UK Hospital closing 5 operating rooms to free up resources for COVID-19 patients
As Kentucky health care officials brace for a Thanksgiving that they worry will supercharge community spread and risk further burdening the state’s health care system, hospital administrators, already faced with limited staff and waning patient capacity, are making tough calls.
University of Kentucky administrators told staff late Monday night that Albert B. Chandler Hospital would be closing five of its 32 operating rooms to free up more resources for an influx of coronavirus patients and to decrease overall hospital admissions.
“The time is upon us to make a difficult decision,” interim Associate Chief Medical Officer Dr. Christopher DeSimone told staff in an internal email Monday night. “My biggest concern is limited access to care. Having said that, this is the right decision for the uncertainty that lies ahead.”
Dr. Mark Newman, UK vice president for health affairs, said in a statement Monday night that the closing of ORs “is no easy decision.”
UK’s number of hospitalized coronavirus patients has more than doubled in the last month, from about 30 in late October to 81 as of early Tuesday. A quarter of those patients are in intensive care, Dr. Colleen Swartz, UK’s vice president for hospital operations, said Tuesday.
The news comes less than a week after Gov. Andy Beshear announced new restrictions to tamp down aggressive spread of the virus across Kentucky, where the positivity rate has nearly doubled since mid October, from 5 percent to more than 9 percent. On Sunday, Beshear said another surge of coronavirus post-Thanksgiving will mean “our hospitals will simply not have the capacity to give everyone the care they need.”
It’s difficult, though, to keep real time tabs on Kentucky’s actual hospital capacity. Unlike other states, Kentucky has not made public individual hospital metrics, only statewide. Each week, the Kentucky Hospital Association pulls hospital occupancy information from the state Department for Public Health to update its coronavirus dashboard. Last week, 73 percent of the state’s total hospital beds and 86 percent of ICU beds were occupied (24 percent of ICU beds were occupied by COVID patients).
But it’s not clear whether Kentucky’s total number of beds (11,575) includes staffed beds only. Or if neonatal intensive care unit beds, for instance, are included — an amount much less relevant when trying to discern coronavirus patient capacity.
The closure of Chandler’s operating rooms goes into effect the Monday after Thanksgiving and will remain in effect through the end of December. Predictive models UK is using “account for the expected congregation of people” during the holiday, and “models show an increase in COVID cases three weeks from now,” UK said in a statement.
Most of the COVID-positive patients admitted to UK are currently housed two to a room on the tenth floor of Chandler. Expanding that capacity to ORs is part of the university’s surge plan: a Level 1 through 5 color-coded plan based on the number of COVID patients hospitalized at a time. UK is currently at Level 2, yellow, where the range of patients is 63-128.
Each time a new level is reached, it triggers a shuffling of resources and potential expansion of space for COVID patients. If UK hits Level 3, 129-256 COVID patients, it means Chandler needs to consider expanding to another floor to make room for those patients, in this case the ninth floor. COVID patients could be housed in the hallways of these units, and nurses will be instructed to take on an additional patient.
Level 3 also means hospital officials will consider stopping some surgeries at Good Samaritan Hospital in order to reassign those staff to Chandler’s COVID units, according to the plan.
If UK admits more than 90 COVID patients, which wouldn’t yet put it over the threshold into Level 3, “additional closures will be considered,” officials said.
UK in its Monday night statement is not yet to the point of canceling elective procedures — a move that would come later if hospitalizations continue to rise, and all signs point to that happening. UK also said it is not furloughing staff. But earlier this month Lexington hospitals, UK included, modified their visitation policy to further limit the number of people inside and to make sure they’re always masked.
‘Extremely concerned’ about Thanksgiving
Statewide, other hospitals are noting dramatic increases in COVID patients, too.
Donald Lloyd, president and CEO of St. Clair HealthCare in Morehead, said his hospital on Monday was at 80 percent capacity.
The hospital is being “aggressive” in using outpatient treatment and moving admitted patients out of the hospital to home health care, if they’re well enough, in order to ensure the hospital keeps as many open beds as possible, he said.
Lately staffing has been “awfully tight,” because of the need to quarantine and isolate doctors, nurses and other health care staff who’ve come in contact with the virus.
“As people come off quarantine and come back, you’re breathing a sigh of relief,” said Lloyd. And though St. Claire, like other hospitals, has a surge plan that involves expanding the number of critical care beds and selectively shutting down other services to free up space and staff, Lloyd is still “extremely concerned” about accommodating the expected surge in patients after Thanksgiving.
“We very well could be at 108 percent (capacity) tomorrow at the rate of increase we’re seeing,” he said.
Karen Hill, CNO and COO at Baptist Health Lexington, echoed that day-to-day unpredictability.
“It is a variable issue every day,” she said. “You can’t tell from one day to the next how many of your staff will have had community exposures and are quarantined, or how many patients are going to be coming through. It really is difficult to say [whether] today’s the day I reach my breaking point.”
Right now, Baptist has more non-critical care COVID patients than critical care, which is “better for the hospital,” because it means they will likely be discharged sooner and require less intensive staff care.
Hill said she’s worried more about not having enough staff than providing enough beds. “The number of staff is the variable of biggest concern because you cannot just produce an excellent nurse overnight.”
Hill, like Lloyd, said the best way for Kentucky to avoid buckling its hospitals is to take individual responsibility against spreading the virus, which starts with wearing a mask and avoiding gatherings of more than two households, or more than eight people, on Thanksgiving.
“The main thing the community can do for us in health care is to try not to infect our workers,” she said.
Herald-Leader writer Bill Estep contributed to this story.
This story was originally published November 24, 2020 at 9:02 AM.
