When COVID-19 hospitalizations hit 433 in January, hospitals were so desperate for space they treated some patients in hallways and sent others to neighboring states. But even as the number of COVID-19 patients has plummeted, hospital beds remain in high demand.
On Sunday, the most recent data available, just 10 percent of regular beds and 20 percent of ICU beds were available in the state, according to the Department of Health and Human Services’ data tracker (covid19.nh.gov/dashboard/hospitals) In certain parts of the state, those numbers were even lower.
The reasons are many, and the impact varies hospital to hospital.
Asked what’s driving high occupancy rates, health care officials across the state cited various factors, from workforce challenges to more local options for specialty care that once required a trip to Boston. One hospital spokesperson cited an increase in behavioral health patients. Notably, the issue that gets the most attention and blame, delayed care, wasn’t on their lists.
While they are seeing patients who are sicker because they put off care during the pandemic, they said there is no reliable data to quantify how often that’s happening.
“Things that someone would have put off that could lead to hospitalization, like heart failure, fluid management, management of diabetes, or vascular problems, are really difficult to timestamp because they kind of happen at one point or another,” said Dr. Kevin Desrosiers, chief medical officer at Elliot Hospital in Manchester. “And it’s hard to know if this is the result of a chronic lack of management or just an acute event.”
The state Department of Health and Human Services reports daily occupancy rates at 26 hospitals and four specialty hospitals on its COVID-19 dashboard. When coronavirus patients were filling hospital beds, the data helped illustrate the intense demand on hospitals.
It’s harder to interpret the rate now that COVID-19 hospitalizations have fallen below 100 most days, a number that includes active infections and patients recovering from the disease. That’s due to a few reasons. There is no universal ideal hospital occupancy rate to use as a comparison. And the same occupancy rate means different things at different hospitals, depending on their size, staffing, and acuity of their patients’ health problems.
Parkland Medical Center in Derry was at 95 percent capacity recently, with an average daily census of 47, said spokesman Ryan Lawrence. Unlike some hospitals, it can look to two other hospitals in its HCA Healthcare network when it’s tight on beds: Portsmouth Regional Hospital and Frisbie Memorial Hospital in Rochester. But like other hospitals, staffing beds has been a challenge as increasing numbers of health care workers have left their jobs.
Lawrence said HCA Healthcare is trying to recruit and retain staff by increasing wages for nursing and support staff. It has also expanded its staffing pipeline, he said, by offering tuition reimbursement, nurse residency programs, and $800,000 in scholarships for people pursuing careers as a nurse or licensed nursing assistant.
Desrosiers said admissions at Elliot Hospital, which has 296 beds, were increasing before the pandemic. Prior to 2019, the hospital typically had 180 patients a day during the summer, a slower season. That jumped to more than 300 at the peak of the pandemic. But even when the hospital had eight to 10 COVID-19 patients in the summer of 2020 and the following spring, admissions rarely dropped below 220, Desrosiers said.
He pointed to new health care options available to patients.
The hospital opened its new cancer center before the pandemic, making it easier for people to get medical and radiation oncology in one place. It has renovated its emergency room, and is offering more outpatient medical care.
It has a 30-bed neonatal intensive care unit, giving families who would have traveled to Boston a local option. Similarly, it has stepped up its care for adults by having intensive care physicians on site seven days a week, 24 hours a day, Desrosiers said. And the hospital now offers high end neurosurgery and is expanding its vascular surgical care.
“So as we’ve been able to increase our complexity and build the infrastructure to support it, we certainly have seen an increase in demand,” he said.
Like Lawrence, Desrosiers said health care is available only if there are health care workers to provide it.
“The key for us is really working hard to make sure we’re staying ahead of (workforce challenges),” he said. “So, really understanding what’s happening in the market, what people are looking to do, and how we can retain some of our own staff. I think for us, it’s been about really trying to create a great place to work and make sure that we’re competitive with wages.”
Managing occupancy has hospital leadership also thinking about improving efficiency.
“It’s really just about making sure that we’re constantly focusing on our processes to make sure that patients are getting all the care they need at the right time, minimize any sort of waiting, and then making sure patients can kind of flow through the system,” Desrosiers said. “We’re constantly looking hourly, you know, what the beds, what the census looks like, and how many patients we expect to have a discharge. And working hard with our discharge partners, whether the patients are going home with services or going to a skilled nursing facility, that all of those pieces need to line up correctly.”
That includes lining up transportation, sorting out insurance coverage, and keeping other administrative tasks on track to ensure patients aren’t occupying a bed longer than they need to.
“The resource is certainly going to be there,” Desrosiers said. “The question is, ‘When will it be? Now or an hour from now?’ We want to prevent long waits for people, so we’re doing everything we can to make sure we are as efficient as we can be and serve those patients right when they need care. That’s definitely a challenge.”