Vermont hospitals are under pressure from pent-up demand, Covid-19 pack ICUs – Community News
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Vermont hospitals are under pressure from pent-up demand, Covid-19 pack ICUs

On August 21, a tent for patients will be set up outside the emergency room at the University of Vermont Medical Center in Burlington. Photo by Glenn Russell/VTDigger

In Vermont hospitals, intensive care beds are filling up. While the majority of patients have illnesses other than Covid-19, health officials are closely monitoring the numbers as the state experiences a surge in virus cases and hospitalizations.

The number of open beds in the state is approaching single digits some days, and the share of occupied beds is rising to about 90% — the tightest ICU capacity since the pandemic began more than a year and a half ago, according to data from the Vermont Department of Financial Regulation.

In comparison, officials say that in late spring and early summer, ICU beds were 70% to 80% occupied.

Most of the ICU’s staffed beds in Vermont are filled with critically ill patients whose stroke, heart attack or other preventable condition has worsened over the past 18 months due to lack of medical care, state leaders said this week.

About 10 to 15% of available beds are now occupied by Covid-19 patients, state leaders said.

Vermont reported nearly 600 new infections on Thursday, a new record. But current hospital admissions reflect an earlier wave, as people don’t get seriously ill right away. That could mean Vermont could face another surge in hospitalizations as the holiday season approaches.

Staff vacancies have made it difficult to keep beds open, Governor Phil Scott said earlier this week. State regulators said that on any given day, five to eight of the state’s ICU beds cannot be used due to a lack of clinicians.

Already in the throes of another wave attributed, at least in part, to Halloween activities, the state faces uncertain months ahead as the holiday season and colder weather accelerate transmission of the highly contagious Delta strain. could accelerate. Scott said Vermont’s high vaccination coverage would likely prevent a significant increase in the number of infected people leaving the hospital. At the same time, the ongoing campaign to vaccinate children aged 5-11 could significantly reduce transmission.

Therapeutic options, including a pill developed by Pfizer, could help keep coronavirus patients out of the hospital, but that treatment probably won’t be available in time for the winter months.

With coronavirus hospitalizations on the rise in neighboring New Hampshire, clearing intensive care beds by transferring patients out of state is no longer an option, said Gilman Allen, a critical care specialist at the ICU at the ICU. University of Vermont Medical Center, the largest unit of its kind in the state.

“We find that we have to accept more and more patients from outside our service area,” Allen said. “I’ve accepted from New Hampshire, parts of Vermont that would normally have gone to (Dartmouth-Hitchcock Medical Center) or Albany, because those hospitals are all full and they’re refusing transfers.”

State officials and hospitals have taken some steps to reopen ICU beds that were closed due to staff shortages. There has been a lot of pressure to create extra space for patients who are ready to leave the ICU by solving bottlenecks in long-term care, rehabilitation and psychiatry. These efforts have been partially successful, but staffing issues continue to thwart some progress.

Last month, for example, staffing issues forced the Brattleboro Retreat to close some of its recently reopened hospital beds. The state attempted to meet that challenge by partnering with White River Junction VA Medical Center to offer additional psychiatric beds to non-veterans.

Human Services Secretary Mike Smith said these measures should bolster the state through a wave in the near future.

[Looking for data on breakthrough cases? See our reporting on the latest available statistics.]

“We’re worried about the holidays,” he said. “We want to get through the holidays, and then we will re-evaluate at that time.”

Smith acknowledged that the state needs to come up with long-term solutions to address the gaps in its health care system.

Earlier this fall, Smith’s department, along with other regulators, launched a study into appointment wait times after a seven-day study found that some patients waited months or longer for appointments. The executive branch’s team plans to complete the investigation before the start of the Montpelier Legislative Assembly in January, with the aim of informing longer-term policymakers on these issues.

Meanwhile, UVMMC has postponed or canceled operations when capacity is too tight. But it’s not a good long-term solution. When patients are unable to receive timely care, benign conditions such as high blood pressure can evolve into complete emergencies.

“If we delay a repair of an aortic aneurysm and three or four months later that aneurysm ruptures, that patient will end up in the ICU with multi-organ failure, on dialysis, potentially on that ICU bed for weeks,” Allen said.

But hospital staff have also tried to clear ICU beds more quickly by transferring critical patients to intermediate “step-down” wards for patients who are stable but still need closer monitoring.

“We’ll make sure it works,” Allen said. “That’s the bottom line.”

Scott on Tuesday called on Vermonters to “make smart, practical choices, starting with vaccinating.”

“None of us want to take a step back,” he said. “But we need your help to keep older or vulnerable Vermonters out of the ICU.”

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