As hospitals across North Carolina prepare for a possible surge of patients infected with the coronavirus, it is not clear whether enough medical staff are available to provide adequate care or whether the state has enough equipment, including hospital beds and ventilators.
Hospitals are tracking and publicly reporting some statistics related to their capacity to treat patients, including the number of available beds and ventilators at their facilities.
The most recent state data on the number of hospital beds is from September 2018. That total – 21,222 beds – is the number licensed by the North Carolina health regulators.
“A lot of times, hospitals don’t have all their licensed beds staffed,” said Cody Hand, senior vice president of N.C. Healthcare Association. “That’s taken us a few weeks to tease out how to get the right data and the most useful data.”
State health officials are now surveying hospitals across the state to get figures on beds and ventilator capacity. But that process is voluntary, and not every hospital responds consistently.
In the last week since the state began reporting hospital data, the response rate has averaged about 80 percent.
That should account for the majority of beds in North Carolina since the larger hospital systems are responding consistently, Hand said.
But there's no information on staffing levels, a crucial factor – along with physical space and protective gear – that can limit the number of patient beds available.
Individual hospitals, rather than the state or his association, are tracking staffing on their own, Hand said.
"We don't do it consistently at NCHA for a reason, and that's because our hospitals are already answering a lot of federal and state surveys," he said. "Adding another question is really, at this point, not beneficial."
For now, the NCHA does work with staffing agencies and hospitals to relocate healthcare personnel where surge capacity is needed.
“The biggest thing I worry about is staff,” Hand said. “Our doctors and nurses are working as hard as they can ... My concern is that those putting their lives at risk aren’t going to get needed help or relief.”
State doesn’t track staffing data
An effort this week to find a dataset to track staffing levels at hospitals across the state was unsuccessful.
The North Carolina Department of Health and Human Services has not released any data on staffing levels, and a spokeswoman confirmed late Thursday afternoon the agency is not tracking the data.
Reporters from six newsrooms across the state sent questions to every hospital system in North Carolina. Most didn’t respond at all. With the exception of one hospital system, the answers hospitals did provide did not include specific staffing numbers.
The goal was to find data to gauge whether hospitals will be able to adequately care for coronavirus-infected patients, even if they have enough beds and ventilators.
The size of that workforce can make a big difference in a hospital’s capacity.
At Cone Health, for example, the network’s four Triad-area hospitals can currently staff about 600 beds between them. At “flex capacity,” according to a spokesperson, that number can increase to nearly 900 beds -- if the hospitals can find the personnel to staff them.
Each COVID-19 patient admitted to the hospital to treat the virus needs a squad of health care workers—not just doctors and nurses—to care for them, whether in the ICU or a less-severe acute care unit.
“Staffing is determined by the condition and diagnosis of the patient,” explained Meghan Berney, a spokeswoman for CaroMont Regional Medical Center in Gaston County.
Berney explained that a COVID-19 patient on supportive oxygen therapy — which could range from simple supplemental oxygen to sedated intubation — would need a care team including the following:
- Registered Nurse – from a 1-to-1 or 3-to-1 ratio, depending on patient condition
- Certified Nursing Assistant – depending on patient condition and nurse ratio from above
- Hospitalist – inpatient physician
- Intensivist – critical care physician
- Respiratory Therapist – depending on patient condition
- Specialist(s) – should a specialty physician consult be needed (cardiac, neuro, pulmonary, etc.)
- Ancillary staff – phlebotomists, environmental services, food services, facility services (these staff would be limited depending on patient diagnosis)
Hospital administrators say the defining factor in their ability to care for sick patients may be whether they have enough qualified and healthy staff to tend to them.
“There’s a facility footprint and then there’s a human resource footprint, and trying to align those is tricky,” said Dr. Joseph Rogers, the chief medical officer for the Duke University Health System. “We can repurpose a lot of space. We can’t go out and hire 1,000 new nurses or respiratory therapists or physicians.”
Linda Butler, the chief medical officer at UNC Rex Hospital in Raleigh, said she feels good about the hospital’s supply of ventilators, but worries more about having enough qualified nurses and therapists to run them.
“You need nurses who can take care of that level of patient,” Butler said. “And if nurses are getting sick or there’s a nursing shortage anyway, because this is a high-growth area, we are being creative with staffing plans.”
That includes recruiting administrative employees who still have their medical licenses or calling on people who have recently retired.
‘It’s not a flip of a switch’
Dr. West Paul, chief clinical officer at New Hanover Regional Medical Center, said his hospital is working to find ways to add staffing capacity to treat a potential influx of COVID-19 patients.
“We can repurpose a lot of other machinery, including anesthesia machines, to be ventilators, but usually the critical limitation is the actual people, the technical capabilities to run them on a day-to-day basis,” Paul said. “It’s not just running the machines, it’s taking care of the patient and knowing what the patient needs to adjust the machines.”
Paul said their facility has the equipment to intubate, the process of putting a patient on a ventilator, more than 100 patients at a time, but that doing so would be incredibly difficult from a staffing perspective.
“It’s not a flip of a switch; each ventilator is individually tuned to the patient and his disease or her disease process. So it is a constant in and out adjustment of what we are doing,” he said.
Paul said NHRMC system hospitals are working to train physicians and staff who might not usually work with ventilators to be able to care for COVID-19 patients. He added that training is being assisted by medical facilities and experts largely on the West Coast.
As of Wednesday, more than 1,900 people with medical credentials have volunteered to serve in North Carolina if the need arises, according to North Carolina Emergency Management officials.
Of those, “700 are vetted and ready to work,” North Carolina Director of Emergency Management Mike Sprayberry said at a news media briefing Wednesday. “These are medical professionals who can be assigned to hospitals.”
No hospitals have yet requested help. But once they do, volunteers near a medical facility can go to work to fill in for sick workers and otherwise support the medical surge, Sprayberry said.
The Department of Emergency Management vets volunteers by checking with licensing boards. Background checks are performed by the State Bureau of Investigation and the state fusion center, NCEM spokesman Keith Acree said.
“Hospitals and medical facilities can request staffing by type from the state Emergency Operations Center in order to help with the medical surge,” Acree wrote in an email.
Those requests can seek doctors, nurses, pharmacists and others. The volunteer pool also includes janitors and those with experience in medical records. People interested in volunteering can register at terms.ncem.org.
N.C. Medical Board spokesperson Jean Brinkley said the licensing body has taken several emergency measures to expand the healthcare workforce, cutting down on licensing hurdles for doctors and physician assistants. That includes granting emergency licenses to healthcare workers licensed in other states and those who have retired in the last two years.
Through the end of March, Brinkley said, the board issued 180 out-of-state doctors and PAs emergency licenses, and a handful of retired doctors have reactivated their licenses through the process as well.
All those steps, Brinkley said, are an attempt to "clear the runway" and expand treatment for patients.
This story was jointly reported and edited by Kate Martin, of Carolina Public Press; Gavin Off, Ames Alexander and Doug Miller, of The Charlotte Observer; Richard Stradling, of the Raleigh News & Observer; Nick Ochsner, of WBTV; Emily Featherston, of WECT; and Tyler Dukes and Ashley Talley, of WRAL.