KCH, HMC Continue Handle Patient Overcrowding

A Blu-Med tent erected outside Kona Community Hospital’s emergency department has not yet been used as health care workers continue to manage patient overcrowding within the Kealakekua facility.

The tent went up in July after KCH called three Code Triage within five weeks, bringing all hospital managers together to discuss the overcrowding crisis, which has been an issue for the past several months. Since Big Island Now first reported about the Blu-Med tent on July 21, one Code Triage was called.

Administrators already intended to erect the tent by mid-August. On Friday, Aug. 5, the tent was not officially open. KCH spokesperson Judy Donovan said health care administrators haven’t felt the need to got into the tent just yet.

“The decision to take the tent operational will be reviewed daily,” Donovan said. “I can’t say at this point when that will be.”

KCH plans to leave it up through the winter.

“As flu season hits, and winter residents return, we are likely to have increased difficulty managing in the ED if we are not able to reduce the waitlist inpatient population,” Donovan added.

A self-contained, negative pressure, climate-controlled medical facility, KCH officials say the hospital will use the tent as an emergency overflow. With the hospital out of beds, the tent will be equipped with eight medical-grade cots.

Currently, Donovan said they are overflowing into other areas of the hospital, with health care workers seeing patients at KCH’s former emergency department lobby, which was converted to a potential COVID waiting area.

“It’s not a comfortable place to be treated,” she added.

KCH is averaging five to six patient holds a day. Donovan said those holds are patients already admitted to the hospital but continue to be treated in ED till a bed on the acute care floor opens up.

As of Friday, Aug. 5, KCH had 78 inpatients plus the five being held in ED awaiting a bed.

In July, KCH had 34 patients waitlisted, awaiting discharge to a skilled nursing facility for continued care and/or rehabilitation. That number has dropped to 25 as Kohala Hospital and Life Care have had bed openings.

The overcrowding issues are not unique to KCH. For the past two to three months, Hilo Medical Center has been experiencing high patient census and have been operating above its capacity.

On Friday, HMC started with 173 patients in the facility, 17 of which were for COVID-19. HMC spokesperson Elena Cabatu said there are 14 patients in the overflow areas of the hospitals and 10 holds are in the emergency department awaiting a bed on the floor.

Thirty-seven HMC patients are waitlisted.

Cabatu said there are multiple contributing factors causing HMC to be full, including: a continuous flow of sicker patients seeking care as well as long-term care facilities having limited capacity due to staffing shortage and COVID outbreaks.

“Difficulty in discharging patients results in a high amount of waitlisted patients waiting in a hospital bed,” Cabatu said. “Fewer open beds means patients are held in the emergency department waiting for a bed to open, causing an increase in wait times in the ED.”

Cabatu said HMC has implemented a number of solutions to address the crowding and continue to care for the community. The hospital has opened additional beds in its extended care facility as well as utilizing overflow beds in other patient care areas such as OB unit, short stay and recovery.

“Staff are working overtime and travelers have been brought in to staff additional beds,” Cabatu said, adding enrollment has doubled for HMC’s Nurse Residency Program, which will train 45 new nurses.

HMC has also launched a paid Nurse Aide Training Program. Staff are encouraged to enroll in Critical Care Nurse Training Program to help care for sicker patients.