Short Staffed

Two people walk out of Ascension Via Christi Hospital in Manhattan on Tuesday. The hospital is transferring 8 to 30 patients to other hospitals each month because of a lack of staff to care for them.

Jess Rutledge of Wamego was having a lifetime high: The birth of his first child.

And then he got nearly as low: His wife, who did not want to be named in this story, suffered from cardiomyopathy, which led to a form of heart failure a week after giving birth in April.

However, she couldn’t get into Ascension Via Christi Hospital in Manhattan. There wasn’t enough staff on hand to help her.

Her case illustrates a common problem, often discussed in the community but rarely publicly acknowledged: The hospital has plenty of room for patients, but often can’t accept them because there isn’t enough staff to take care of them. They end up being sent out of town for care, even in fairly routine medical situations.

Jess Rutledge said his wife initially was treated and stabilized at Wamego Health Center before she required additional care that the hospital couldn’t provide. Rutledge wanted his wife to go to the Manhattan hospital, but they had a long wait ahead of them.

“It was almost six hours before she was able to get transported,” he said. “(Via Christi) kept telling us, ‘We just don’t have a room available.’ There was talk of us taking her over to Topeka. You’re looking at a 45-minute drive in a medical transport versus a 15-minute drive (to Via Christi).”

‘Very frustrating’

For Rutledge, even the possibility of not getting help in Manhattan caused stress for his family.

Hospital officials said Via Christi receives two to three patient transfers a day from other facilities. Rutledge’s wife eventually became one of the incoming transfers.

Rutledge said he thought the delay meant all of the rooms were full until he met his wife at Via Christi, where they seemed to be the only people on the entire floor.

“I got up to the third floor, and I got off the elevator,” he said. “I walk down the hallway, and I must have passed seven or eight rooms completely empty. Lights totally off.

“What if her heart had been a lot worse than it wound up being?” he continued. “What does that kind of delay do? It could have been really bad.”

Rutledge, whose wife also had given birth to their son at Via Christi, said he didn’t have many complaints about the quality of care during either of her stays.

“The nurses and doctors we had who saw us there were all very good, very professional people, but there was clearly a lack of them there,” he said.

Rutledge said staffing also affected them when his wife was discharged. She was originally supposed to leave in the morning, but he said she had to wait until 4 p.m. because the one cardiologist on staff who could sign off on her release had to go into surgery.

“I was home with my son, and she had a family member with her in the hospital,” he said. “It’s very frustrating, and I kept texting her asking ‘Is everything OK?’ Now I’m thinking something’s gone wrong, and they won’t let her go home.”

Wait time

Hospital president Bob Copple acknowledges a problem. He said in an interview with The Mercury that the hospital has experienced 8 to 30 “bed cap transfers” per month — sending patients elsewhere when it otherwise wouldn’t — because of the staffing issues.

“The reason we capped the beds is we didn’t have sufficient staff, and we’re not going to put patients at risk,” he said. “So we try to not go past the ratio of patients that a nurse would be asked to take care of.”

Copple said an additional 30 to 40 patients a month get transferred from the emergency room when people need care not provided in Manhattan. He said these patients are typically sent to Topeka or Kansas City.

Both types of transfers represent a small percentage of the 1,800 to 1,900 patients treated per month in the emergency room, Copple said.

However, no matter how small the number, it does affect members of the community, and the relative performance of the local hospital.

According to a national survey by the Hospital Consumer Assessment of Healthcare Providers and Systems, 63% of Via Christi patients reported that they “always” received help as soon as they wanted.

This is below the Kansas average of 78% and the national average of 70%.

Hospital officials said the average patient wait time for the emergency room is approximately two hours from triage to discharge for outpatients. They said it also takes an average of two hours for admitted patients from diagnosis/provider decision to being placed in an inpatient room.

According to one former employee, the issues come from beyond the hospital itself and to overall ownership.

Shae Adams, who worked as an emergency room nurse at the hospital, said Via Christi is losing staff and struggling to maintain a good staff-to-patient ratio.

“Hiring prospects are dwindling as an arguable effect of being surrounded by hospitals that pay more, offer more staff support, have more ideal staffing, and currently have a better rapport with (the Centers for Medicare & Medicaid Services) and the community,” she said.

Officials said the majority of “bed cap” transfers are for patients who need the intensive care unit (ICU).

