Arizona Hospitals: Overcrowding And Capacity Issues

Arizona hospitals have been overwhelmed by the surge in COVID-19 patients, with many intensive care units (ICUs) understaffed and nearing capacity. The situation is dire, with hospitals reaching, and in some cases, surpassing occupancy levels not seen since the state's infection peak. The pandemic's worsening has resulted in a historically low number of ICU beds available, and the Arizona Surge Line, designed to prevent hospital overload, has witnessed the highest number of patient transfers since July.

Arizona hospitals are understaffed

Arizona hospitals are struggling with understaffing issues, particularly in their intensive care units (ICUs). Data from the federal government reveals that hospitals across Arizona are reaching capacity as their ICU beds fill up with COVID-19 patients. The situation is dire in both rural and metropolitan areas, with some hospitals surpassing occupancy levels last seen during the state's infection peak in July.

One of the hospitals facing ICU staffing challenges is St. Joseph's Hospital and Medical Center in Phoenix, managed by Dignity Health. The hospital reported being 95% full, with approximately 75% of its ICU beds staffed. Of the ICU patients, 35% are COVID-19 positive. Similarly, the Chandler Regional Medical Center, also operated by Dignity Health, is grappling with understaffing. The facility is nearly at full capacity, with 95% of its beds occupied and only 82% of its ICU beds staffed. Nearly half of the ICU patients at this location are COVID-19 patients.

The Flagstaff Medical Center in northern Arizona illustrates the severity of the issue in this region. The facility is almost 90% full, with 84% of its ICU staffed and approximately half of its ICU beds occupied by COVID-19 patients. The HonorHealth Scottsdale Shea Medical Center faced similar challenges, with only 58% of its ICU beds staffed during the last week of November.

The Arizona Surge Line, a statewide mechanism for preventing hospital overload by transferring patients between facilities, has witnessed the highest number of transfers since July, underscoring the current strain on hospitals. In response to the crisis, Gov. Doug Ducey has allocated $60 million in CARES Act funding to enable hospitals to offer bonuses and attract more staff. This allocation is in addition to the $25 million pledged earlier.

Hospitals nearing capacity

Several hospitals in Arizona are nearing capacity as their intensive care units (ICUs) are understaffed and filling up with COVID-19 patients. St. Joseph's Hospital and Medical Center in Phoenix, run by Dignity Health, reported being 95% full, with approximately three-quarters of its ICU beds staffed. Of the ICU patients, 35% have COVID-19. Similarly, the Chandler Regional Medical Center, which is also operated by Dignity Health, is understaffed and nearing capacity with 95% of its beds full, 36% of its ICU beds occupied by COVID-19 patients, and only 82% of its ICU beds staffed. Flagstaff Medical Center in the northern parts of the state is facing similar challenges, with 84% of its ICU staffed and nearly half of its ICU beds filled with COVID-19 patients. The hospital is also almost 90% full.

The situation is not unique to these hospitals, as data from the federal government reveals that hospitals across Arizona are being pushed to their limits. Of the 47 hospitals examined, seven were at 100% capacity, 10 were at 90% or higher, 11 were at over 70%, and seven had more than half of their ICU beds occupied by COVID-19 patients. Some hospitals are already facing a shortage of ICU space, with a historically low number of beds available as the pandemic worsened towards the end of the year. For instance, the HonorHealth Scottsdale Shea Medical Center only had 58% of its ICU beds staffed in the last week of November.

The strain on hospitals is not just due to the increase in COVID-19 patients but also the result of a long-standing staffing issue. Will Humble, the director of the Arizona Public Health Association, stated that hospitals will likely start cancelling holidays and requiring staff to work six to seven days a week. To address this, Gov. Doug Ducey announced $60 million in CARES Act funding to enable hospitals to offer bonuses and attract more staff. This is in addition to the $25 million he pledged in November. The Arizona Surge Line, a system designed to prevent hospitals from being overwhelmed by transferring patients to different facilities, has witnessed the highest number of transfers since July.

To alleviate the burden on hospitals, several healthcare organizations have urged Gov. Ducey to enforce stricter measures to curb the spread of COVID-19. They have recommended closing bars and nightclubs, restricting restaurants to outdoor dining and takeout services, implementing a mandatory mask mandate, and limiting public gatherings to 25 people. In a letter, these organizations emphasized that the "health care system is overwhelmed and on the brink of considering the need to implement crisis standards of care."

