Healthcare professionals are often described as the heroes of the COVID-19 crisis.
For more than a year, they have shown a remarkable resilience. Under extreme duress, they have expanded their skill repertoire and stretched their own physical and emotional limits to provide complex and compassionate care. The article underscores the difficulty of formulating capacity plans to respond quickly and effectively to successive surges in demand while normal revenue streams are constrained.
Video Spotlight: Burnout in the ICU
This post is based on The New York Times article, See How Covid-19 Has Tested the Limits of Hospitals and Staff, by J. Keefe, Y. Parshina-Kottas, & S. Fink, February 23, 2021, and the YouTube video, COVID-19: Doctors and Nurses Talk about Burnout as Another Wave Hits U.S., by TIME, November 23, 2020. Image source: Chaikom/Shutterstock.
1. Describe the capacity plans needed to deal with sudden increases in demand volume and mix?
Guidance: To overcome the increased utilization of ICUs around the country, new areas have been repurposed and can accommodate COVID-19 patients. The staffing of these expanded ICUs has been more challenging. ICU care requires specialized personnel. As a result, pulling staff from other disciplines is not straightforward. Moreover, the care of COVID-19 patients is complex, takes more time, and requires a team approach. To make matters worse, the medical professionals caring for COVID-19 patients also get sick, which further reduces the ICU capacity. In response to these challenges, hospitals have brought in travel nurses (more expensive), trained personnel from other units, decreased the time that each dedicated nurse spends in close contact with a patient, and increased nurse to patient ratios from 1:2 to 1:3.
2. What do you think of altering staffing rules by allowing ICU nurses to care for three patients rather than two?
Guidance: The staffing rule decision is temporary but it still carries risk. Caring for more patients means spending less time with each one. Because caring for a COVD-19 patient is more complex and takes more time, corners may be cut with the new staffing ratios. However, what are the alternatives? Should hospitals provide sub-optimal care or refuse patients and let them die? Obviously, sub-optimal care is better than no care at all in this case. The key is to make the rule on staffing ratios very flexible so that they can be reverted to normal levels as soon as patient volume drops below a certain limit.
3. What are the long-term consequences of running ICU operations at full capacity?
Guidance: This is an issue that has received less attention in the press. Healthcare workers have been working under these conditions for more than a year. Long hours, high risk, and chronic stress lead to burnout. COVID-19 further exacerbated the burnout problem among nurses, leading some to quit. Nurse turnover only intensifies the capacity problem. For the nurses who decide to stay, the pressures increase, and medical errors become more likely.