Hospital spokeswoman Michelle Kennedy said officials have started a master planning effort around replacing the hospital’s ICU, although it is still a few years out.

According to Adams, part of the issue is the way the hospital has to use the ICU unit.

“We have a whole Intermediate Care Unit that is no longer staffed at night,” she said, “meaning all ICU and IMCU patients stay in our eight-bed ICU. The IMCU area is used for daytime outpatient procedures, and our cath lab is only in operation during the day.”

Transfers on the rise

Patients being transferred also have to deal with the financial cost, which can be particularly frustrating when it’s a service that Manhattan could provide.

Riley County EMS director David Adams said patients are charged a flat fee that’s determined by equipment needed during the ride, as well as a mileage charge.

In March, Adams told Riley County commissioners that transfers from Via Christi nearly doubled, going from 248 in January through October 2017 to 493 from January through October 2018.

Adams said EMS has been experiencing the same rate of transfers in 2019.

Hospital officials said they hope to bring the numbers down through finding more staff to hire.

While Copple noted hiring challenges for physicians in 2017 and nurses in 2018, he said it takes a lot to operate a hospital including ultrasound techs, lab techs, respiratory therapists and sleep lab techs.

Copple said the hospital has 480 to 500 total employees. He said 35 to 50 positions have been open at any given time during the past 18 months.

The hospital’s vacant jobs include two ICU nurse positions and five nurse positions for the medical/surgical units.

“There’s all sorts of things written about national shortage of physicians, national shortage of nurses and all that kind of stuff,” Copple said. “You don’t see very many articles about how you can’t hire respiratory therapists. And that’s what helps support your ICU and your medical unit.”

Copple said officials are hopeful that hiring issues will be solved in 2019.

“We see that there’s an end coming to that, but it’s been a process,” he said. “We’re slowly digging ourselves out of that hole.”

He said the hospital provided $1 million in market increases for salaries, which has made filling positions easier than in the past.

“As an organization, we’ve been able to give raises the last three years. That helps,” he said. “We have a recruiter just for nursing positions. We’re going to a lot more schools to do visits. Career fairs. All of those outreach things.”

Copple said the hospital also seeks people who are military spouses and/or connected to K-State. He said people have questioned the approach, but employees who fit that description typically come in with experience and require less training.

“If people have some kind of reason to be here, that’s much easier recruiting than going to somebody cold who doesn’t know anything about living in Kansas,” he said.

Seeking solutions

Even if the hospital has a successful 2019 in terms of hiring, the need for hospital workers will continue to grow as the Baby Boomer generation ages.

The Bureau of Labor Statistics projected the United States will have 203,700 nurse openings annually through 2026 because of both created positions and retirements.

In 2018, the Association of American Medical Colleges said the U.S. could see a shortage of up to 120,000 physicians by 2030.

Copple said K-State officials have been discussing some programs that could represent a proactive approach to the future work shortage problem.

K-State’s College of Health and Human Sciences will begin its physician assistant program in January 2021. Wichita State University currently has the only physician assistant program in the state.

Copple said he’s also hopeful that K-State can start its nursing program in fall 2020.

“Everybody knows we’re going to have a nursing shortage,” he said. “That’s just another way to get more nurses and also have them educated here in our community. Even if only a few of them out of every class stay, we’re ahead of where we are now.”

Copple said there have been preliminary talks with the University of Kansas School of Medicine about a family medicine residency program in Manhattan.

He said this will require a lot more meetings with local physicians because they will be the ones who have to make the commitment to train.

“The intent of the program actually would be to train physicians who want to work in small communities or rural communities,” he said. “There’s a huge need for that not only in our region but across the state.”

Copple said the hospital’s goal is to eliminate bed cap transfers, but ultimately many transfers are still appropriate because Via Christi doesn’t provide certain services.

He said this includes transfers to inpatient behavioral health facilities, neuro and vascular surgeons, and pediatric intensive care (PICU).

“Not only will it continue, it’s actually the best thing for taking care of a patient,” he said.

Despite Rutledge’s previous frustrations, including someone giving his wife the wrong type of heart medication, he said he would still trust going to the hospital.

“I would like to think it was some form of a perfect storm,” he said. “But I would be lying if I said it didn’t make me a little apprehensive to go back in there.”