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Baystate grappling with four crises: COVID, staffing, capacity, behavioral health

  • Workers construct a rapid response triage outside the Emergency Department at Baystate Health in Springfield, Monday, Mar. 16, 2020. GAZETTE FILE PHOTO

Staff Writer
Published: 12/17/2021 5:42:06 PM

SPRINGFIELD — Baystate Health system is facing four crises: COVID-19, staffing shortages, capacity management and behavioral health, the hospital system’s president and CEO said Thursday.

In a press briefing, Mark Keroack said that across its western Massachusetts health care system, Baystate has 1,800 openings for a total workforce of 13,000 — more than three times more than usual. That labor shortage, combined with a huge surge in COVID-19 and behavioral health patients, has led to hospitals operating well above their licensed bed capacity.

“We are still very much in a crisis state,” Keroack said.

COVID-19 case counts are rising across the state. Hampshire County had an average daily incident rate of 53.4 cases per 100,000 residents for the two-week period ending Dec. 11. In Hampden County, that number was 75.4 per 100,000, with a test positivity rate of 8%.

Keroack said that on Wednesday night, Baystate Health had 1,095 inpatients despite being licensed for only 988 beds. He said Baystate has been averaging 10% over its licensed bed capacity.

The problem, Keroack said, is less an issue with increased volume and more related to reduced flow. Patients with complex issues, like COVID-19, are staying in their beds longer, treatment times have stretched to accommodate testing and the donning of protective equipment, and staffing shortages at other facilities such as nursing homes are making it more difficult to discharge patients to those places.

“It’s very much like putting cones up on the highway and having the traffic jam behind the reduced capacity,” Keroack said. “The current state leads to a lot of crowding in our emergency department.”

The past two years have put tremendous strain on the hospital system’s employees, Keroack said, leading many to leave health care professions altogether.

Keroack said a large number of senior nurses have retired recently, and the pipeline of replacements hasn’t been sufficient to completely replenish the pool of nursing faculty members in the region. That means that despite waiting lists at nursing schools, limited faculty — and by extension limited clinical placements — has meant that not all aspiring nursing students are able to quickly jump into the field.

For other direct-care employees, Keroack acknowledged that the staffing shortage is “a salary and wage thing.” He said the hospital will have to continue to boost its pay until “the free market decides to recalibrate this.”

As for COVID-19 patients, Keroack said there were around 130 of them within the system at last count. He said that about a third of those patients are vaccinated and have caught breakthrough infections.

“These folks tend to have been older individuals, often they may have co-morbid conditions,” he said. “They tend to have milder disease.”

The other two-thirds of patients are unvaccinated, and tend to skew younger, according to Keroack. He said they have more serious disease, and in some cases the hospital has had to “pull out all the stops” to try to save their lives. That includes some who have been hooked up to an extracorporeal membrane oxygenation, or ECMO, machine, which pumps and oxygenates a person’s blood outside their body.

“It’s kind of frightening to see in an individual only in their 30s have their lungs stop working,” Keroack said.

In western Massachusetts, vaccination rates are lower than statewide — particularly in Hampden County. Keroack said the county has around a 59% vaccination rate, though some areas of metro Springfield have vaccination rates in the 40% range.

“That does mean that more young individuals are getting sick, and some of them seriously ill,” Keroack said.

Another problem the hospital system has faced is a surge in behavioral health patients, particularly children. Keroack noted that Baystate is in the process of closing three community hospital behavioral health units as it builds a new behavioral health hospital in Holyoke that will ultimately increase bed capacity by 50 for those patients. That new facility is more than a year from completion, however.

So far, Baystate has not begun rationing care, though Keroack said those conversations have begun.

“I want people to be ready because we’re not far from it,” he said.

Keroack encouraged people to get vaccinated against COVID-19. If it has been six months since a person’s last vaccine, he urged them to get a booster, noting that emerging studies suggest that a booster dose provides much stronger protection against the new omicron variant, which has been shown to be more infectious than the delta variant, which is the variant currently circulating in the region.

When asked about mask mandates, Keroack said that by his count there are 17 municipalities in western Massachusetts that have implemented one and another 10 that have done so for municipal buildings only. He said that such mandates are a good idea, even if they only boost mask wearing by a little bit.

“I would love to see the governor change his mind and do a mask mandate,” he said, referring to Gov. Charlie Baker’s refusal to implement a statewide mandate.

Keroack, himself an infectious disease specialist, said he does see the COVID-19 pandemic ultimately ending, with the virus eventually becoming one of the regular winter viruses humans live with every year.

But as climate change and human actions lead to diminishing biodiversity across the globe, scientists have warned that the likelihood of pandemics is rising.

Keroack noted that Baystate treated its first COVID-19 patients in a special unit created in 2014 during the Ebola epidemic — one of 10 such units nationwide, which was built with federal funding. He said Baystate has experts who look at emerging pathogens worldwide and are on the lookout for the next pandemic. That’s why the hospital system was on top of COVID-19 early in the pandemic, he said.

“They’re constantly on alert,” he said of Baystate’s infectious disease experts. “I don’t think COVID will be the last one.”


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