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The contract health worker surge

Don’t know how sustainable this is.

Dr. Esmaeil Porsa, president and CEO of Harris Health System, said the hospitals in the system were at a breaking point when he learned that 100 temporary medical workers were being sent to help.

As cases surged, the hospitals were admitting more children and pregnant women with complications from COVID-19, and patients who needed intensive care waited in emergency rooms for ICU beds to become available.

The nurses, respiratory therapists and other contract staff “definitely arrived here at a pivotal moment,” Porsa said. “They did exactly what I had hoped that they would do, which is allowing us the opportunity of a couple of things: to provide a little bit of relief for front-line staff who have been running around ragged, but also created an opportunity for us to expand our capacity.”

[…]

Gov. Greg Abbott announced the Texas Department of State Health Services would deploy state-funded relief workers to hospitals, and 8,100 have either arrived from other states or are expected soon.

It’s the second time the state has taken such action. At the height of the state’s winter surge, almost 14,000 medical workers were deployed across the state, according to DSHS. From July 2020 to early August of this year, the state spent more than $5 billion in federal disaster funds and coronavirus relief funds on medical personnel.

Abbott’s move came after hospitals and local health officials complained that they were having to outbid each other to hire contract nurses amid a statewide shortage of hospital staff.

W. Stephen Love, president and CEO of the Dallas-Fort Worth Hospital Council, said that competition among hospitals meant “they’re going to take from Peter to give to Paul, so to speak. That’s why using the state with their purchasing power [is important].”

The new push to bring more health workers to Texas comes as many have reached their limits, said Carrie Williams, spokesperson for the Texas Hospital Association.

“This surge has come faster and stronger than previous surges, and it comes at a time when the frontline [worker] is burned out,” Williams said in a statement. “We were already starting from behind when this surge hit.”

According to DSHS, the state’s hospitals requested more than 15,000 temporary staffers between Aug. 12 and Aug. 25. As of Aug. 25, almost 4,000 have been deployed, with most going to regions with the state’s most populous counties and metro areas.

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Health officials continue to stress that the main way to reduce the need for additional staff is clear: more vaccinations. As of Aug. 25, about 47% of Texans were fully vaccinated.

Since Jan. 1, Porsa said, everyone who has died at LBJ Hospital and Ben Taub Hospital from COVID-19 has been unvaccinated.

“Space is not unlimited, resources are not unlimited,” Porsa said. “At some point it doesn’t matter how many nurses you throw at the problem, we are going to arrive at a situation where we’re not going to have enough clinicians, we’re not going to have enough doctors, we’re not going to have enough something else.

“We will run out of options at some point, and this is really really important for people to realize that this cannot go on forever, and they know what the solution is.”

It’s still not clear to me how there could even be that many not currently working medical staff out there to be brought in, but they do exist in some number, for which we are grateful and lucky. It’s also not clear at what point demand will outstrip supply, and as noted above, we may run into other limits even sooner than that.

How long can we last? There’s actually a tiny bit of cause for optimism in the most recent data.

The average number of daily COVID hospitalizations in the Texas Medical Center dropped for the first time since early July from a record 390 patients to 388, the medical center reported Monday.

The metric reflects the daily average of hospitalized patients over the previous week. The drop comes amid declining COVID hospitalizations both nationally and statewide.
A three-day decline in total COVID hospitalizations in Texas brought the number to 13,557 on Saturday, the most recent day for which data is available. The Centers for Disease Control and Prevention also reported a drop in the average number of new daily hospitalizations nationwide, from 12,354 on Thursday to 12,051 on Friday. More recent national data is not yet available.

Dr. James McDeavitt, executive vice president and dean of clinical affairs at Baylor College of Medicine, said the decline is part of the natural course of the pandemic.

“When you see an outbreak like this, the virus kind of runs through the population until it gets to the point where it starts running out of people to infect,” he said, adding, “That does not mean herd immunity.”

He warned that the virus still has room to spread, especially as schools reopen. In an interview last week, McDeavitt said hospitals will continue to feel the strain of the current surge as cases decline.

