In 34 years of practicing medicine, Dr. Robert Mead, a family physician at Bellin Health, never had to turn away an ambulance or decline patients in need of comprehensive care.
But several times over the past couple of weeks, Mead said, Bellin had to “go on diversion,” meaning the hospital wasn’t able to accept a patient either coming via ambulance or as a referred transfer from another health care provider.
It’s become an alarming trend in hospitals across Wisconsin.
Wisconsin’s hospital leaders say their facilities are bottlenecked as the number of COVID-19 patients continues to rise, forcing them to turn down requests for transfers from smaller hospitals of patients who need advanced or specialty care. It's driving some patients to travel hundreds of miles from home to receive hospital care.
As the COVID-19 pandemic approaches the end of its second year, Wisconsin hospitals face numbers of COVID-19 hospitalizations not seen since late 2020, before vaccines were first made available.
Despite being overburdened by COVID-19 patients, hospital leaders still stress that patients in need of emergency care should go to the hospital. Many facilities, however, have had to reshuffle how, where and when their patients are treated.
They’re all facing the same problems: Not enough staff, patients who are sicker and need to stay longer, struggles to find long-term care facilities with the space for those patients when they’re ready for discharge — and the lurking presence of influenza, which health officials say is already circulating at higher levels than in 2020.
Officials say patients coming to the emergency room are having to wait there longer than usual for a bed elsewhere in the hospital to open up. On the flip side, they say it’s also difficult to release patients who are ready to leave but need help recovering, because the state’s nursing homes are just as inundated.
‘We have no place to go'
On Friday, the Wisconsin Hospital Association reported 1,457 patients were hospitalized with COVID-19, the most so far this year. Of those, 393 patients have been admitted to an ICU.
Since the pandemic hit Wisconsin, over 9,000 Wisconsinites have died, Department of Health Services secretary Karen Timberlake announced at a media briefing on Thursday. Additionally, Timberlake said the state is adding thousands of confirmed cases each day, numbers health leaders haven’t seen since last December.
Dr. Ashok Rai, CEO of Prevea, said on Friday that, because about 20% of hospital beds at HSHS Wisconsin are being taken up by COVID-19 patients, patients from smaller hospitals outside of Green Bay can't be admitted. But he made clear that Green Bay residents should still go to be the hospital if they're in need of care.
“Everybody in our normal area that comes to the emergency department is getting great care. If you're getting sick here locally, you should come in," Rai said. "You're not the ones that are being transferred.”
But things get complicated for those patients being transferred from smaller outlying hospitals. Because the majority of the COVID-19 patients coming in to the hospitals are unvaccinated, the duration of care is longer and patients require additional resources, which means patients needing to be transferred from smaller hospitals aren't able to receive care.
Ken Nelson, the chief nursing executive for HSHS Wisconsin, said that many patients come to the hospital in the early stages of COVID-19 infection and get admitted before their illness peaks. Once admitted, their stay is longer than a normal patient “by a significant amount,” Nelson said.
And then there’s the matter of staffing.
Patients entering intensive care may need to be on a ventilator for a long time. Multiple people must move them in bed, performing the sometimes life-saving maneuver of “proning,” which requires patients to be flipped from lying on their back to lying face down. This is done because, gravity and other forces compress the lungs when patients are on their backs. Turning them over allows ventilation of the compressed lung region.
In Green Bay, HSHS St. Vincent Hospital functions as a transfer site for outlying hospitals that lack a service that St. Vincent can offer. The hospital has, for example, a comprehensive stroke center that smaller hospitals without such a service rely on. Nelson said that in the last few months, the hospital set a record in calls for transfers.
St. Vincent has received calls from 200 to 300 miles away, with some out-of-state hospitals calling in search of care.
“We're seeing these calls from places outside the normal areas that we would be receiving calls from, even from out of state, and that tells us two things,” Nelson said. “Number one, it tells us that there are a still a lot of sick patients out there, COVID or not COVID. And number two, it also tells us that everybody is running up against these capacity issues.”
Mead, one of the lead physicians of Bellin's COVID-19 incident command, said that the hospital, which can normally accommodate transfer referrals, had to decline transfer requests in September from as far away as Iowa.
“Our goal is to concentrate on taking care of our community,” Mead said. “Our hospital was overflowing in early September, so we were not able to take any of those patients.”
About a quarter of Bellin's hospital beds are filled by COVID-19 patients, Mead said, and it gets graver inside the ICU, where 50% of the patients are sick with COVID-19. None of the COVID-19 patients in the ICU are vaccinated. Across the hospital, 75% of the COVID-19 patients are also unvaccinated, he said.
“We still have a commitment to take care of non-COVID patients. We’re able to do that, because we know a lot more this year than we did last year,” Mead said. “But there are times when we have little to no beds to admit people.”
At UW Health in Madison, another large care facility that typically fields transfers from smaller regional partners, chief quality officer Dr. Jeff Pothof said what used to be a sure bet that they’d be able to take a patient from another location has become more tenuous.
If the hospital doesn't have a bed immediately available, they’ll call back when they do, he said — but the gap between those two calls is growing to be a day or sometimes longer. Meanwhile, the hospitals on the other end sound more desperate.
“What we hear is there isn’t any place that can take their patient,” Pothof said. “We get more phone calls from hospitals we don’t usually get phone calls from, sometimes hours and hours away and from different states.”
Hospitals are also similarly strapped for places to send patients when they’re able to leave the hospital, but need more rehabilitation before returning home.
