Hilo Medical Center is operating well beyond capacity as the number of COVID-19 patients there continues a steady climb upward.
On Monday, there were 38 COVID-positive patients in the hospital, 10 of whom were in the intensive care unit, the highest number to date.
HMC on Monday was caring for 17 ICU patients, far beyond the hospital’s 11-bed ICU capacity.
The 10 COVID-positive patients are in the hospital’s 11-bed ICU, while six ICU patients are in the progressive care unit.
“As the largest hospital on the island, we cannot divert patients,” HMC spokeswoman Elena Cabatu said. “We have a plan to care for everyone who come to us for care.”
Dan Brinkman, Hawaii Health Systems Corp. East Hawaii Regional CEO said the number of hospitalizations have steadily worked its way up over three weeks.
“We hit a peak on Friday and Saturday, then we came down a little bit on Sunday and a little bit more (Monday),” he said. “So two days is not a trend, but we’re hoping it’s a start of a downward trend.”
Cabatu said the hospital is constantly assessing its campus for locations in which to care for patients.
Brinkman said HMC initially opened overflow beds in the hospital’s elective surgery recovery area, which served up to 12 patients.
“Then, when it seemed like numbers weren’t going to work their way down,” Brinkman said administrators began looking for more space on the hospital’s campus.
On Friday, HMC opened a 16-bed overflow unit in its Extended Care Facility.
According to Brinkman, the hospital received a waiver from the U.S. Centers for Medicare and Medicaid Services to use a wing of the Extended Care Facility for patients who are ready to be discharged from the hospital but are not yet ready to go home.
“In the meantime, we emptied our pre- and post-surgical surgical area so we can catch up on the backlog of surgeries,” Brinkman said.
Running at this high level is tremendous strain on both employees and supplies, he said.
“Functionally, (HMC is) probably running at about 120% capacity, sometimes a little more,” Brinkman said.
That requires more staff.
While 12 more traveling nurses arrived this week, joining another 12 relief workers who arrived earlier this month, Brinkman said a vast majority of the workload has been assumed by HMC staff.
“They really come together,” he said. “Hilo people are great about that. We’ve had no shortage of volunteers. … We have been able to handle this because people have stepped up. They’re tired but we’re holding on and still doing quite a good job.”
According to Brinkman, HMC still has capacity for more patients in its Extended Care Facility overflow unit and can again use the pre- and post-surgical recovery area.
The hospital also is looking at potentially using another part of the Extended Care Facility should the need arise, and there are a few other options for overflow patients.
HMC would “probably be able to find more locations and space” for overflow patients, but Brinkman reiterated that staffing would be a limitation.
Oxygen demand
Healthcare Association of Hawaii on Monday said because of the significant increase of COVID-19 patients in Hawaii’s hospitals, demand for oxygen could soon outpace supplies.
Daily consumption of medical grade oxygen, which is 99% pure, has increased approximately 250% since the beginning of August.
According to a news release from the trade group, hospitals use oxygen to assist patients with illnesses like emphysema, lung cancer and the coronavirus. Intensive care patients generally are on high-flow oxygen or a ventilator, while most hospitalized COVID patients are on high flow oxygen.
Hawaii has two liquid oxygen plants, both of which are operating at full capacity and now are only producing medical gas.
While oxygen generally is not imported from the mainland, it can be done in ISO tanks that contain approximately 3,500 gallons, HAH said, but because of the pandemic and increased need for oxygen, there is a worldwide shortage of these tanks.
Meetings between federal and state emergency management organizations, the state Department of Health, HAH and suppliers, have been held. Officials are exploring all options and logistics to determine the best steps forward.
“Of course we’re concerned,” Brinkman said. To ensure demand doesn’t exceed the supply, “we’re looking at ways to most efficiently utilize the oxygen and conserve a very valuable resource.”
According to Brinkman, HMC and other hospitals in Hawaii are looking at best clinical practices so that no oxygen is wasted.
HMC has adequate supplies and typically refills its “very large tank” when about 1/3 of the oxygen supply remains, he said.
Right now, Brinkman said the issue is not the ability to resupply, but rather the statewide producation, “that there’s enough and we’re using it most efficiently.”
Email Stephanie Salmons at ssalmons@hawaiitribune-herald.com.