KCH Nears Patient Capacity; Forced to Set Up Blu-Med Tent Outside Emergency Department

Kona Community Hospital administrators decided Wednesday, July 20, to deploy its Blu-Med tent outside the Emergency Department to triage incoming patients as the facility exceeds capacity.

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.

Administrators already intended to erect the tent by mid-August; however, they were forced to expedite the plan after the hospital called its third Code Triage in five weeks. That brought all hospital managers together to discuss the overcrowding crisis, which has been an issue for the past several months.

“We’re at capacity and passing capacity,” said KCH spokeswoman Judy Donovan.

As of Wednesday, KCH had 86 patients in-house with 10 patients in the Emergency Department — three were waiting for transfer to another facility to receive acute-level care and seven need beds in the hospital. The facility’s capacity is 94.

Nearly half of the hospital bed space is being taken by patients who are no longer acute but are unsafe to return home, needing a continued level of care.

KCH Lead Care Coordinator Christine Berkes said this issue is a problem for all West Hawai‘i.

“It’s not because we’re short staff,” she added, “our patient census is overwhelming our resources.”

The tent should be operational today.

Nowhere to Go

Thirty-four of the 86 patients are waitlisted, awaiting discharge to a skilled nursing facility for continued care and/or rehabilitation.

Chief Nurse Executive Diane Hale said family members are bringing their loved ones in and are refusing to take them home because they are unable to provide for their continued care. While they don’t fault the families, Hale said the hospital ends up shouldering the burden.

“We have a patient who has been with us for over two years,” Hale said, adding “We are not a long-term care facility. We don’t have activities, don’t have rehab and it’s heartbreaking.”

Hale said most facilities on the island are also at capacity and managing their own waitlisted patients. In the past, KCH has been able to discharge to Kohala Hospital, but it is also at capacity.

According to Hale, Life Care of Kona, one of the county’s skilled nursing facilities, stopped offering a number of beds because of staffing issues.

“These patients are ready for the next level of care, but there are no accepting facilities,” Berkes said.

Life Care Executive Director Meredith Eder said that prior to the pandemic, Hawai‘i was dealing with a shortage of health care professionals.

“The pandemic has exacerbated those shortages and sparked a trend of post-acute health care professionals leaving their positions at long-term care facilities to accept work in higher-paying acute settings,” according to Eder in a statement provided to Big Island Now on Wednesday.

Eder’s statement didn’t go into detail regarding the number of staff at Life Care.

“The staffing situation has not affected our ability to provide the premier services our residents and community have come to expect from us, only the number of patients we can provide those services to,” she stated. “Staffing levels are reviewed daily. We are still taking new admissions, but we are limiting them to accommodate current staffing levels and to ensure we can maintain our commitment to safe and personalized care.”

Berkes said KCH has reached out to facilities on other islands and has not been successful in placing any waitlisted patients.

“The waitlist population is a testament to the disparities in care that the people in Hawai‘i face,” Berkes added. “We don’t have the facilities to get the proper care and resources they need.”

Hospitals Beds on Order

To address the immediate needs, KCH administrators ordered seven hospital beds and are working on hiring eight travel nurses. Those beds and additional nurses are expected to arrive by early to mid-August.

“We give great patient care,” Hale said. “We have people who are great at what they do. We’re just concerned we don’t have the beds.”

With no hospital beds, Emergency Department Manager Regina Moreno said patients are lying on “uncomfortable gurneys and recliners.”

A low percentage of patients are being treated for COVID-19. Moreno said the majority of patients are there for a variety of other reasons. Hospital Emergency Department staff are currently identifying their most critical patients through a triage system.

Moreno said the tent, additional beds and travel nurses are all just temporary solutions.

“The (overcrowding) problem will still exist,” she said.

Long-Term Solutions

The overcrowding in hospitals and lack of resources is not unique to KCH. It’s a struggle nationwide, and there are no easy solutions.

“Many people don’t know this is a problem until it’s in their household,” Donovan said, referring to the crisis with their waitlisted patients.

Donovan said the public needs to know how dire the capacity issue is and to start talking about it. She encouraged residents to reach out to their local advocacy groups and write to their legislators.

At Life Care, Eder said they are being aggressive in their efforts to recruit and hire new staff, and working to onboard them as quickly as possible. However, the process will take time. The challenges to hire in Hawaii are well-documented, especially on the Big Island.

“The Hawaii Healthcare Association recently requested an emergency proclamation from the governor to waive state licensing for health care professionals for at least 90 days,” Eder stated. “We support the proclamation and encourage our local and state leaders to get involved and push for similar legislation that will accelerate the hiring process so we can more quickly increase our staffing levels and, as a result, increase the number of patients in our care.”

Hale said the federal government has to be involved and increase reimbursement so post-acute care facilities, like Life Care, can keep their doors open.