COVID cases, other factors push Las Vegas hospitals to limit

Hospitals across the Las Vegas Valley once again are straining to care for rising numbers of COVID-19 cases, only this time while facing new challenges contributing to record-high patient counts.

“The hospitals are very, very busy,” said Mason Van Houweling, CEO of University Medical Center and incoming chair of the Nevada Hospital Association. “Hospitals have seen record, record volumes that they’ve not seen in their history.”

In interviews with the Review-Journal this past week, hospital representatives and employees described difficulties similar to those seen during surges in the winter and last summer. Staffing shortages are common, elective surgeries are being postponed, and intensive care units are at full capacity.

But unlike last year, hospitals are now scrambling to treat patients who delayed seeking care or had surgeries postponed earlier in the pandemic.

Compounding staffing problems, some exhausted health care workers have chosen early retirement or found a new profession. Those who remain are bracing themselves for another COVID-19 surge they fear could rival the one Nevada saw in the winter.

“We don’t have the time, the resources or the hands to get enough done … not to our satisfaction,” said Ralaya Allen, an emergency nurse at Sunrise Hospital and Medical Center. “I’ve seen some of the strongest nurses break down because it’s overwhelming. It’s too much.”

The highly contagious delta variant of the disease also is inflicting a harsher toll on the unvaccinated, said Tyler Uhrmacher, an ICU nurse at MountainView Hospital. He’s seeing younger patients in his unit experiencing more severe symptoms this time around.

“Ten out of 12 were in their 40s and 50s,” he said. “The patients are sicker, they’re requiring to get intubated sooner if they need to get intubated, and it’s harder to get them off the ventilator.”

Increased patients

Southern Nevada hospitals have felt the greatest impact from this summer’s wave, particularly the COVID portion of the caseload, the Nevada Hospital Association reports.

Clark County’s confirmed and suspected COVID-19 hospitalizations have more than quintupled since early June. The number stood at more than 1,000 as of Thursday, rivaling the peak of last summer’s surge. Across the county, patients who have tested positive for COVID-19 represent about 24 percent of hospital patients, according to hospital association data.

Seven hospitals in the county have surged above their licensed bed counts, the hospital association reported Wednesday. Five also reported experiencing staffing shortages.

The association also reported that “multiple” hospitals had ICU occupancy above 90 percent. Although it did not identify specific facilities, federally published data shows that as of mid-July, eight hospitals had surpassed that threshold, including Sunrise Hospital and Medical Center.

“COVID is back. We’d all hoped so dearly that it was behind us,” said Dr. Steven Merta, chief medical officer at Sunrise Hospital.

But Merta said the hospital’s COVID-19 patients remain less than 60 percent of what they were in early January at their peak. But he acknowledged the hospital is still very busy, especially in its intensive care unit.

Merta said some people who delayed mammograms, colonoscopies and other diagnostic tests last year may now be experiencing worsening illness that needs treatment. Others are getting procedures or surgeries that were postponed earlier in the pandemic.

“Everybody’s trying to play catch-up,” UMC’s Van Houweling agreed in a separate interview.

There’s a convergence of other factors too, he said.

The summer heat can exacerbate chronic conditions, resulting in trips to the emergency room, Van Houweling said. An increase in violence is sending more patients to UMC’s trauma center. And more patients are being treated for mental illness.

Staffing shortages

One of the greatest problems facing hospitals continues to be a shortage of nurses and other personnel.

Hospitals are reckoning with early retirements brought about by the pandemic. “So we’re trying to recruit and retain and refer and hire those new graduates coming out of nursing school as quickly as we can,” Van Houweling said.

Uhrmacher, the ICU nurse at MountainView, said he knows some hospital workers have left for more lucrative work as travel nurses. Replacing those who have left with new graduates can take months of training, he said.

“This is a slow process,” he said. “And you want it to be a slow process, so they can learn all of the technical skills required within those jobs.”

Allen said Sunrise Hospital’s emergency department had three nurses leave recently, and another two plan on quitting soon. That translates to 60 shifts each month that will need to be filled by other people. The loss is even greater when factoring in the combined experience those nurses had.

Staffing shortages mean higher patient-to-nurse ratios, Allen said.

“It’s putting a huge pressure on the infrastructure of the hospital, the staffing and the ability to care for patients,” she said. “Is safety a concern for staff and patients? Absolutely.”

MountainView and sister hospital Sunrise are offering incentives for workers to take extra shifts, according to employees.

To ease its own staffing crunch, the Valley Health System is asking part-time and per-diem staff to work additional shifts and is assigning clinical supervisors to care for patients, among other measures, representative Gretchen Papez said in an email. The system operates six hospitals in the Las Vegas Valley.

Postponing surgeries

To reduce patient volumes, the hospitals have again begun to postpone some elective surgeries.

“While we are currently able to continue performing outpatient surgeries and procedures, we are closely monitoring surgeries that require an inpatient bed for an overnight or multi-night stay,” Papez said. “Some elective surgeries have been, and may continue to be, postponed and patients should contact their physician’s office to reschedule.”

The situation is similar at Dignity Health-St. Rose Dominican Hospitals.

“We are being overwhelmed with an ever increasing number of patients but have limited beds and staff,” representative Gordon Absher said in an email. St. Rose is asking doctors to consider delaying surgeries that require an overnight stay.

On Thursday, Sunrise announced in an internal memo that it would pause adult inpatient elective surgeries for at least a week because of their impact on hospital bed availability.

“Sunrise Hospital is experiencing an historic high in inpatient census,” the memo stated. “To manage our high census, we have exhausted all available space.”

It said they are continually looking for new spaces to put patient beds. At Sunrise, a pediatric wing had been converted to hold 12 adult patients, according to the memo.

Papez said that Valley Health System hospitals have plans in place, if needed, to open overflow units in areas such as post-anesthesia care units, convert private rooms into semi-private rooms and identify open areas for hallway beds.

Younger, unvaccinated patients

Frustrating hospital administrators and workers alike is that many of the COVID-19 hospitalizations could have been avoided.

The vast majority of hospitalized COVID-19 patients are unvaccinated, both administrators and workers said. Merta estimated that more than 90 percent of patients with the virus in Sunrise’s ICU are unvaccinated. The patients also are younger than in previous surges.

“In today’s COVID delta variant world, nobody’s safe,” Merta said. “We have seen a shift from the 65- to- 75-year-old cohort down to the 20-, 30- and 40-year-olds,” populations less likely to be vaccinated.

There’s a relatively simple way for community members to help health care workers who are struggling to care for growing numbers of patients, several of those interviewed said.

“Please get vaccinated,” Van Houweling said. “Do it for yourself, your family, but also for the health care workers.”

Contact Mary Hynes at mhynes@reviewjournal.com. Follow @MaryHynes1 on Twitter. Contact Michael Scott Davidson at sdavidson@reviewjournal.com or 702-477-3861. Follow @davidsonlvrj on Twitter.