Burnout among nurses, lingering staffing shortages and the record number of hospitalizations all factor into a longer recovery period.

“From the peak, we’re probably still a month-and-a-half to getting to something that feels like business as usual,” he said last week. “So best case, we’re into October now before we start to get some relief.”

So don’t get too cocky. It’s good that maybe we’ve peaked and will start to see a decline, but we’re still a long way out from where we were in May and June, and we could easily reverse course again. We need to keep getting people vaccinated, because the alternative is more of what we’re going through now.

Abbott flails about on the COVID surge

He remains committed to the bit.

Gov. Greg Abbott announced new moves Monday to fight the coronavirus pandemic as it rages again in Texas, including asking hospitals to again put off certain elective procedures to free up space for COVID-19 patients.

Still, the governor did not back down on his refusal to institute any new statewide restrictions on businesses or to let local governments and schools mandate masks or vaccines.

Instead, Abbott announced he had written to the Texas Hospital Association asking hospitals to “voluntarily postpone medical procedures for which delay will not result in loss of life or a deterioration in the patient’s condition.” As coronavirus was consuming the state last summer, Abbott took a more restrictive approach and banned elective surgeries in over 100 counties before ending the prohibition in September.

Abbott also announced Monday he was asking state agencies to open additional COVID-19 antibody infusion centers that aim to treat COVID-19 patients with therapeutic drugs and keep them from requiring hospitalization. And he said the Department of State Health Services “will be utilizing staffing agencies to provide medical personnel from out-of-state to Texas health care facilities to assist in COVID-19 operations.”

That is a reversal for the state. In July, the state told cities and counties it would not send additional health care workers to aid hospitals with the latest surge of COVID-19 patients, like it had earlier in the pandemic. Instead, state officials said, city and county leaders should dip into $10.5 billion worth of federal stimulus dollars to pay for those workers should hospitals need them.

[…]

As part of Monday’s announcement, Abbott’s office said he was directing state agencies to “increase vaccination availability across the state” but did not provide further details.

“Texans can help bolster our efforts by getting vaccinated against COVID-19,” Abbott said in the news release. “The COVID-19 vaccine is safe and effective, and it is our best defense against this virus.”

Well, some hospitals had already taken the step of halting elective procedures, so way to be out in front on that, bro. Part of this “plan” includes recruiting more nurses from out of state to help us with the shortage we are now experiencing. I presume this means he’ll be trying to lure them from states that have COVID under a greater degree of control, probably places where the Governors in question made an actual effort to get people vaccinated and didn’t kneecap local leaders’ attempts to keep their people safe. I have no idea why any of them would want to come here now, but God bless ’em if they do. I guess we should be thankful that Abbott is doing something other than literally fiddling while the state burns, but color me a little too grumpy to care about such crumbs.

The nursing shortage

Just gonna leave this here.

A nursing shortage and a high volume of patients prompted Lyndon B. Johnson Hospital on Sunday night to declare an “internal disaster” in the emergency room, where wait times swelled to 24 hours, Harris Health System officials said Tuesday.

Internal disasters limit the flow of ambulance traffic to the hospital and are usually triggered by infrastructure problems, such as fires or diagnostic machine failures.

On Sunday, however, the hospital could only staff 16 of its 24 ICU beds. At one point, about 130 people were in the ER waiting room from an “onslaught” of patients with a variety of health problems, said Dr. Esmaeil Porsa, president and CEO at Harris Health System. The rise in patients came as the state of Texas is dealing with an acute surge of COVID-19 hospitalizations; on Tuesday, the state reported 7,305 hospitalized patients, an increase of 38 percent over last Tuesday.

The system needs about 250 more nurses to fully staff both LBJ and Ben Taub Hospital, said Porsa.

“It got a point where it was actually unsafe for us to accept more patients because we just did not have enough staff,” he said.

Porsa said the 215-bed hospital is no longer under an internal disaster but remains at capacity. It has since added staff for two ICU beds.

The disaster designation was first brought to light by an emergency room doctor who emailed State Sen. John Whitmire Sunday night about the “untenable” situation there. The email, obtained by the Houston Chronicle, pleaded for more nurses.