ICU beds filling with COVID-19 patients

Arizona hospitals and their ICUs are understaffed and reaching capacity as ICU beds fill with COVID-19 patients. Hospitals are struggling to manage the growing number of patients seriously or critically ill with COVID-19. As of Tuesday morning, both of Banner's ICUs in Pima County were at capacity. The Tucson Medical Center, with 36 ICU beds, had 20 of those dedicated to COVID-19 patients.

The strain on hospitals is being felt across rural and metropolitan parts of the state, with many reaching—and surpassing—occupancy levels not seen since the state's infection rates peaked in July. The pandemic has worsened as November turned into December, with hospitals reporting historically low numbers of available beds. The HonorHealth Scottsdale Shea Medical Center only had 58% of its ICU beds staffed in the final week of November.

The long-term issue, according to Will Humble, director of the Arizona Public Health Association, has always been staffing. Hospitals will likely begin canceling holidays and asking staff to work six to seven days a week. Gov. Doug Ducey recently announced $60 million in CARES Act funding to allow hospitals to give bonuses and boost staffing levels.

Some patients have spent up to four months in the hospital for COVID-19 treatment, which has complicated matters for hospitals. Procedures such as knee and heart valve replacements have been pushed back as hospitals continue to reach capacity. Arizona was one of the worst in the nation for its shortage of doctors and nurses before the pandemic, and legislation aimed at remedying the issue previously stalled.

Hospitals not in full compliance with pricing transparency laws

According to Patient Rights Advocate, 20 out of 25 hospitals evaluated in Arizona are not in full compliance with the law requiring posted prices. The hospital price transparency law, which went into effect in January 2021, requires hospitals to post a comprehensive list of the costs of items and services, and it must be in a consumer-friendly format. Banner Health, Dignity Health, and Abrazo Health facilities all received 'non-compliant' ratings. It is unclear if any Arizona hospitals have received warning letters from CMS or are currently being evaluated for compliance with federal pricing transparency requirements.

The federal government has started taking action against hospitals not complying with pricing transparency laws. The Centers for Medicare and Medicaid Services (CMS) issued two civil penalties to hospitals in Georgia, totaling over a million dollars, and the agency will continue to investigate hospitals to ensure consumers have the information they are entitled to.

Cynthia Fisher, the founder and chair of Patient Rights Advocate, a nonpartisan, nonprofit group, said, "Price transparency is truly informative." "It shifts the power to the consumer to be well-informed of all prices in healthcare in advance of getting their care, and then consumers can benefit from competition and through their choice drive down the cost of healthcare."

While some hospitals in Arizona may not be fully compliant with pricing transparency laws, it is important to note that Northern Arizona Healthcare offers price-estimating services to help patients predict the cost of health services. This service is available to all patients, regardless of insurance.

Hospitals may implement crisis standards of care

In the context of hospitals in Arizona, the implementation of crisis standards of care typically arises during a mass casualty event or a public health emergency, such as the COVID-19 pandemic. Crisis standards of care are activated when the demand for healthcare services exceeds the available resources, and hospitals may need to implement them to manage limited resources and ensure the continued provision of essential medical services.

During a crisis, hospitals may face challenges such as insufficient bed capacity, equipment shortages, or a lack of adequate medical staff to address the surge in patients. In such situations, crisis standards of care provide a framework for allocating scarce resources and determining patient care priorities. This may involve implementing measures such as:

• Repurposing non-traditional spaces, such as classrooms or conference rooms, to accommodate patients;
• Increasing the nurse-to-patient or doctor-to-patient ratios, resulting in each healthcare provider caring for more patients than usual;
• Prioritizing patients with a higher likelihood of survival for critical care resources like ICU beds or ventilators;
• Transferring patients to hospitals that may be located farther away to balance the patient load across healthcare facilities;
• Longer wait times for patients seeking medical care, including emergency services.

The activation of crisis standards of care can significantly impact the level and timeliness of care patients receive. It is essential to communicate these changes effectively to the public to manage expectations and promote understanding. Workshop participants and healthcare professionals emphasize that even in crisis situations, no patient should be "left to die." While critical care resources may not be available to all patients, palliative care and compassionate support remain essential components of the healthcare response.

To ensure a coordinated response during a crisis, collaboration between healthcare administrators, public health officials, and elected leaders is crucial. A unified message delivered by a recognized leader, often an elected official, can help inform the community about evolving standards and promote trust in the healthcare system. Additionally, an informed public that understands the uniform nature of crisis standards across regional boundaries can better accept the sacrifices and challenges that arise during a mass casualty event.

Frequently asked questions