Mercy Hospital’s intensive care unit has been overflowing with patients in recent months.
Intensive care unit staff members at Mercy have been overworked and exhausted since July as they have been forced to expand their critical care unit to handle a crush of COVID-19 patients.
The constant influx of the critically ill has strained staff, but amid the challenges they have faced, doctors, nurses and respiratory therapists have maintained their same standards of care, said Dr. Gus Hallin, medical director for Mercy Hospital’s ICU, in an interview this week with The Durango Herald.
“Since the delta (variant) surge really started to hit in July, we've been extremely busy,” he said. “Two years ago, our average ICU census at Mercy was about five patients. Since July, and especially in the last three months, we've been between 16 and 20 patients on life support, so almost 400% of what we were in the past.”
Staff members were caring for 18 patients when Hallin finished his shift Wednesday morning.
Neither Mercy Hospital nor Centura Health, the health care corporation that owns Mercy, responded to requests for comment.
The majority of patients are hospitalized with COVID-19, Hallin said.
The ICU has also had its typical baseline of five non-COVID-19 critical patients throughout the duration of the pandemic.
When Mercy Hospital first opened its 212,000 square-foot facility in June 2006, it was designed for a maximum of 10 ICU beds, Hallin said.
The ICU was initially staffed for six beds, but has been permanently staffed for 10 since in March 2020, he said.
The pandemic has stretched that capacity, forcing the ICU to expand its operations to general care floors.
“We’ve converted a lot of our step-down units in the transitional care unit to ICU beds,” Hallin said. “Now there’s generally between six and 10 ICU-level patients in our transitional care unit still staffed with ICU nurses and respiratory therapists.”
A step-down unit provides intermediate care for those patients with medical needs between the general ward and an intensive care unit.
A transitional care unit offers short-term care for patients transitioning from the hospital to their homes.
Three to four respiratory therapists work during the day and another two to three care for patients at night in the ICU.
Before the pandemic, the unit would staff three nurses during the day and three at night, but Mercy’s ICU has added three to four additional nurses per shift to accommodate the additional patients.
Nurses have turned to recruiting colleagues with critical care experience from the operating room and emergency departments at Mercy, and from outside traveling nurses to help shoulder the load of patients.
Expanded staffing requirements have forced the nurses, who typically work 12- to 14-hour shifts three days a week, to add extra hours and days to ensure the ICU meets its staffing needs.
“I’ve heard in the last few months a range of more like four to six shifts per week,” Hallin said.
Ideally, in an ICU, the nurse-to-patient ratio is one nurse per two patients to ensure the best care, he said.
Mercy’s staff has at times been stretched beyond that 1:2 ratio during emergencies.
“We’ve occasionally had to go up above that and watch them extra carefully,” Hallin said.
Inundated with patients, doctors, nurses and respiratory therapists have had to adapt.
“Over the last 20 months, we've all developed a certain efficiency that we didn't have to have before,” Hallin said. “When we prone patients, (our staff) have gotten really good at doing that quickly and effectively with a team. We rarely had to do things like that. Now, it's almost a daily occurrence.
“Our nurses have been nothing short of heroic,” he said. “They’ve completely risen to the challenge these last few months and they’ve really come together as a team.”
The adjustments Mercy staff members have made have not prevented fatigue.
“The last two years have been a bit of a blur,” Hallin said. “I'm so exhausted on my days off I’m finally starting to recover when I go back to work and then it starts over again.
“(The pandemic) is hard to put in perspective,” he said. “I was a medical student at University of Illinois in Chicago and then a resident in Albuquerque in the late ’80s and early ’90s. I dealt with the AIDS crisis in those years. I was in Albuquerque in 1993 when we had the hantavirus crisis. I’ve never seen anything like this.”
Mercy Hospital and Centura Health have requested assistance from the Federal Emergency Management Agency and the state in recent weeks, seeking both additional staff members and supplies.
Colorado’s Staffing Shortage Fusion Center, which was reactivated by the state in September 2021 and coordinates short-term staffing requests from hospitals, sent 25 medical staff members to Mercy, a spokeswoman for the Colorado Department of Public Health and Environment told the Herald in an email.
The state sent the interim personnel to Mercy on Jan. 3 for orientation and began working on Jan. 5, the spokeswoman said. Hallin said he expects them to stay with Mercy until April.
“It's been a real godsend. They're very enthusiastic and they’ve been incredibly helpful so far,” he said.
Nurses sent by the state now fill three of the roughly seven nursing positions on each shift, covering about a third of critical patients.
Yet, even as Mercy’s ICU staff members find some relief, they are still facing the rapidly spreading omicron variant that has sent cases skyrocketing.
San Juan Basin Public Health reported 314 new cases in La Plata County on Wednesday, a pandemic record.
The omicron surge has only just begun to hit Mercy, Hallin said.
The majority of the ICU’s patients entered the hospital in late November and early December, meaning they were likely infected with the delta variant.
“Protecting health care becomes extraordinarily important as people are getting sick,” said Liane Jollon, executive director of SJBPH. “What we want from a public health perspective is to not have too many people sick at once so that health care cannot treat people and save lives.
“The guidance that the state has put together is that 2,000 people hospitalized with COVID-19 (statewide) at once would be the point of no return for breaching our health care system,” Jollon said. “We have approached that number. We approached it in December 2020, (when) we got to just under 1,900. In the delta wave, we got close to 1,600.”
Hallin said the overwhelming majority of the patients in Mercy’s crowded ICU are unvaccinated. Only vaccination and boosters will stop the immense strain that’s being placed on the ICU and its staff, he said.
“The data is gradually becoming clearer. At least 85% of the population has to be vaccinated against these newer variants, possibly even higher,” he said.
Though Mercy’s ICU has been overflowing with patients, the team has maintained its quality of care.
“Not a single patient in the ICU has been let down to a lower standard,” Hallin said. “We have maintained an extremely high standard (for) everybody, which has always been the Mercy way.
“We had what I think is the best group of nurses and respiratory therapists in the state of Colorado going into this, so we were well prepared,” he said. “The way they’ve reacted to this is just awesome and I want the community to know that.”