Kansas and Missouri hospitals consider shuffling of patients to handle COVID-19 surge
CoxHealth, a southwest Missouri hospital chain, embarked on an ambitious project in April to transform an empty floor in one of its Springfield buildings into a 51-person COVID-19 unit in just two weeks.
It sat empty for five months.
“And of course it’s completely full now,” said Steve Edwards, CoxHealth president and CEO.
Faced with the prospect of overwhelmed hospitals this past spring, health leaders in Kansas and Missouri weighed erecting tents or other buildings to house a possible huge influx of COVID-19 patients. Some facilities, such as CoxHealth, added beds. Missouri officials worked with the federal government to retrofit a St. Louis-area hotel. Kansas examined 10 potential sites.
The enormous tide of patients didn’t arrive, and contingency plans were put back on the shelf. By summer, mask use was helping to keep the virus mostly under control.
But the surge feared in the spring is here now, fueled by a wave of COVID-19 cases as fall temperatures push people indoors. Both states are reporting thousands of new cases each day on average. Next week’s close-quarter Thanksgiving gatherings will likely only feed the spread of the virus.
Kansas and Missouri hospitals are again taking extraordinary measures, including reviving discussions about quickly adding bed space. But officials are wary of the idea and warn that staff shortages—made worse by community spread— would limit their ability to deliver care. More than a third of Kansas hospitals are expecting to be shorthanded over the next week..
“There are no tents being erected today, there’s no open real estate being converted to field hospitals today, but it’s certainly being talked about,” said Garold Minns, health officer of Sedgwick County, home to Wichita.
As an alternative, officials in both states are considering plans to shuffle COVID-19 patients between large and small hospitals depending on the severity of their illness. Rural residents, as their conditions worsen, would be taken to big city hospitals for intensive care and then sent to smaller providers once they begin recovering— a potentially complicated logistical challenge.
Hospitals are also trying to fit more patients into existing space. Wichita hospitals are holding COVID-19 patients in emergency rooms, for instance. Hospitals in many areas are cutting back on non-emergency procedures and delaying some operations, just like in the spring.
It’s a strategy they hope will work long enough for new restrictions to begin flattening the region’s astronomical case counts. Kansas City, Mo., unveiled new limits on restaurants and gatherings on Monday, following Johnson County’s own announcement Friday.
Just how much time hospitals can buy isn’t clear. Across the Kansas City metro, only 10 percent of staffed intensive care beds were available as of Friday, according to the the Kansas Hospital Association.
Statewide figures for Kansas and Missouri are slightly better. Twenty percent of all staffed ICU beds were available in Kansas on Friday, 30 percent in Missouri as of Saturday, according to the state’s Department of Health and Senior Services.
The percentages will likely fall in the coming days because of a time lag between the reporting of new cases and hospitalizations.
“We really expect the next seven to 10 to 14 days are actually going to be much, much worse on the hospitalization front,” David Wild, vice president of performance improvement at the University of Kansas Health System, said Monday.
‘Alternative’ sites not sought
Hospitals are heading into the surge with some advantages they didn’t have in the spring. Drugs and steroids are now available to help treat severe cases. Testing is much more widely available than in the early weeks of the outbreak. Shortages of personal protective equipment have in many instances been resolved.
As cases have spiked in Kansas and Missouri, the federal government has been providing both states with additional equipment. A White House official told McClatchy that Missouri has received nearly 150,000 goggles, 300,000 N95 respirator masks, and nearly 210,000 boot covers over the last three weeks. Kansas had secured nearly 275,000 coveralls and 100,000 surgical gowns, as hospitalizations have increased.
“The reality is that the United States is more prepared than ever before to confront the coronavirus,” White House spokesman Michael Bars said. “Through the ingenuity and dedication of our frontline medical workers, clinicians, and scientists we now have more information on how to better treat patients and protect the most vulnerable through increased care, life-saving therapeutics, state-of-the-art testing, mitigation techniques to prevent community spread, and hospitals that are better prepared.”
During the early months of the pandemic, Kansas, Missouri and the federal government -- seriously considered building makeshift hospitals to accommodate a spike in hospitalizations.
In Missouri, a hotel in Florissant, near St. Louis, was retrofitted this spring to accept patients. It housed fewer than 30 before emptying out by June, the St. Louis Post-Dispatch reported at the time.
But new alternative care sites aren’t in the works, at least not yet.
A spokeswoman for Missouri Gov. Mike Parson said health leaders have told the governor that hospital beds “are not the issue.”
“The area we are monitoring closely is the staffing of the hospital beds,” Parson spokeswoman Kelli Jones said in a statement. “This administration is working and has worked hard to help support capacity management.”
Dave Dillon, a spokesman for the Missouri Hospital Association, said the association wasn’t aware of any plans to build new alternative care centers, though he indicated that could change. Michael Cappannari, external affairs director with FEMA’s regional office, said that the U.S. Army Corps of Engineers has not received requests from Missouri for any additional site assessments or for build-outs of alternative care sites.
Lee Norman, secretary of the Kansas Department of Health and Environment, said the state and the Corps of Engineers reviewed 10 potential sites in the spring. None were ever used.
While hospitals are again talking about their capacity options, Norman indicated officials are trying to avoid temporary construction if at all possible.
“It’s very clear, universally, that the hospital executives and leaders would rather surge within their current footprint than have to be out ... in a tent in the Kansas fall or winter,” Norman said.
More transfers possible
Kansas and Missouri are both eyeing plans that would transport COVID-19 patients around the state in an effort to open up bed space in the largest hospitals. Both states have regular hospital beds available, but they are scattered across the region.
Norman said Kansas is working on plans to transfer COVID-19 patients from large hospitals to smaller hospitals once they start to recover and are no longer contagious. At the University of Kansas Health System, for instance, 42 of the hospital’s 126 COVID-19 patients on Tuesday were in the recovery phase.
In turn, the state would deploy what Norman termed an “air traffic control” service that would coordinate referrals of severely ill patients from small hospitals to larger hospitals. He said the operation would free up nurses and other medical professionals to spend more time caring for patients instead of spending hours on the phone seeking beds.
KDHE spokeswoman Ashley Jones-Wisner said the agency is aiming to hire Cheyenne Mountain Software for $1.3 million to provide a statewide patient transfer and bed resource platform.
LMH Health has already received calls asking the Lawrence hospital to take transfers from other providers. The hospital had 35 COVID-19 patients on Tuesday and 120 patients total. Traci Hoopingarner, vice president for clinical care and chief nursing officer, said the current number is manageable but that the pressure ramps up considerably after 150 admissions.
But the facility has been preparing for months for a surge, including cross-training staff to work with COVID-19 patients. “We’ve been working on it for a while,” Hoopingarner said.
In Missouri, Dillon said facilities are weighing a “reverse triage” system in which severely-ill patients or those more likely to develop severe symptoms would be sent to metro area hospitals and that recovering patients would sometimes be sent to rural areas. He said most efforts remain in the planning stages.
“This has not been implemented yet,” Dillon said in an email, “but it is an example of the types of conversations taking place to manage surge, and to get the right patients to the right care at the right time.”
Tara Copp contributed to this report.
