High Demand For ICU Capacity, Staff Makes Transferring Patients Difficult

Speaker 1: 00:00 COVID-19 cases are continuing to climb in San Diego County. And with that comes an increase in hospitalizations for the disease, but state metrics show, I see you availability is shrinking KPBS, health reporter Taryn mento ask the leader of sharp healthcare, how they're balancing resources and mid demand. She spoke with Sharp's chief operating officer, Brett McLean. There's a lot of concern if there will be enough resources to go around. So just tell me what it's like managing resources in your facility Speaker 2: 00:30 Without the incredible analytic support that we have in PR in particular at sharp. Uh, we would not have been able to, uh, weather this, uh, as good as we have. We manage on literally sometimes an hourly basis. The human resource needs that we have, which are really the most stretched of all. Uh, we manage the bed capacity and the type of beds, uh, whether those are typical med surge, uh, hospital beds or ICU, et cetera, we manage the incoming volume that will normally come through our emergency rooms and our trauma rooms every single day. And we manage the supplies. Uh, so it is, uh, uh, really a throughput work, really, uh, engineering feat, uh, and we just have a super talented folks, uh, managing this on a daily basis. Speaker 1: 01:22 Uh, several reporters were asking the County, um, during their news briefing, you know, how will decisions be made when we have more need than we have staff space equipment. So who is the authority on making those decisions? Is it you, does it come down to you Speaker 2: 01:38 Right now? Uh, the direction that's coming down from this state is that we're not under that order to stop all, uh, non COVID cases, right? So every health system comes together on their own and makes decisions on the specifics. Uh, we at sharp are lucky enough to have, you know, multiple sites and multiple different places that we can provide different low levels of care. So we're making decisions on a daily basis to move patients from one hospital to another, if there's room in space in order to manage our COVID population, uh, as well as our non COVID population. So that is something that we, uh, that we do on a daily basis. And I'm absolutely involved in that. We, we actually have a small team that meets twice a day, clinical leadership at each of our facilities, uh, every morning at seven 30 and every afternoon at five to talk about what's going on right now, what can we do within the system? What do we need to do to find more resources, uh, that one place might have versus another? Uh, and then we make decisions moving forward for the next day or the next week, Speaker 1: 02:43 Just, uh, many facilities, but just one healthcare system in San Diego. Um, and so responding to the need does go beyond sharp. How are decisions on resource allocation at other facilities, their system, just like you described effecting, Speaker 2: 03:01 Uh, while sharp is the lady and, uh, provider, uh, in San Diego, there are other, uh, very substantial, uh, systems as well. We actually communicate every single day, seven days a week together on what our, uh, volumes are, what our, uh, what we've found in terms of testing, what those rates are. We take a look at boys or something happening with both us since scripts, maybe in the South Bay at Chula Vista. We look at that, we communicate that back and forth. That partnership has really helped us, uh, to identify where some peaks and valleys may be coming, but it also allows us where, where possible to move patients within facilities as well. It's a, uh, not a common every single day thing, but it does happen. Uh, and we work together based on, you know, what those, uh, what those volumes are telling us that we need to do. So that process has been fantastic. Speaker 1: 03:55 Have you had any trouble with other facilities taking patients when requested for a transplant? Speaker 2: 04:01 Well, I, I would say, uh, to date, uh, the issues around any type of difficulty in transferring has really not been a space issue to the significant issue is staffing. Uh, and we're all dealing with the same issues of, uh, the same, uh, pools of staff, uh, that are exhausted, that, uh, are working, uh, like I have just never seen anybody work before. It's just amazing to spend time, uh, at the front lines and just watch and observe what's happening. Uh, we've got, you know, dwindling pools of traveler nurses because the whole country's going through the same issue, right? So there's certainly a lot of, uh, competitiveness if you will, and at different rates and all of that. So, uh, that is, uh, pulling, uh, some staff, uh, into other areas, but it really is around, uh, staffing that's, that's the issue. So if we have the difficulty maybe accepting a patient that needs a transfer, it's not, uh, to date, it's not because of space, it's because of not having the appropriate right. Kind of staffing. And maybe we need another five, six hours to fix that, to be able to move on. And I would say that's the case for everybody. Speaker 1: 05:12 Is there risk to the patient? Would that delay, Speaker 2: 05:17 You know, the patient is still typically in a, another care facility. Uh, and we have, you know, let's say, uh, you know, uh, in our emergency room, we may have an ICU patient that's in there. Uh, that's been deemed to be when we find a bed will be an ICU patient, but we still have, you know, significant resources in the, in the emergency room from staffing and the doctors, uh, and, uh, all of that to care for that patient. And, uh, in a very similar way that they would be cared for on the, on the ICU, but it's gonna delay things. It's gonna delay, you know, other patients that are coming in they'll have to wait longer. It will, you know, the system will just get slower and, you know, because of that, but it is the thing that keeps me up right now is, uh, capacity and, uh, the ability to have enough staff to care for these patients, which is why, uh, we're just in this window right now of the ability to bend this curve down. Uh, again, I, I really feel that we have, uh, you know, at least probably three tough months ahead of us, but we can make those three months better by right now, today, changing our behaviors, changing the way in which we, uh, spend time with each other. And, uh, you know, uh, where are our masks, Speaker 1: 06:36 But we have heard, um, from projections presented at a County board meeting that by Christmas, we will be full. Is that the impression you're operating under as well? Speaker 2: 06:46 Yeah, I am, uh, upper in under both, uh, that as a major fear, uh, that it's going to get worse and I'm also operating under, uh, the hope that, uh, we bend that curve together and do the things that we need to do to, uh, make these next couple of months, uh, as good as they can be. So I'm hopeful, uh, but we have to prepare for the worst. And so that's, uh, that's the work that we do every day. What is the worst? I think the worst is that, you know, hospitals are full. Uh, and when you say that again, I mean that from both a space, as well as a resource or a staffing perspective, that we are, uh, having to enact some of our, uh, federal, uh, help, if you will, for some of the, you know, uh, other sites, uh, the mobile sites, tents, uh, things like that, uh, that we will have more and more delayed care, meaning people won't go to the hospital when they have that first a twinge of chest pain, right. Uh, that's super dangerous. That is not a, that is not what we need to be doing, but that's on my list of things, uh, of the worst is that those, you know, that stuff still happens. People still have heart attacks, they still get in car accidents, they still have strokes. Uh, and we need to care for those patients as we do now. So that, that's the picture I hope we don't see Speaker 1: 08:06 Was KPBS health reporter, Taryn, Mentos speaking with sharp COO Brett McLean. [inaudible].