At Gundersen Health System’s La Crosse hospital, chief nursing officer Heather Schimmers said the number of patients ready to be released to a long-term care facility but still at the hospital is four times higher than normal. The hospital on Friday was looking for long-term care for 44 patients, she said.
“We’re paralyzed. We have no place to go with these folks,” Schimmers said.
Schimmers said everyone who comes to Gundersen for care is able to be treated there, but they’ve had to deny hundreds of requests from nearby hospitals to bring patients to La Crosse. They’ve diverted patients before for other reasons, like if a piece of machinery breaks or the operating room is too full — but today, they’re doing so in a more sustained manner, she said. In October, they had to deny 380 calls for a patient to be transferred to their facility.
Gundersen serves a tri-state area: western Wisconsin, southeastern Minnesota and northeastern Iowa. But it’s not uncommon now for those requests to have come from places like western Minnesota, Schimmers said.
Smaller rural hospitals in other parts of the state that are used to sending patients with relative ease to the closest larger facility are now struggling to find anywhere to take people who need a higher level of care.
DeAnn Thurmer, president of SSM Health’s hospitals in Ripon and Waupun, said Friday that an intubated patient recently had to stay in the emergency department for 36 hours while they waited for a bed elsewhere to open up. One of their emergency room doctors had to call 50 hospitals looking for bed space for another patient.
“We even started calling Illinois and Minnesota,” Thurmer said.
Patients who need more specialized care are usually transferred to SSM Health St. Agnes Hospital in Fond du Lac, just about a 30-minute drive away. But that hospital, too, is now struggling to find space.
St. Agnes president Katherine Vergos said her staff is calculating hour by hour where beds might free up to take more patients.
The hospital has postponed inpatient surgeries, but Vergos noted that just because a surgery isn’t an emergency one doesn’t mean it’s not critical. She described a cancer patient who recently had to wait three weeks for a procedure that would determine what type of lung cancer they had.
The picture is much the same at ThedaCare’s hospitals in the Fox Valley. It “feels like no one has beds available,” Lynn Detterman, senior vice president for the system’s south region, said Friday.
Because ThedaCare is the region’s center for trauma care and also houses a comprehensive stroke center, they’re still accepting those patients who are coming from other places, Detterman said. But other requests for transfers for more general medical care are not being met.
Since their options for transferring patients to other facilities are limited, Detterman said, their staff has had to get creative in how they can meet patients’ needs. That includes having members of their marketing and human resources staff perform duties like bed-making, cleaning rooms and putting meal trays together for eight hours once every two weeks.
During the Thursday news briefing, DHS secretary Timberlake underscored that struggles with staffing, not so much physical space in the hospital, are causing the current crunch. A field hospital like the one built last year at the Wisconsin State Fairgrounds wouldn’t fix the fact that there aren’t enough employees to help patients, she said.
As hospitals scramble to make things work, the number of patients sick with the virus keeps growing. A Friday statement from Aspirus in central Wisconsin said COVID patients accounted for more than one in four of their inpatient beds. Advocate Aurora Health said its COVID inpatient census across its 26-hospital system has doubled in the last five weeks.
A spokesperson for Ascension Wisconsin said 152 COVID patients were hospitalized in their facilities, about the same number as were hospitalized in January. At Marshfield Clinic, 113 COVID-19 patients were occupying beds Friday morning, a spokesperson said, and they, too, have had to decline “numerous” transfer requests from other health systems.
Hospitals across the state are seeing the same trends: The majority of hospitalized COVID-19 patients are unvaccinated. They’re urging people to seek the answers they need if they’re still unsure about the shot. Those who were immunized more than six months ago should get their booster dose, they say.
Health leaders plead with community to get vaccinated, boostered and wear masks
Mead, from Bellin, sympathizes with those who hesitate to get the vaccine, which he attributes to misinformation about vaccine safety. While it’s true, he said, that vaccinated people still are vulnerable to COVID-19 infection, the vast majority of them only experience mild cases. Vaccine effectiveness and masking effectiveness are “not a controversial thing in the medical community,” he said.
“Those are as close to absolute fact as you can get in medicine, within the medical community,” Mead said. “99% of doctors agree that masks are effective and vaccines are effective. We have 350 physicians on our staff and only two of them are unvaccinated.”
He pointed to areas such as Dane County, where mask wearing is enforced and about 76% of its population is vaccinated. The infection rate there is a third of what it is in Brown County, where no mask mandate exists and 60% of the population is vaccinated.
Rai, of Prevea, urges those already vaccinated to get a booster shot six months after completing the Moderna or Pfizer vaccine regimens and two months after the Johnson & Johnson shot.
"Delta is still the variant that we have in front of us," Rai said, on whether the booster would be effective against the new omicron variant. "Get the booster as it's available to you. That level of protection, from everything we've seen, is going to provide some level of protection against omicron too."
At St. Agnes in Fond du Lac — a county where less than 50% of residents are fully vaccinated — Vergos said 200 unvaccinated patients had been admitted and 35 had died from COVID-19 complications in the last four months. That’s compared to 80 vaccinated patients, four of whom died.
“If I could just plead with people to think outside of themselves, outside of only themselves, and think about the common good,” Vergos said, that’s the message she most wants them to hear.
To schedule a vaccine appointment, you can use DHS's website, Wisconsin COVID-19 Vaccine Registry.
Natalie Eilbert is a government watchdog reporter for the Green Bay Press-Gazette. You can reach her at firstname.lastname@example.org or view her Twitter profile at @natalie_eilbert.
This article originally appeared on Appleton Post-Crescent: COVID in Wisconsin: Hospitals turning away patients as cases climb, staffs struggle