Just a reminder, a lot of doctors and nurses are thoroughly burned out from the earlier COVID waves. They had every reason to believe that things were finally better and they could get back to their regular, normal jobs, but that was not to be. And now we’re asking them do it all again, for an even bigger surge with no help at all from state government in sight. It’s just going to get worse from here.

The robot nurse

We are living in the future, for better and for worse.

https://www.instagram.com/p/B01H56Fn8_0/

A friendly one-armed, bright-eyed robot is roving the hallways of Medical City Dallas’ Heart and Spine hospitals, helping nurses with routine tasks that previously took time away from patient care.

Nicknamed Moxi and regarded as one of the staff, the robot is equipped with sensors to help it navigate, and even anticipate people’s movements, as it travels across hospital floors. Medical City Dallas partnered last fall with Austin-based artificial intelligence firm Diligent Robotics Inc. to become the first North Texas hospital to employ a robot full time in a clinical setting.

“When we were opening up the hospital back in October, one of the things we wanted to really focus on was being an innovation center and bringing new technology to the health care setting,” Medical City Chief Operating Officer Josh Kemph told The Dallas Morning News.

When a nurse is interacting with it in a way that would normally trigger an error message, Moxi instead emits pleasant beeps and chirps to notify them. Some patients even have their own names for the assistant, which has its own Instagram account run by Diligent.

But Moxi is so much more than just a pretty face.

Texas will face a shortage of more than 71,000 nurses by 2030, according to the Texas Health and Human Services Commission. And with the demand for nurses expected to only continue increasing, Medical City Dallas director of surgical and procedural services Stefanie Beavers says she hopes it will also make it easier for the hospital’s existing workforce to optimize their day-to-day work.

“This really offers health care facilities an opportunity for the nursing workforce to focus on patient care and be directly at the bedside versus taking them away, and allowing their time to be truly dedicated to patient care tasks,” Beavers said.

It never crosses the threshold into patient care, instead delivering things like blood samples back and forth to a lab and updating patients’ medical records instantaneously for hospital staff.

“She’s really meant to be a team member that’s supporting you in the background,” Beavers said.

For now, at least, Moxie is a modern version of the FBI mail robot, which does simple drudge work like delivering specimens and allowing the human nurses to do more important things. It’s also a lot cheaper to employ than human nurses, or human nurses’ aides, and in the way of driverless cars, it’s just a matter of time before they have the capability to cross that threshold into patient care. That may be 20 or 30 years down the line, but it’s out there somewhere. I just hope we can have a productive conversation about what that will mean for the rest of us before it happens.

We need more doctors and nurses

If the state of Texas ever expands Medicaid, or less likely does something on its own to improve access to health care for its residents, it’s going to have to confront a different problem: A persistent shortage of doctors and nurses.

As of May 2011, the demand for nurses in Texas exceeded the supply by 22,000. Members of the Texas Nursing Workforce Shortage Coalition, which includes about 100 medical centers and hospitals statewide, warned in a letter that “without stable, continued funding for nursing education, this gap will widen to 70,000” by 2020.

Physicians are hardly faring better. The Association of American Medical Colleges estimated that there was already a shortage of 7,400 physicians nationwide in 2008, and fully implemented health care reform would widen that shortage to more than 130,000 physicians by 2025.

Texas has a ratio of 165 doctors for every 100,000 residents. That falls far below the national average of 220 physicians for every 100,000 people, earning Texas the ranking of 42nd in the nation, he said.

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Texas legislators reduced support for nursing education by $17 million, or 36 percent, during in 2011.

Physician students also have fallen victim to a tightening budget.

Never let it be said that there’s a problem our Legislature can’t make worse by cutting funding for it. That letter from the Texas Nursing Workforce Shortage Coalition can be found here. This problem isn’t limited to Texas, either. Part of the problem with doctors is specialization – as the story notes, there’s plenty of plastic surgeons and dermatologists, but far too few general practitioners, who tend to make a lot less money than their peers. It’s a complex problem and it’s going to take some creative thinking to tackle it.