Rural Hospitals Facing Unique Challenges as COVID-19 Surges

Like all hospitals in Illinois, Katherine Shaw Bethea Hospital in Dixon followed Gov. J.B. Pritzker’s executive order and for a period from March through April ceased all elective surgeries.

The hospital spent millions to prepare for a surge of coronavirus cases that didn’t come.

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But while the first, spring COVID-19 surge didn’t hit Dixon, KSB President David Schreiner said in recent weeks there has been an explosion of cases, and that earlier planning is coming into play.

“Our in-patient census has been high, so there have been times when we’re at over 100% occupancy. You think: How can that happen? But it means that we created two patients in one room … we haven’t done that as KSB since the 1980s,” he said. “We had full intensive care unit beds with multiple ventilators. We continue to see high-volume in our drive-thru COVID clinics.”

Southern Illinois Healthcare has devoted two of its three downstate facilities, including its Carbondale hospital, to coronavirus patients.

Chief Medical Officer Dr. Marci Moore-Connelly said SIH saw a blip of a COVID-19 spike in the spring, but nothing like what the system has experienced in recent weeks.

“We averaged over the summer probably about 10 COVID patients a week that were getting admitted. The last four weeks we currently are right around a census of 50 and 60 COVID in-patients daily,” she said. “As we see more in the community, we obviously see more with our employee population too.”

Moore-Connelly said on Tuesday, 180 SIU employees were out for coronavirus-related symptoms; 100 of them have tested positive for the virus. Others may be in quarantine because a relative has COVID-19.

For both hospitals, the major issue isn’t room for more hospital beds should patients need them; it’s the worry over whether there will be enough medical personnel to staff the beds.

“Our staff are tired. They’re working extra hours. They’re being called on days off and asking if they can come into work, they’re picking up extra shifts,” KSB’s Schreiner said.

Take nursing as an example: SIH’s chief nursing officer says health care facilities always have nursing shortages, even before the pandemic.

But the shortage is amplified when staff nurses can’t work because they either have COVID-19 or are in quarantine, at a time when there are more patients than ever.

“It requires your coworkers to pick up additional shifts. It also requires for us to not be able to potentially take some patients into beds that we typically would be able to,” said SIH Chief Nursing Officer Jennifer Harre.

Contracting with private agency nurses also isn’t viable like it once was, given high demand nationally.

Harre said it’s a perfect storm.

“To care for a COVID patient just takes more resources,” Harre said. “So if a typical nurse ration on a medial floor may be five to one — five patients to one nurse — on a COVID floor, it may be more like three patients to one nurse just because of the time that it takes to put on the right PPE, take off the right PPE.”

Hospital administrators said managing the staff situation is a constant puzzle.

Morris Hospital in Grundy County last week saw an all-time high of 41 patients – more than half the patients in the entire hospital. 

It’s down to around 30 patients as of Tuesday, but CEO Mark Steadham said that can change rapidly.

Morris has 89 hospital beds total, though some are dedicated for special purposes, like maternity.

“So when it comes to medical and surgical patients, it’s really about 60 patients we can have. So when you think about it, 40-plus patients out of 60 beds were COVID-positive patients. That’s a significant impact on us. Last week we had to postpone three elective surgeries simply because we didn’t have beds to put those patients in after surgery,” Steadham said.

Many of Illinois’ 51 critical access hospitals, which are classified by the government as having 25 beds or fewer, are also facing these pressures for the first time, given that the first COVID-19 surge was primarily concentrated in urban areas.

“We have patients that are sick coming in our doors no different than in a larger facility, but the challenges are a little bit more unique,” said Pat Schou, director of the Illinois Critical Access Hospital Network.

It comes as financial pressures have in recent years forced small, rural hospitals to close.

Schou said it’s important – particularly given Illinois’ large agriculture-centered economy – that rural areas have quality health care access.

“We’re here to serve you. When you’re driving up and down those highways and you have to come in to a rural hospital, you want to make sure that it’s an excellent hospital,” she said

Among the issues are limited resources — staff, financial and equipment.

“Sometimes we’re the last person on the list to get testing equipment, or PPE, things like that. Just because we’re smaller,” she said. “We’ve had difficulty getting surgical gowns … we’ve had to buy — many of our hospitals have bought material and made their own.”

KSB in Dixon is what’s known in the industry as a “tweener” — it’s a general and acute-care hospital, and in between a critical access hospital and a larger one that’s part of a broader network or affiliated with a university.

Schreiner said that can have advantages, but it can also mean that the hospital has to compete with larger systems for PPE.

“We have to go out there and find that. In the spring it got really tight, and then like everyplace else we built up our levels, and now we’re going though that in a very quick way. So we worry about supplies and having the necessary safety equipment for our employees,” he said.

Follow Amanda Vinicky on Twitter: @AmandaVinicky

Note: An earlier version of this story incorrectly identified the name of Dr. Marci Moore-Connelly. The story has been updated to correct the error.

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