With only one ICU bed open and a staffing shortage, Kona Community Hospital is preparing for the worst with a proactive approach.
On Saturday, eight of the nine ICU beds were in use, four occupied by COVID patients. Hospital spokesperson Judy Donovan said Kona Community Hospital (KCH) has the capacity to surge to 11 ICU beds but the facility is nearing capacity. The hospital has 10 ventilators with four currently in use, but Donovan said an additional five units, three transport ventilators and four bi-level positive airway pressure (BiPap) are on the way.
Capacity cannot be counted only by beds in use Donovan said. Staffing, available equipment and pharmacy have to be factored.
“Staffing remains at a critical level,” she said. “The traveling staff we were relying on can’t afford to be here.”
She said the high cost of housing and lack of rental cars has severely curtailed traveling health care professionals from coming to Kona, even when the hospital bumped up salary levels.
“They still can’t afford to be here,” she said.
Staff have been taking on extra shifts and working overtime to compensate for the shortage.
But some relief is on the way.
Thirty-two critical care nurses and three respiratory therapists are expected to arrive Monday for a four week contract through ProLink Staffing.
Although funds through FEMA will help with emergency staffing project, the hospital did not anticipate receiving them for at least a few weeks.
Fortunately, an anonymous individual donated $200,000 through the Kona Hospital Foundation to cover the contract plus housing at the Sheraton Kona Resort and Spa at Keauhou Bay and transportation busses provided by Roberts Hawaii.
Kona Hospital Foundation is a 501(c)3 nonprofit organization created to accept gifts and solicit donations for new medical technology, expanded services and enhanced facilities solely for Kona Community Hospital. Tax deductible donations can be made on their website at khfhawaii.org.
Donovan said they are seeing more severe cases of COVID in the hospitals, and many more younger patients than at the same time last year. Pre-COVID, the KCH emergency room averaged 60 visits per day. They are now seeing between 70-75 each day. Between Aug. 1 and Wednesday, 11, 264 tests were administered in the ER with 40 positive results or a 15.1% positivity rate.
“If we had a higher vaccination rate or didn’t let our guard down it wouldn’t be happening at this level,” she said.
Another concern is patients coming into the ER who need specialty care the hospital does not provide. With hospitals around the state reaching capacity, they are having a hard time finding a facility to accommodate the next level of care.
Patients can wait several hours and longer while ER personnel search for a hospital that will take them.
“All the hospitals are in the same boat,” said Donovan. “This can be critical for cardiac and trauma patients.”
In preparation for a further surge, the Incident Command Team at KCH made the decision to set up an emergency triage tent as a precautionary measure. Donovan said their objective is to stay in front of the surge, which they expect to peak in mid September.
“We are now fully prepared in the event that the Emergency Department experiences an overflow of ED patients with COVID-like symptoms,” said Donovan. “We were blessed last year to have low COVID numbers at the hospital. It gave us time to plan.”
KCH currently has nine COVID-positive inpatients, including one in the obstetrics department. None of these patients are vaccinated.
“Since we began measuring vaccine status of admitted patients, only one COVID positive patient was vaccinated,” she said.
Visitation restrictions are in place at KCH. No visitors are allowed into the hospital. Compassionate exceptions will be made on a case-by-cases basis, including for laboring obstetrics patients and end of life situations.
With a spike in positive cases in the North Kohala region, Donovan said Kohala Hospital is currently on lockdown with some staff working remotely. COVID patients coming into the ER are either discharged to home for isolation or transferred to Kona Community Hospital to be admitted.
“The Kohala Hospital administration and staff are very protective of their long term kupuna patients,” she said of the decision to lock down the facility.
Queen’s North Hawaii Community Hospital in Waimea would not provide information on how many COVID patients are hospitalized at their facility.
“We are licensed for 35 beds – that includes 4 ICU beds. It does not include our ER beds,” said hospital spokesperson Lynn Scully. “With regard to COVID inpatients, to protect the privacy of the people who entrust us with their care, QNHCH does not release or confirm small case numbers, such as COVID cases.”
Scully said the hospital provides COVID testing outside the Waimea hospital’s ER and are seeing an increase in numbers.
“We’re testing on average anywhere between 40-65 a day,” she said. “Most of these are people who think they may have been exposed.”
Scully said the hospital currently has adequate beds, staffing and supplies to care for any patients who need care – outpatient or inpatient, COVID or non-COVID.
“We anticipate 4 FEMA nurses coming later this month as part of the statewide request for staffing assistance. They will be supporting primarily in the ER and ICU,” she said.
QNHCH is starting to offer the IV Regeneron monoclonal antibody to COVID patient who meet the criteria on an outpatient basis.
“Our medical providers are excited about this as the studies have shown it can reduce the risk of hospitalization in COVID patients,” said Scully.
“We strongly encourage anyone who has been postponing receiving the COVID vaccine to do so now,” urged Donovan.
According to the Hawaii Emergency Management Agency, there were a total of three ICU beds available on the Big Island on Saturday.
Editor’s note: Laura Ruminski is a Kona Hospital Foundation board member.