Arizona’s nursing shortages are causing critically ill COVID-19 patients to wait longer for hospital transfers, which makes it even more difficult for non-COVID patients in rural areas to get needed care.
Throughout the pandemic, hospitals across the state have relied on a call-in system, or “surge line,” set up in spring 2020 by Gov. Doug Ducey’s administration to speed the transfer of the sickest COVID-19 patients to facilities with more staffing, bed space or medical expertise.
So far in September, the average placement time for a hospital needing help with a critically ill COVID-19 patient has been between four and five hours, whereas last month the average placement time was slightly above two hours, according to the Arizona Department of Health Services.
During the state’s recent surge of mostly unvaccinated COVID patients, some rural hospital doctors have not been able to transfer critically ill non-COVID patients to Tucson or Phoenix hospitals, and so they asked the state to expand its surge line to include all critically ill patients.
The Arizona Department of Health Services denied the request Tuesday, citing the nursing shortages.
“While the Arizona Surge Line has facilitated the transfer of COVID-19 patients for the majority of requests, a small percentage of transfer requests in the last week are still pending due to statewide hospital staffing shortages,” wrote Don Herrington, the department’s interim director, on Tuesday.
“Due to the health care staffing shortages across the entire state limiting available beds across the health care system, expansion of the Arizona Surge Line to all patient transfers is not currently a viable option to improve patient transfers,” he wrote in response to a request from the Arizona Border Counties Coalition.
The coalition of county representatives recently asked for emergency help for rural hospitals in Pima, Cochise, Santa Cruz and Yuma counties, stating the facilities are “nearing collapse.”
Doctors and hospital administrators in Arizona’s rural hospitals say there’s no way to tell which urban hospitals have space for non-COVID patients without making numerous phone calls. Increasingly, they say, they are not finding places for patients to go.
In at least one instance, a Cochise County patient died of a treatable condition, Dr. Cristian Laguillo told the Arizona Daily Star last week. Multiple other patients have been at risk of dying while waiting for care, Laguillo and several of his colleagues told the Star.
“As the Arizona Border Counties Coalition, we are requesting that the existing COVID-19 surge line be expanded to allow for non-COVID acute care patients,” the group wrote in its request. “This resource should be provided immediately to ensure proper care to rural patients requiring lifesaving treatments.”
Since it was started more than a year ago, the surge line has facilitated 7,937 transfers. Of these, 6,423 were transfers to higher levels of care and 1,190 were to skilled nursing facilities. Since Aug. 22, there have been 303 transfers.
Arizona on Wednesday reported more than 70 additional COVID-19 deaths for the second consecutive day and for the fifth time in September, bringing the state’s pandemic totals to 1,072,863 cases and 19,658 deaths, according to the ADHS coronavirus dashboard.
“At this time, our focus is helping hospitals with staffing issues that are the main reason for reduced availability of patient beds,” said Steve Elliott, an ADHS spokesman.
Banner Health announced in late August it had more than 1,000 nursing vacancies statewide, for instance. Ducey recently committed $60 million to bring in 340 out-of-state nurses, Elliott noted, with 189 scheduled to start by the end of September.
That’s not soon enough, said Steve Harris, CEO of the Santa Cruz Valley Regional Hospital in Green Valley.
“The extra nurses start in October,” he said. “I need the surge line today.”
The Copper Queen Community Hospital in Bisbee will eventually receive four more nurses although start dates have been pushed back from September into October.
“All hospitals are struggling with staffing,” said the hospital’s CEO, Robert Seamon, who said they are grateful for the help and anxious to get it. “This program relies on being able to secure nurses from across the country. Everyone is competing for the same resources.”
To qualify for staffing support under Ducey’s program, hospitals must have programs in place to refer patients when monoclonal antibody treatment could help reduce the chances of severe illness. They also must offer vaccinations to unvaccinated patients at discharge.
Pima County Board of Supervisors Chair Sharon Bronson called the state’s response “extremely disappointing.”
“The pandemic has exacerbated the long-standing struggles of rural health care facilities that provide a range of chronic and acute care to the hundreds of thousands of Arizonans who live outside the Tucson-Phoenix-Prescott population corridor,” she wrote in an email to the Star.
“We know COVID-19 is stressing critical and acute care everywhere in our state, but rural hospitals and emergency centers rely on the larger hospitals in the metro population centers of the state to provide the urgent care that smaller, rural health centers may not be able to provide.”
Bronson said if rural hospitals in Pima County and the other border counties can’t get their critical patients the care that’s needed, “it creates a two-tiered system of care in Arizona — the haves and the have nots.”
“As elected officials representing the four border counties,” she said, “the members of the coalition had hoped the state’s health leaders would seek to work with us to prevent or end such inequitable health care provision in our state.”
Arizona’s hospitals are continuing to report that most of the COVID-19 patients being treated have not been vaccinated.
“We continue to urge everyone 12 and older to get vaccinated against COVID-19,” said Elliott. “As the CDC reported last week, those who are fully vaccinated against COVID-19 are more than 10 times less likely to be hospitalized or to die from COVID-19.”