Tertiary centers: Overwhelmed with backlog of patients after COVID-19
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What we’re seeing right now is very different than what we experienced with the COVID-19 surge back in December 2020.
Back in late 2020 and early 2021, many of our hospitals had a record census of COVID-19-positive patients, and practices had to dial down some of their clinical care (new patient referrals, elective surgeries, transplants) to accommodate those high COVID-19 patient numbers in the hospital.
More recently, the surges related to COVID-19 have been different. The hospitals are extremely full of patients who have delayed their care because of COVID-19, and can no longer delay their care. They put off elective procedures or evaluations that now have come to clinical attention and require more urgent needs. Therefore, the hospital practices were already running at high capacity going into the recent surge due to delays of prior care, and have found it more challenging to dial down the practice like we were able to do previously. Then, when you add this surge of COVID-19 patients, even though the numbers may not be as high as they were a year ago, that challenges a hospital system that’s already full of very sick patients.
The other thing that layers into the current situation, which is making it even more challenging, is that there’s been a significant drop out in the health care workforce during the pandemic, with loss of one in five health care workers at all levels and roles throughout the pandemic. We’re operating at a very high capacity, yet with a 20% reduction in workforce. It is difficult to hire and replace those lost positions in a setting where things are so incredibly busy and the primary focus is on caring for the patients in need. Vaccine requirements have led to further loss of workers in health care, adding additional strain to the system. Bed capacity is extremely limited in many areas.
Going Forward in 2022
We are likely to see this continue until we see a decline of the current COVID-19 numbers, which may now be delayed until we see the impact of the highly contagious omicron variant. Once we are able to see a decline in the COVID-19 numbers, it’ll allow practices to catch up on the backlog; this is not just a backlog of patients coming into the hospital with more urgent issues, but also a backlog in the outpatient practices where patients have either delayed care or have been waiting for external or internal consultations within a health care system. The practices are spread so thin providing extra care in the hospital setting where it’s more acutely needed, leading to delayed outpatient appointments. However, we need to work to maintain outpatient access for acute needs in order to prevent patients from going to the emergency department for issues that could be addressed in the outpatient setting. It’s a really delicate balance.
Once we see COVID numbers decrease, it’s going to take time to catch up on that backlog that we’ve seen. It’s going to take much longer before we are able to replace the loss in workforce, given that often takes 6 to 12 months or more, depending on licensure and credentialing timelines. We may feel the impact of the loss of workforce throughout much of 2022 until the workforce is replete.
Smaller hospitals are even more significantly impacted. Many have had to close their doors for new care or divert cases, just because they have no hospital beds, no capacity, or not enough people to care for those patients. There have been catastrophic stories of cases shared around the country of patients presenting with issues that were completely treatable who have suffered adverse events including death because of the absence of an available hospital bed. Those stories serve to heighten the awareness of the urgency needed to get the pandemic under control so we can go back to taking care of patients in the way we’re skilled to do it.
Patients Put Off Routine Care
Unfortunately, we’ve seen people who have delayed routine care in our GI practices, including surveillance for things such as colorectal neoplasia, Barrett’s esophagus and other conditions. People may have delayed some of those surveillance needs because they didn’t feel comfortable doing that in the setting of the pandemic or because of access issues wherever they live. We need to work to avoid the potential outcomes of delayed surveillance or routine care, which could include more advanced stage disease at presentation. So while we continue to work together through these unpredictable and unprecedented times, we need to remember that our patients need our reassurance that it is safe to come into our facilities to receive their necessary health care, and are here for them at a time when they may need us most.
- For more information:
- Amy S. Oxentenko, MD, FACP, FACG, AGAF, is the chair for the department of medicine at Mayo Clinic in Arizona. She previously mentored the next generation of women at Mayo through her role as residency director in Rochester. Oxentenko also leads the Women in GI committee for the ACG.
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