Back in early March, Methodist University Hospital converted ICU space for cardiovascular patients into a surplus COVID-19 ICU, just in case predictions turned out to be accurate.

This weekend, more than four months later, it expects to open the 16-bed unit.

For days now, patients with all kinds of illnesses – not just COVID-19 – have had longer-than-normal wait times in emergency rooms across the city because the beds upstairs were all full.

Coronavirus: Almost 90% of local ICU beds in use

“People are held in the ER all the time. It’s not like it’s a COVID-specific event,” said Dr. Scott Strome, executive dean of the College of Medicine at University of Tennessee Health Science Center.

“The problem now is that it is really stressing our system. We are at a point now, no question, where this is stressing our system.”

On Friday, July 10, 90% of the 2,636 regular hospital beds and 87% of the 477 ICU beds in the city were full.

Patients in slightly more than 13% of regular hospital beds were COVID-19 positive (209) or had been tested but results were not back (110). But 32.2% of patients in the ICU believed to have COVID-19 were awaiting test results. Until the results of those tests are in, they have to be treated as if they have the virus.

On Tuesday, Methodist University opened an extra ICU ward, specifically to relieve stress on its overtaxed emergency ICU.

“We are actively opening units to maintain our flexibility,” said Dr. Richard Aycock, chief of staff at Methodist, who is working nearly 12-hour days in the most challenging era of his career.

Baptist Memorial Health Care is doing the same.

The Memphis metropolitan area has 548 additional hospital beds and 234 ICU beds that can be put in service as needed. The issue is that they are not beds hospitals are currently staffed to cover. So, as the COVID-19 numbers tick up, the challenge is finding skilled staff, often on short notice.

“We are at the point where folks need to start collectively shifting into surge-capacity mode and trying to create more beds,” Strome said. “If the numbers keep going up, things will be getting tighter and tighter.” 

What is often lost in the discussion of hospital capacity and the pandemic, Aycock says, is that COVID-19 alone is not filling up hospital beds.

“Hospitals work at near-capacity even without these strange times.”

While there isn’t hard data, Aycock and other physicians say non-COVID patients are coming to the hospital in worse condition than normal.

“We have this sense that patients are coming to us later in their disease course, so it is taking more to treat them,” he said.

That requires longer stays and more beds.

The hospital systems each track where they are in terms of beds, staffing, personal protective equipment, even blood supply, on dashboards that are like data mines.

“We have a daily meeting, each facility reports all their comings and goings, (admissions and discharges) COVID numbers, surgical procedures,” Aycock said, going down the agenda in his head.

“We are much more prepared than we were back in March. We’ve learned how to really take care of these patients in an efficient way. We are expanding our capacity in all our hospitals as much as we can.”

To maximize the efficiency of limited ICU space, hospitals here need to find hundreds of nurses with specialty-care experience.

“They’ll need to look at nurses that have been furloughed,” said Tina Gerardi, executive director of the Tennessee Nurses Association. “But, in many instances, those nurses may not have critical-care experience or may have worked in a surgical center, post-anesthesia. The hospitals will be looking to do some quick retraining.

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“I would hope they look to the Tennessee Medical Reserve Corps,” Gerardi said. “These are nurses throughout the state who have volunteered to go to high-impact COVID areas. The hospitals will already know what their training, education and experience is, so they can select from them.”

Pools of nurses are willing to go wherever they are needed, “very similar to the nurses from Tennessee who went to New York and New Jersey,” Gerardi said.

“There are people who enjoy emergency-ICU work and if they are willing to travel, now is the time,” she said, noting that Vanderbilt University Medical Center got a “tremendous” response when it called for volunteers last spring.

“In New York and some other areas that were hard hit, they were able to get people. They wanted to come, wanted to help and be part of the front line.”

While it is possible to staff up, the question, Gerardi says, “is will we have ideal staffing? I can’t answer that, but probably not.”

Baptist is hiring traveling nurses, but for the most part, it is hiring people it hopes will become long-term employees.

“As the census goes up, we are able to adjust and adapt pretty quickly to be able to care for the patients that come to us,” said Susan Ferguson, chief nursing officer for the Baptist system.

From April to June, Baptist hired 510 people in a variety of clinical positions. Right now, it has an additional 204 new hires in various stages of orientation; 106 of them are nurses.

When Nancy Averwater, vice president of HR for Baptist, looks back on these harried days of the pandemic, she will remember them for how they forced change from within.

“We’re thinking through how to re-engineer our work and do it in a way that provides the highest quality and most effective care,” Averwater said. “That in itself creates an opportunity for us.”

Methodist, which didn’t furlough many staff when the pandemic initially emptied hospitals, is finding employees in staffing agencies. It is hiring traveling nurses, but it also is using its own float pool – nurses who can fill in on several floors, depending on need – and cross-training dozens of others.

“We’re scaling up our nurses, including in our adult and pediatric areas,” Aycock said. “We are cross-training pediatric nurses to the adult world so we can have more flexibility. 

“We are certainly meeting our needs, but there are stress points along the way. It just takes time to expand these services.”

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The time factor is hard to predict. Based on current levels of social distancing, Dr. Manoj Jain, infectious disease expert advising Memphis Mayor Jim Strickland, predicts an average of 550 people will be hospitalized per day in September; the numbers jump to 700 in October, 780 in November and fall slightly to 740 in December.

The number of COVID-19 patients in the hospital will outpace the number of daily new cases beginning in September, when Jain predicts Shelby County will report an average of 500 cases a day.

Friday, the Shelby County Health Department reported 362 new cases; 317 others were in the hospital.

Shelby County hospitals have been steadily adding staff and beds. In mid-June, Shelby County had 339 extra beds for the surge. Today, it has 548.