Johnson Memorial Hospital experienced coronavirus milestones this week that have administrators concerned, staff strained and local patients being treated outside the county.
The number of patients being seen for COVID-19 symptoms is now about equal to those seeking care for other ailments, said Dr. David Dunkle, president and CEO at Johnson Memorial Health. As a result, all of the hospital’s beds were full Wednesday, and patients were being sent to other area hospitals when it was safe to do so, he said.
The number of COVID-19 patients hospitalized in the past week at Johnson Memorial has fluctuated between 10 and 18, he said. On Monday, 17 were hospitalized. That number fell to 10 by Tuesday night, and shot back up to 13 by 10 a.m. Wednesday.
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Hospital leaders are working on a plan to get the situation under control. At this point, all options are on the table including, as Dunkle said last week, shutting down elective surgeries.
“You consider everything but you hope you don’t have to reach that point,” he said. “You look at all possible avenues. You look at what your needs are and what your resources are. Sometimes you have to resort to something you wouldn’t be comfortable with in a non-pandemic time.”
Revolving door
The hospital consolidated its COVID-19 unit and critical care unit, a temporary response to its consistently high number of COVID-19 patients, and a revolving shortage of critical care nurses who are out due to COVID-19, possible exposure to the virus or other illnesses.
The consolidation allows nurses to provide better care to both groups of patients, as the severity of those patients’ conditions demands a high level of care and monitoring, Dunkle said.
Because rooms in the merged unit have negative airflow to the outside, CCU patients who do not have COVID-19 are safe from the virus, he said.
The hospital’s staff shortage worsened this week. On Tuesday, 22 staff members — or about 3% of the total workforce — were out sick or in quarantine due to potential exposure, Dunkle said. And unfortunately, the most severe staff shortage right now is among critical care nurses, though other areas of the hospital are also challenged. The hospital has tried for weeks now to add critical care staff, but there are not a lot of nurses with that skillset who are looking for work, he said.
Staff members are overworked and stretched thin, but they’re fighting as hard as they can, Dunkle said.
“We are stretched so thin my nursing director is working shifts to help out,” he said. “I’m so proud of my team. So many have stepped up, but there comes a point when you can only work so much.”
To help ease that workload, nurses from other units have been temporarily reassigned to the CCU. Though non-critical care nurses aren’t licensed to do everything a critical care nurse can, they are helping with tasks such as passing out medications. It’s a team effort to provide the best care possible under the circumstances, Dunkle said.
Evaluating diversion
Patient diversions are in place now, in part, to give staff a break, said Tony Lauinger, the hospital’s emergency medical services coordinator.
Stage 1 diversion is triggered when all beds at the hospital are full, and when staff is stretched too thin. Stage 2 diversion is triggered when the hospital is truly overwhelmed and needs to right the ship, Lauinger said.
About 6 p.m. Tuesday, the Franklin hospital reached that point, and Stage 2 diversion was needed to bring back operations to a manageable level. As of Wednesday afternoon, all EMS services associated with the hospital — including most local fire departments — were asked to assess patients to determine whether they are eligible for transport to the hospital, he said.
Despite diversion, all critically ill patients will get care somewhere, and they will get care at the closest hospital that has space available. If the closest hospital happens to be full at the time, EMS personnel have access to a database that shows where patients could receive the best care at that time, Lauinger said.
Depending on the patient’s location and emergency room availability, patients might be sent to Indianapolis, Columbus or Shelbyville hospitals, Dunkle said.
However, diversion can change hour by hour, local health care leaders said. Dunkle on Wednesday afternoon was considering lifting the diversion order, but hadn’t made that decision at press time.
At some point in the last week, all three area hospitals that serve Johnson County residents were on diversion. Franciscan Health Indianapolis was also on diversion Wednesday, but Community Hospital South was not, spokespeople for those hospitals said. All three were diverting patients Tuesday.
The turn of events Tuesday at Johnson Memorial show just how fluid the situation is, Dunkle said.
“I had breathed a sigh of relief. We were down to nine or 10 COVID patients. Then a few hours later, we went on diversion and had eight people waiting for a bed,” Dunkle said. “It changes that quickly.”
Regardless of whether area hospitals are diverting patients, local health care leaders urge all Johnson County residents to call 911 if they need medical attention. Even if paramedics determine a patient doesn’t need to be taken to the hospital, it is better to be safe than sorry, Lauinger said.
“We are not saying not to call. We will get there and we will physically evaluate you,” Lauinger said. “If you are critically ill, we will get you somewhere.”
