Sicker patients now packing University of Iowa hospitals

IOWA CITY - Despite a massive drop in patients, surgeries and visits around last spring's arrival of COVID-19 to Iowa, numbers have rebounded at Iowa's only academic medical center, putting the University of Iowa Hospitals and Clinics to some degree back in pre-pandemic shape - but with key differences.

For starters, while average daily patient count numbers have almost returned the hospital to the nearly-full status that began its 2020, the patients packing the hospital today are sicker, UIHC Chief Executive Officer Officer Suresh Gunasekaran on Wednesday told Iowa's Board of Regents.

While inpatient transfers from other health care facilities across the state have returned to pre-COVID-19 levels, those seeking care at UIHC are battling more complex conditions.

'Unfortunately, those patients are a lot sicker now than the transfers that we were having before,” Gunasekaran said. 'Our emergency department transfer rate is also higher, as well as our direct admissions. … What this means is that we are seeing a higher volume of sick patients from around Iowa that need to come to UIHC. And we are struggling to keep up after the events of earlier this year.”

Although UIHC for the 2020 budget year originally expected losses topping $100 million from halted surgeries and other COVID-19 expenses, tens of millions in federal stimulus support and a restoration of shuttered operating rooms mitigated the projected losses and put UIHC's operating income at the end of the year $14 million above budget - and just $10.5 million below last year.

With the hospital's finances now on restorative footing, executives are addressing patient care concerns - including that UIHC continues to be the go-to facility for transfers from other hospitals, but for markedly more complex needs.

'So when transfers come back at the same rate, but the patients are sicker, what that means is they're coming in, we take them, and on average they need to stay in the hospital longer, which is what's causing the crunch,” Gunasekaran said.

UIHC transfers are averaging 205 a week - slightly below previous levels of 212 a week, but well above the pandemic phase of 169 a week.

'The reason transfers aren't up is because our beds are full,” Gunasekaran said. 'If the sickness level were the same as before the pandemic, transfers would actually be up 10 to 15 percent.”

Because UIHC is accepting only the transfers it can handle, 'many hospitals across the state are disappointed when we decline to take a transfer, and many have complained to me because they believe it is happening at a higher rate than it did before.

'That's not the case,” Gunasekaran said. 'It's that we have sicker patients now than we did before.”

When asked why patient are sicker now, Gunasekaran surmised the answer might be twofold.

'One is that there is going to be a public health impact to delaying health care for three months,” he said. 'I think a lot of chronic diseases didn't get managed as well as they could, and they progressed to a different state.”

Secondly, many other hospitals don't have the ability to handle the sicker patients.

'It's usually that each critical access hospital may have one transfer per month,” Gunasekaran said. 'But now they have eight patients that are sicker that they need to transfer to us.”

Hospitals aren't the only ones expressing frustration about rejected requests for care. Patients are walking into the UIHC emergency room and leaving without being seen at a higher rate than ever.

'We've had two months of the worst left-without-being-seen rate in our emergency department since I've been here,” Gunasekaran told the regents. 'I regret to tell you that in the month of August, 20 percent of patients left without being seen, which has never happened.”

Typically, on the worst day, that rate is between 7 and 10 percent.

Gunasekaran said part of the problem is the influx of patients with behavioral health needs - which would include mental health issues.

'We're trying to figure out how to manage the increasing volume of behavioral health patients that are in distress and need care,” he said. 'In August, the main reason the left-without-being-seen was so high was the large number of behavioral health patients that were in the (emergency department) that we couldn't move because the beds upstairs were completely full.”

Gunasekaran said UIHC is working with hospitals statewide to improve the process, and he's optimistic about the opportunity to get better.

Within the hospital ranks, employees are working overtime and feeling taxed, fueling a push to hire more workers. Among the stresses is work-life balance, with parents needing to stay home with their children who otherwise would be in school.

'Frankly, the overtime is also being driven by the fact that the schools are virtual and more of our workforce is trying to be flexible in meeting their child-care needs,” Gunasekaran said. 'At some point, people do have to take vacations.”

UI Vice President for Medical Affairs Brooks Jackson presented some highlights on a prospective light at the end of the coronavirus tunnel - primarily in vaccine research happening on and beyond the campus.

'The data emerging on the leading COVID-19 vaccine candidates, currently in large phase three clinical trials in the U.S., looks very promising,” he said. 'While it is vital that we let the science lead these efforts to ensure that any vaccine meets the nation's existing high standards for safety nets, and while it is difficult to predict the timing of vaccine approval, we are beginning now to work on the plan for the logistics of COVID-19 vaccine distribution. This groundwork will ensure that we can be ready to administer rapidly one or more COVID-19 vaccines when the time comes.”

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