major states.

Source: Kaiser Family Foundation

The other coronavirus measures Brown announced on Monday was indirectly aimed at easing the crush of patients seeking hospital care as the pandemic hits Oregon. By banning gatherings of more than 25 people and ordering restaurants and bars to close or switch to take-out only, the governor and his advisers are stepping up ongoing efforts to “flatten the curve.” The idea is to slow the transmission of the coronavirus to a point where hospitals can handle the influx of patients.

The solid purple curve represents the number of cases over time without intervention. The diagonal striped curve represents the number of cases over time if protective measures are taken.

United States Centers for Disease Control and Prevention

Brown, Edwards and other state officials who spoke at Monday’s press conference said they were looking for additional beds in a non-hospital setting to increase patient capacity. But no details were discussed.

Former Governor John Kitzhaber, a nationally recognized emergency physician and healthcare expert, shared a note with OPB on Sunday in which he said the state should operate facilities such as Portland’s unused Wapato Prison , which is currently under private ownership with the intention of transforming it. in a homeless shelter.

Doctors in Oregon and elsewhere have sounded the alarm bells about the potential bed shortage. They look at what has happened to health systems in other countries, and it concerns them. In places like Italy, doctors have had to make tough decisions, such as determining that patients over 80, who are more likely to die from COVID-19, will not receive health care.

But Italy has an average of 3.2 beds per 1,000 inhabitants. If Oregon sees a spike in cases, which models are currently suggesting, the situation could be much worse.

In a letter to the state of Oregon, signed by more than 430 Oregon doctors, they wrote. “We see ourselves making decisions in the next two weeks about who will live and who will die because we do not have the resources to take care of them.”

This is particularly clear in small communities. Curry Health Network operates Curry General Hospital in Gold Beach and Curry Medical Center in Brookings, as well as several other smaller clinics in the area. Jessica Carlson is president of the medical staff at the Curry Health Network and a surgeon at Curry General Hospital. She said their network and others like it were not configured to handle a deluge of patients as they might see with COVID-19.

Related: A glossary of coronavirus terms, from ARDS to zoonosis

“For example, we usually have a 96 hour restriction on admissions, so we have to try to get all of our patients out within 96 hours,” Carlson said. This usually involves sending patients who need long-term care to hospitals with more resources.

The governor has removed those restrictions on hospitals like Carlson’s, but that doesn’t change the fact that they’re not set up for long-term care.

“Functionally we have 16 beds. Five of those beds are in the emergency room, ”said Carlson. “We have two rooms that we can convert, but we don’t have a standard intensive care unit.

This means that there are already times when there are stretchers and beds lining the hallways.

“Our county has 22,000 inhabitants. But, wow, only 16 beds, ”Carlson said.

They also lack ventilators, which are an essential part of treating coronavirus patients. At Curry General, they are primarily used to keep patients alive until they can move elsewhere.

Carlson Hospital essentially only has one person for each job, she said.

There are only three doctors for both ERs and admitted patients, “she said.” Just myself, an ER doctor and a hospitalist. That’s it.”

The PeaceHealth Sacred Heart Medical Center at RiverBend in Eugene is the primary hospital in the southern Willamette Valley and surrounding areas, with a few smaller satellite campuses. It has 347 approved beds. It also has the highest occupancy rate in the state – 96.6% in 2018.

To prepare for a possible increase in the number of cases, RiverBend has set up tents and caravans outside the hospital to help sort out potential patients.

In a statement, the hospital wrote: “Please note that this is part of our pre-planning efforts and we currently have no capacity issues. We prepare for a potential future state as the need arises. “

That’s what all hospitals are doing right now: preparing for future capacity issues. But the question remains: If Oregon has the worst bed-to-person ratio in the country, why? It may just be an unexpected population growth, as happened in the area served by RiverBend. But when asked at a press conference, Oregon Health Authority director Patrick Allen said the low number of beds in Oregon did not reflect a poor health care system, but rather a good one.

Allen said Oregon is able to keep the total number of beds so low “by providing access to primary care so people don’t need hospitalization, which allows us to reduce costs and reduce costs. health system“.

When asked if that made Oregon worse off in crises like this, Allen replied, “Well, it’s hard to argue that we should keep people sicker so we can have it. hospital beds, right? “

But the idea that early intervention and primary care prevent people from accessing hospital beds is not reflected in the experiences of doctors and nurses, who say the trend of the past decade is to try. to do more with less.

Hospital beds per person are declining.

As the population of Oregon and Washington grows, the number of hospital beds has not kept pace. The United States as a whole also has a decreasing number of beds per person.

Source: Kaiser Family Foundation

This is also not reflected in the data. The total number of staffed beds in Oregon has grown very slowly, but steadily since 2012. But the percentage of those beds occupied has grown even faster, according to data from the OAHHS.

At Monday’s press conference, Brown said she had asked the federal government for help. On March 3, she asked the federal government for additional assistance of $ 7 million to $ 10 million per month. About 10% of that has happened so far and she expects more later.

But during a call on Monday, President Trump told governors that if they wanted more help, they should try to find it on their own first. Especially when it comes to lifesaving equipment like respirators and ventilators, which Brown has also asked the federal government for. Oregon has only 688 ventilators statewide. They help people with weakened lungs breathe and can make the difference between life and death for patients.

In search of more doctors, more nurses, more ventilators and more beds, Oregon will face stiff competition. Because while Oregon may have the worst person-to-bed ratios in the country, the United States has one of the worst in the world.

Oregon and Washington are the last in the United States. The United States is behind 30 others.

The leading countries have more than 10 beds per thousand inhabitants. The United States has less than three.

Source: OECD Health Statistics

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