Hospital

At least 16 hospitals in Tennessee ran out of intensive care unit beds last week, according to newly released federal data, and an expected spike in COVID-19 hospitalizations from the Thanksgiving holiday looms. 

The federal numbers show 36 hospitals across the state reported having no empty ICU beds last week. But because the U.S. Department of Health and Human Services only tracks volumes for units with more than four beds, it's possible other hospitals with a small number of ICU beds are full as well. The Post was unable to confirm if the other 20 have any ICU units. (Also worth noting: Only 91 of Tennessee’s 126 general and specialty hospitals reported their data last week.)

The ICU shortage was spread across the state, from 48-bed Newport Medical Center in Newport to 230-bed Saint Francis Bartlett Medical Center in Memphis, reported no available ICU beds on average last week. In Nashville, 132-bed TriStar Southern Hills Medical Center said all 23 of its ICU beds were full.

"TriStar Southern Hills Medical Center has seen an increase in COVID-19 patients and overall patient volume in the past week similar to what other hospitals are seeing in the Nashville area. Many of these patients require high-level care from our ICU team which results in our unit being at capacity," a TriStar spokesperson told the Post. "On a regular basis, there is a continual flow of patients admitted and discharged out of the ICU to a lower level of care. We have opened additional step-down and medical bed areas to help meet the needs of our community during this time. We ask that those in Nashville remain vigilant about wearing masks, social distancing and proper hand hygiene to help prevent the spread of the virus."

Statewide, hospitals are seeing an increase in emergency department visits related to COVID, suggesting widespread community infections and the potential for a backlog of sick patients awaiting inpatient admission.

According to federal data, 15 hospitals —  a mix of rural and urban — last week said 40 percent of emergency department visits were patients with COVID. The impact varies by facility: Officials at Three Rivers Hospitals, a 25-bed critical access hospital in Waverly, said that up to 60 percent of their ER visits were related to COVID while Vanderbilt University Medical Center, the 1,400-bed research institution in Nashville, reported only 7 percent were COVID patients. On average, COVID patients make up 19 percent of total ED visits across the state, with East and West Tennessee most acutely impacted. 

“That means we are clearly having a lot of spread in the community and people are getting really sick because you don’t just go to the emergency department if you don’t really need to,” Melissa McPheeters, an epidemiologist and health policy research professor at Vanderbilt University Medical Center told the Post. “So I think that is another very concerning sign because then the question is: How many of those patients are getting admitted out of the emergency department?” 

With staffed bed occupancy at a premium, hospitals are having to take only the sickest patients, therefore raising the standard for getting admitted into a hospital. The sickest patients can also be diverted to other hospitals — although most out-of-state hospitals are no longer accepting transfers — but even that safety net is dwindling as outbreaks impact all corners of the state and country. 

“The thinking is, well, if a patient needs a certain kind of specialized care, we can always transfer them into an urban center. Now that capacity is just not there, so there just isn’t that opportunity for movement.” McPheeters said. 

“To the degree that those rural hospitals are already stressed, this is not going to stop car accidents from happening. It’s not going to stop people from getting cancer. It’s not going to stop people from getting appendicitis or whatever they need care for," she added. "So I think the fact that it is so widespread and that the rural communities and their hospitals that may or may not have as much staffing or equipment [...] to deal with this sort of high-acuity situation is a huge problem.”

As a number of hospitals are pushed to the brink and some patients are denied medical care, the state’s death rate is at risk of climbing. For now, though, it remains below the national average. 

“The nuances of the numbers aren’t the only part of the story. Understanding who is getting hospitalized and who isn’t and what the capacity limits are doing to hospitals’ ability to actually care for enough patients or for other types of patients gets a little bit lost in the numbers,” McPheeters said. “Everyone should be very concerned about the high number of hospitalizations. Remember that it may still be a little early to see some of the effects of Thanksgiving.”

This post originally appeared in our partner publication, the Nashville Post

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