Crush of COVID-19 hospitalizations affecting all aspects of patient care at Lewiston hospitals

A steady stream of people enter a crowded entrance to St. Mary’s Regional Medical Center emergency department Friday afternoon, where the Lewiston hospital is experiencing a “bottleneck” in patient services. Russ Dillingham/Sun Journal

LEWISTON — With state health officials reporting more COVID-19 cases in Maine than ever before, leadership from local hospitals say it’s more than just the surge in hospitalizations that concern them, but also the strain it has had on operations from admission to discharge.

“I would say that we’ve become very accustomed now, to how to live within a pandemic and also how to live with limited resources,” Central Maine Healthcare chief medical officer Dr. John Alexander said Thursday. “And, you know, that’s an unfortunate statement of reality, but that’s really just the way that is.”

CMH is the parent company to Central Maine Medical Center in Lewiston.

Alexander said that on a daily basis, leadership at CMMC evaluate how to allocate staff, equipment and other resources to “meet the greatest need.” He said the hospital is “managing” the situation, but that he wouldn’t characterize it as “dire.”

“That’s how we’ve been functioning now, it feels like, for a long time. I think realistically, we’ve been at this capacity for the last several weeks or so,” Alexander said.

On Wednesday, Gov. Janet Mills announced that she had authorized the deployment of an additional 75 members of the Maine National Guard to health care facilities across the state to help in nonclinical roles.

Alexander said that he is expecting at least 12 members of the National Guard to arrive as early as next week to assist at CMMC and CMH’s two critical access hospitals, Bridgton Hospital and Rumford Hospital.

Some members will help CMMC open an on-site skilled nursing facility unit for what are known as “swing beds” for post-inpatient care. “Swing beds” are typically used on an as-needed basis by small, rural hospitals to provide acute or skilled nursing care, according the U.S. Centers for Medicare and Medicaid.

The unit will be located in a currently empty wing of the hospital, which Alexander said remains open, “primarily due to all the staffing shortages that we’ve seen really over the last year or two.”

This will help alleviate some of the “backlog” affecting hospitals across the state. With few to no beds available at long-term care or rehabilitation facilities, those patients are sometimes waiting weeks for a spot to open up so they can be discharged from the hospital.

“There just isn’t the capacity out in our communities to be able to take care of those patients,” Alexander said. “So that’ll be a huge help for us because that means that we can open up beds for patients within our community and specifically for those patients who unfortunately have spent a fair amount of time in our emergency department during their admission.”

Also on Wednesday, the governor said she had requested rapid response medical teams under a federal program on behalf of CMMC and Maine Medical Center in Portland. Maine Med’s request was approved late Thursday, while CMMC’s request was still pending, as of Friday evening.

Alexander said on Thursday that if approved, the federal team would primarily assist in the emergency department, intensive care unit and inpatient COVID units.

“They’ll be providing us with support personnel, both clinical and nonclinical support personnel, so that our team members can get some well-needed rest. Which is to say so that they aren’t working, you know, extra shifts in order to provide the care that we need to for our community,” he said.

FEELING THE PRESSURE

St. Mary’s Regional Medical Center spokesperson Steve Costello said the hospital is not yet at the point where they would need to open another unit like at CMMC.

“We have been in communications with (Maine Department of Health and Human Services Commissioner Jeanne Lambrew) and stand by to open additional space, if necessary,” Costello said. “If that were needed, we would ask for the assistance of the National Guard at that point.”

At the same time, though, emergency department providers at the Lewiston hospital are feeling the same pressure from this backlog and other complications brought on by COVID-19.

Staffing levels in the emergency department at St. Mary’s are appropriate for the volume of patients they’re seeing, said department nursing director Heather Nadeau. But sometimes, there just aren’t enough beds available.

“One of our biggest challenges is the limitations of beds in the inpatient units and patients that are being boarded in the Emergency Department,” Nadeau said Friday.

That means if a patient needs to be admitted to the hospital, they’re waiting longer in an emergency bed waiting for an inpatient bed to open. That means that there is one less bed available in emergency.

“The difficulties with COVID are so layered,” said Dr. Carl Ramsay, the emergency department medical director.

“There’s this taking care of all these people,” who are COVID positive, he said.

“And then there’s the impact on each other, the other patients who are COVID or not COVID (positive), because of subtle things like, when you put a patient who has COVID in a room, you can’t put another patient in that room for 45 (minutes) to an hour and five minutes.”

The time it takes to get a new patient in to a patient room, an X-ray suite or a CAT scan room is slowed down due for the requisite dwell time and cleaning to occur.

“So, you can see how these very subtle ways of having more people sick, or just positive with their test, you can see how that impacts everything else you do operationally to try and be efficient,” Ramsay said.

There’s also a number of people who show up at the emergency department looking to get tested for COVID-19. Many of them are asymptomatic, but perhaps a family member tested positive and they couldn’t find a testing appointment at a pharmacy.

Ramsay said providers try to impress upon patients that if one person in their family has tested positive, everyone else does not need to get tested because they should already be quarantining at home.

“And then if they get sick, of course, they should come back,” he said.

But in the meantime, asymptomatic patients are likely to wait hours before a provider can see them because the emergency department will prioritize the most urgent cases first, Nadeau said, crowding the waiting room and the hallways with potentially COVID-19 positive individuals.

Add on top of that, some patients and their family members are becoming increasingly irritable and aggressive toward staff, Ramsay said.

“As you can imagine, all health care folks dealing with this are fatigued enough,” to then have someone “screaming” at staff, Ramsay said. “We’re just dealing with some people who are very obstinate and it’s uncalled for, quite frankly.”