Sioux Falls hospitals preparing for another surge in COVID-19 patients

Avera McKennan Hospital in Sioux Falls is preparing for another surge of COVID-19 patients that could bring as many as 100 more by early next week.

Avera’s main campus is already full, and hospital officials are doubling up intensive care unit rooms and looking for additional beds outside of its flagship hospital, according to an email that went to employees from Thomas Otten, Avera’s vice president of behavioral health services. That includes setting up a four-bed COVID-19 unit at Avera Behavioral Health Center. Those beds would be for COVID-19 patients who have behavioral health needs and don’t have medical complexities.

The preparation comes amid record high cases in South Dakota. Wednesday’s seven-day average hit 1,272, and the rolling average has been above 1,000 since the end of October. Hospitalizations tend to lag positive cases by several days.

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Otten’s email, written on Nov. 6, indicated that models used by Avera to gauge hospitalizations showed a peak in about 10 days.

In a statement to the Argus Leader, Avera spokesman Cale Feller said doubling up occupancy is part of the system’s plan for handling increased demand.

“For many months, our teams have been actively planning and preparing to meet the needs of our area,” the statement said. “As COVID-19 patient numbers increase across our region, so too does the need to for us to initiate additional levers in our surge plans. This includes some double occupancy rooms where possible, as well as expanding into other clinical areas contiguous to our current ICU that can be temporarily used for inpatient care.”

Paul Hanson, the president of Sanford Health, said in a statement that his hospital is also seeing increased demand.

“Sanford Health is seeing a rise in the positivity rate of COVID-19 cases,” Hanson said. “We continue to rely on our surge planning and take every step necessary to care for the patients who need us the most.”

Tim Rave, the president of the South Dakota Association of Healthcare Organizations, said that surge plans include COVID-19 patients and others.

"This is part of the surge plan for the hospitals," he said in an email. "Yes, there are an increased number of hospitalizations from COVID but there are also an increased number of patients that are in the hospital for reasons other than COVID."

An Argus Leader review of data from the pandemic in South Dakota shows that in July, before cases started accelerating, about 10% of positive COVID-19 cases required hospitalization. Under that metric, every 1,000 new positive results generate about 100 people who need some length of hospital care.

But the 10% rate from July could prove high. At that time, the majority of people tested had symptoms for COVID-19. Since then, the state has expanded testing, and some positive results that are found now might have gone unnoticed in July. That, in turn, would lower the hospitalization rate.

Increased testing, however, only accounts for a fraction of the increase in reported coronavirus cases, and hospitalizations have soared. On Tuesday the South Dakota Department of Health reported that hospitalizations hit a statewide high at 607. That eased somewhat on Wednesday, but will likely increase in coming days.

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The steps being taken by Avera and Sanford are in line with industry response to the pandemic. A May article in the Annals of Internal Medicine suggested that putting COVID-19 patients in geographic cohorts would allow staff to provide more efficient care.

“It may be necessary to use innovative approaches, such as converting single rooms to double occupancy; expediting discharges; slowing admission rates; and converting spaces like catheterization laboratories, lobbies, postoperative care units, or waiting rooms into patient care venues,” wrote the authors, Dr. Vineet Chopra of the University of Michigan, Dr. Eric Toner of Johns Hopkins University, Dr. Richard Waldhorn of Georgetown University and Dr. Laraine Washer of the University of Michigan.

In a statement to the Argus Leader, Nancy Foster, the vice president for quality and patient safety policy for the American Hospital Association, said that hospitals across the county are employing “learned strategies” to address increased hospitalizations across the country.

“Our clinicians know more about how to treat COVID-19 patients than in the spring, which is leading to better outcomes and shorter stays in the hospital,” she said.

“While hospitals can add beds,” she added, “it is much harder to bring in additional health care workers, many of whom are justifiably experiencing a significant emotional and physical toll due to the impact of the pandemic. Surges in rural areas are especially concerning since many rural hospitals have less capacity to expand the ability to care for patients and fewer resources to fall back on.”

In his email to employees, Otten addressed staffing: Anyone interested in picking up a shift in the new COVID-19 unit, he wrote, could send a request to their scheduler.