Montrose Memorial Hospital is contending with the largest number of COVID-19 cases in over a year, as well as a record volume of total patients in the hospital's history.
Jeff Mengenhausen, MMH CEO, reported 18 COVID-positive cases over the past weekend and six deaths from COVID in October so far. As of Tuesday Oct. 19, seven ICU beds were filled by COVID-positive patients.
The CDC does not report numbers when COVID-19 death counts at hospitals are fewer than 10, so they aren't listed on state reports.
Beds were completely full over the weekend with five patients waiting in the ER for an ICU bed or waiting to be admitted, Mengenhausen said.
With 92% of ICU beds in the state of Colorado filled as of Oct. 20, emergency room physicians and nurses had to take on these patients as a waiting room full of 30-plus people waited to be seen.
According to Mengenhausen, there are often no available beds in the state for patient transfer.
“It's not even a ramp up, it's just spiked on us. This weekend we were completely full and Monday was probably the busiest day we've ever had in the history of the hospital.”
When Jeff Mengenhausen began his tenure as CEO in August, he was told that the hospital ER had experienced the busiest month in visits, but at the time, the record had no correlation to COVID. September was busier than August, but COVID-positive cases in the hospital remained low.
Now, Mengenhausen says, October came with an unexpected spike in cases alongside record volumes.
MMH transferred a patient to Kansas last week due to a shortage of beds, a problem pervading both the Montrose hospital and the rest of the state. Earlier in the pandemic, Mengenhausen said, hospitals in Kansas were asking MMH to admit patients.
No staff have been let go or suspended due to the statewide vaccine mandate to date, but approximately 10 have left the hospital already, with approximately 250 remaining on the floor. He anticipates losing a few more come Nov. 1, the deadline for providing proof of vaccination, an expected loss of valued caregivers Mengenhausen describes as painful.
“We are hitting a spike and I don't know how long that spike is going to last,” said Mengenhausen. “Is it going to taper off in two weeks? Is it going to last four weeks? We'll have to see, but we're taking very quick action to try to stand up other beds.”
MMH has enough staff to cover full beds, but is strained now that it is consistently reaching capacity.
The hospital has eight ICU beds, 24 medical/surgical beds, 10 acute rehabilitation beds and nine beds in the family center. The ICU is reserved for high priority trauma cases and is often where COVID patients on ventilators are placed. If patients begin to improve, they can be moved to another unit.
The ER has 12 rooms, but is adding three “hallway beds” to accommodate more patient care.
The hospital implemented a fast track within the emergency room to make room for patients requiring less care, such as people needing stitches or simple care. This plan allows physicians to provide lower emergent patients short visits while attending to patients with traumas or COVID symptoms.
Traditionally the hospital begins experiencing a seasonal slow down in visits toward the end of October and beginning of November, but the prediction model is inverted right now, according to Alexis Garza, the hospital's emergency department medical director. Garza is reportedly seeing anywhere between 65 - 80 patients per day in the emergency department.
“We have not seen any sort of slowdown yet,” Garza said of the hospital’s volume. “If anything, we've seen record volumes. We're just busier right now than we've been before and definitely busier than we usually are this time of year.”
Garza referenced the staffing shortages through the state and country over the past year, as well as the growth Montrose and surrounding areas have been experiencing. MMH also serves a large catchment area beyond Montrose, including Telluride, Gunnison, Ouray and Delta.
Last year, the MMH ER was able to provide quick turnarounds for visits, but with more people in the region and the pandemic still a problem, hospital staff ask for patience as they wade through almost daily bed shortages.
A record number of visits also means keeping people in the ER longer than normal with less space, especially as the hospital faces challenges transferring patients.
The CEO asks the community to be patient, aware, cautious and responsible while remembering the pandemic didn’t “just go away.”
“If we had 30 or 40 [patients], we’d still be full,” he said, noting that hiring a traveling or contract nurse temporarily would cost $200 an hour, adding an expense to the hospital that wasn’t previously there.
Garza echoed the sentiment. While grateful and happy to provide service, she added that Colorado hospitals are “crazy” right now.
“Our hospital has done a very good job with the leadership of upstaffing and hiring traveling nurses and doing everything we possibly can to open up every bed in our hospital. But that doesn't mean that our receiving facilities, even like the University of Colorado, or any other hospital, is not suffering from a shortage and doesn't have actual physical beds to staff,” she said.
Garza said that healthcare providers notice how frustrated patients are and ask for understanding as they navigate the shortages. Healthcare workers can oftentimes feel defeated, not being able to serve and help patients without long wait times.
Garza appreciates people making their own choices regarding their health and continues to treat any person who enters the ER with dignity and to her fullest medical capacity, but she hopes to see people choose to wear masks in public and remain cautious about the transmission of COVID and other respiratory illnesses.
Garza and her fellow ER physicians, as well as MMH, “back the science of the vaccine.”
“It's a situation that we want people to be aware of and that this is what we're seeing,” Garza said.
“Hospitals are very full right now and there are a lot of sick patients in the ICU. More than half the patients in our hospital at Montrose right now have COVID and are in the hospital because of COVID.”
Around a third of patients visiting the ER and exhibiting symptoms receive COVID tests, said Garza.
Tested patients don’t equate to a positive case, but there are also several people who test positive or have another diagnosis who get sent home if they don’t need to stay.
“Eighteen [patients] is a huge number if you look at how many total beds we have in the hospital,” Garza continued. “More than half of the admitted people have known-COVID infection.”
The split between COVID patients who come in who know they’re positive and those who come in seeking treatment for other reasons is around 50/50, according to Mengenhausen. He encourages anyone who feels sick to first get tested before visiting the hospital, but if someone is having more severe symptoms such as difficulty breathing, he also advises they go in immediately.