DHMC runs at 10% over capacity amid staffing shortage and high rates of respiratory viruses


Valley News Staff Writer

Published: 01-16-2023 7:44 PM

LEBANON — Dartmouth Hitchcock Medical Center has been operating at 110% of its capacity for several weeks amid a surge of respiratory viruses and short staffing, and as it continues to be difficult to discharge patients to lower levels of care, such as nursing homes.

As a result, DHMC has been boarding patients in its emergency department and perioperative areas, typically used to prepare patients for surgery, Dr. Colin Stack, medical director of the capacity coordination center at DHMC, said in an emailed statement last week.

“As we continue to help more patients with fewer available spaces, some patients are experiencing longer wait times and delays in scheduling appointments and procedures,” Stack said.

The bed shortage is not new, but at least at DHMC, which has 396 licensed beds, it is worse than usual. Nearly 20% of all patients admitted to DHMC have been there for more than 20 days, which Stack said is “a substantive increase from prior baselines, although the (COVID-19) pandemic impacted trends in many ways such that year-to-year comparisons can be complicated.”

“Many of them are ready for discharge and simply lack a safe or appropriate place to go for the next phase of their care,” Stack said. “These backups and delays in discharges consume bed spaces the system otherwise needs to accommodate new and arriving patients.”

Smaller hospitals in the Upper Valley also are busy, in part because when beds aren’t available at DHMC, small hospitals in the area must find other beds for patients who need the higher level of care available at an academic medical center. Altogether, the result is that it can be difficult for patients to get the care they need in a timely fashion. It also can have a negative effect on health care systems’ bottom lines, as DH reported in November.

“It really is that trickle down effect,” Christina Harlow, who holds a doctor of nursing practice degree and works in Gifford Medical Center’s emergency department in Randolph, said.

Gifford, which has just 25 beds, also is about 20% full with patients who are awaiting discharge elsewhere, primarily to long-term care facilities.

Article continues after...

Yesterday's Most Read Articles

“The beds are there, but there’s nobody to take care of the patients,” Harlow said of nursing homes.

Brendan Williams, president of the New Hampshire Health Care Association, said that the Hillsborough County Nursing Home, for example, has a waiting list of 138 prospective residents, not because it’s full, but because it cannot find the workers to serve more residents.

“Across the state, beds, units and wings are offline because of the workforce crisis,” he said. “The situation is tantamount to the closure of several facilities, if not headline-grabbing as outright closures would be.”

Williams said he’s proud of facilities for not accepting residents they don’t have the resources to care for, but he noted that there are ripple effects throughout the health care system, including “hospitals that effectively must ‘board’ discharge-ready patients.”

Meanwhile, hospitals are trying to encourage patients who don’t need the level of care that they provide to find it through their primary care provider, telehealth or urgent care.

About one-third of the patients arriving in Gifford’s emergency department have some form of viral upper respiratory illness, said Harlow.

“We always have the viruses and colds (but) it does seem like there’s more of it,” Harlow said.

Many patients have come in with high fevers, a common flu symptom, which marks a change from the recent past, she said. Lately the flu and respiratory syncytial virus, or RSV, seem to be declining, while COVID-19 is on the rise again, she said.

Harlow wrote a recent post on Gifford’s website urging people to save trips to the emergency department for true emergencies. She urged healthy people with fevers, body aches, dry coughs and mild sore throats to stay home, rest and take over-the-counter medications or home remedies such as tea or honey.

But if people are really short of breath, getting worse each day, or have vision changes or chest pain, they should seek treatment, she wrote. In addition, people who are experiencing mental health crises, such as feeling suicidal, or who have been sexually assaulted should go to the emergency department.

The New Hampshire Hospital Association also sent out a news release earlier this month saying that because wait times, patient volumes and emergency department capacity were high, patients ought to be sure they are seeking the right level of care for their condition. For example, the association suggested that people go to urgent care for stitches; back pain; colds or flu; mild allergic reactions, cuts or sprains. Meanwhile, people with strokes, extreme burns, difficulty breathing, heart attacks, uncontrolled bleeding or trauma ought to go to the emergency department.

“Our capacity to provide emergency care must be protected for those who need us most,” Steve Ahnen, president of the New Hampshire Hospital Association, said in the association’s release.

Harlow said she understood that people may have difficulty accessing the level of care they need due to staffing shortages across the health care system, including in primary care offices.

“We’re sort of that last stop,” she said of the emergency department. “I don’t blame people for seeking out care.”

She hoped that with her web post she might help educate patients as to when they might not need to come in.

“There’s many situations where they just need reassurance,” she said.

Meanwhile, on the inpatient side, when beds are unavailable for critically ill patients at DHMC or the University of Vermont Medical Center in Burlington, Gifford providers look outside the Twin States to Albany or Massachusetts, Harlow said.

“It’s the whole region,” she said. They are “still having to often send people out of state when there’s no capacity here.”

Valley Regional Hospital in Claremont, which has 21 staffed beds, hired more workers in preparation for this winter, after the spike in demand for care it saw last year, said Tim McNulty, Valley Regional’s senior director of human resources.

Still, the hospital has often been at capacity in recent weeks, McNulty said. Valley Regional still has to send some patients in need of critical care to Connecticut or Massachusetts, and sometimes it can be difficult to find an ambulance to make the trip.

In addition, hospital workers contract respiratory viruses and have to stay home. That can mean the hospital isn’t able to admit as many patients as it otherwise would.

“This winter’s been historically busy for (the emergency department and) urgent care,” McNulty said. “It’s taxing on the staff.”

Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.