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ICU capacity shrinks at hospitals as they scramble to find enough staff to manage COVID surge

Physicians assistant Brendan Smith cared for a patient in a COVID unit at UMass Memorial Medical Center in Worcester.
Physicians assistant Brendan Smith cared for a patient in a COVID unit at UMass Memorial Medical Center in Worcester.Craig F. Walker/Globe Staff

Hospitals in some parts of Massachusetts are watching their intensive-care capacity shrink at a worrisome pace, as they struggle to find enough staff to care for the rising number of severely ill COVID-19 patients.

While ICU beds remain open in many hospitals, the number of available spots has been declining and hospitals expect capacity to tighten even more in the days ahead, according to Steve Walsh, president and CEO of the Massachusetts Health & Hospital Association.

The extent of the difficulties varies by region, but “in some areas, we could have problems this weekend,” Walsh said.

Walsh does not expect staffing to deteriorate to the point that doctors and nurses will have to choose who gets care and who doesn’t. The worst-case scenario, he said, is that patients may have to travel a distance for treatment.

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Amid the troubling resurgence of COVID-19, the ability to deploy adequate staff, especially in ICUs, has become the top challenge for hospital leaders, a much bigger worry than the supply of face masks or breathing machines.

With the pandemic now raging in all corners of the United States, demand for nurses and doctors is at an all-time high and the competition is fierce for temporary or “travel” nurses.

According to the latest data from the state Department of Public Health, 24 percent of ICU beds were available statewide at 3 p.m. Wednesday.

But the northeastern region of the state, encompassing Lawrence, Lowell, Beverly, and Salem, had only 10 percent ICU capacity on Wednesday, down sharply from 15 percent on Monday. In contrast, in Western Massachusetts 41 percent of ICU beds were available.

The state defines an available bed as one that can be staffed within 12 to 24 hours.

Hospitals are canceling inpatient elective surgery, freeing up staff for COVID-19 patients. Additionally, a field hospital in Worcester has opened, and one in Lowell is expected to open Monday — but the number of patients it can serve will depend on its ability to attract enough physicians, nurses, respiratory therapists, and other professionals.

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Three other field hospital hospitals — in Boston,Bourne, and Dartmouth — are not open but can be recommissioned within 72 hours.

Dr. Eric Toner, senior scholar at Johns Hopkins Center for Health Security, said hospitals nationwide face “a suddenly increased demand and no way to suddenly increase the supply.”

“What hospitals do in that circumstance,” he said, “is they stretch their staff. They have them work long shifts, work overtime, no days off. They take staff that don’t normally take care of critical care patients and assign them to critical care roles.”

In Massachusetts, the supply of health care workers has shrunk by thousands statewide, as many become infected with the coronavirus (usually through exposure outside the hospital, according to hospital officials) or they need to quarantine after exposure, removing them from the workforce for 10 days or longer. At any given time, hundreds of employees at a large hospital may be out of work because of a COVID infection or exposure.

At the same time, the traveling nurses who have filled the gaps in previous times are hard to get, as demand for their services grows nationwide. Some hospitals are willing to pay more than $7,000 a week for a temporary travel nurse, thousands more than usual, according to online postings by staffing companies.

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“The demand is higher than we’ve ever seen,” said Lauren Pasquale Bartlett, spokeswoman for Fastaff, a Denver-based company that specializes in rapid response nursing. The agency has about twice as many nurses working this year as in 2019, Bartlett said.

NurseFly, a website that lists job postings for travel nurses, reported openings for more than 300 ICU nurses in Massachusetts this month, four times the number a year ago this month.

“The major difference from the spring is that every state is facing this problem at the same time,” said Walsh, of the Massachusetts hospital association. “In the spring we were able to get traveler nurses pretty much any time.”

Another difference today is that hospitals are trying to avoid the near-complete shutdown to anyone besides COVID-19 patients that occurred in the spring.

This means fewer hospital staff are available to redeploy to COVID units. And even when employees are redeployed, there are limits to how they can help. Caring for critically ill patients, for example, involves specialized skills that are not quickly taught.

“We’re hearing from nurses around the state that there are insufficient nurses to take care of the number of patients,” said Katie Murphy, president of the Massachusetts Nurses Association, a union that represents nurses at 51 acute-care hospitals. The problem is not universal, but even at hospitals that have maintained staffing levels, Murphy said, “It’s just starting to look a little treacherous.”

South Shore Health has hired travel nurses and per-diem physicians to help staff its hospital in Weymouth, while redeploying some workers to busy units and asking others to pick up extra shifts.

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“Unlike in the spring where PPE was really the biggest concern, and then ventilators, and then staffing, I would say staffing has been our number one issue that we are watching very, very carefully,” said Dr. Allen Smith, chief executive of South Shore Health.

At the state’s largest hospital group, Mass General Brigham, nursing leaders joined forces to gain leverage as they tried to secure travel nurses for the winter surge. “Everyone’s competing for the same pool of people,” said Ann Prestipino, a senior vice president at Massachusetts General Hospital involved with planning.

Marie Ritacco, vice president of the Massachusetts Nurses Association and a recovery room nurse at St. Vincent’s Hospital in Worcester, said St. Vincent’s has lost dozens of nurses to other Worcester hospitals that she said offer better pay and benefits.

“We don’t have enough nurses,” she said. Even aides and secretaries are in short supply, increasing burdens on nurses, Ritacco asserted. St. Vincent’s said in a statement that “our staffing guidelines are appropriate.”

At Baystate Medical Center in Springfield, some staff nurses have left their full-time jobs for better-paying work at staffing agencies, said Nancy Shendell-Falik, hospital president. Baystate has enough capacity to treat patients right now, she said, but she worries about another surge after Christmas.

“I hear people talking about big gatherings,” Shendell-Falik said. “There are people unwilling to change their behavior. What I’m really frightened about is what happens two to three weeks from now.”

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Priyanka Dayal McCluskey can be reached at priyanka.mccluskey@globe.com. Follow her on Twitter @priyanka_dayal. Felice J. Freyer can be reached at felice.freyer@globe.com. Follow her on Twitter @felicejfreyer.