This commentary is by John R. Brumsted, M.D., president and CEO of the UVM Health Network.
As we near the end of the second full year of the Covid-19 pandemic, I wish I could say the pressures of this global crisis show signs of easing. But that is not the case.
For months, health systems nationwide, including the UVM Health Network, have been under severe strain due to a rapid and sustained increase in demand for a variety of health care services — many of them acute. This can be directly traced to the early stages of the pandemic, which forced patients to delay seeking both routine and urgent care, and is in addition to the increasing Covid-19 cases we’re seeing.
The current pressure on our system is felt most acutely by our providers and staff, who continue to provide extraordinary care to our patients and their families even as new challenges arise daily.
The effects of pandemic-related health care delays are serious and ongoing in both Vermont and northern New York: Patients are sicker when they arrive at our hospitals, and they require more acute care. This regularly tests the limits of our intensive care units and emergency departments. Additionally, the need for mental health care continues to far outpace available treatment resources.
These challenges have a ripple effect throughout the health care system, and they have been exacerbated by local and national workforce shortages. Many providers and staff are feeling extreme exhaustion and stress, and they are leaving the profession in unprecedented numbers.
Hospitals around the country, including some in our region, have closed beds, limited services and/or refused a significant number of patient transfers in the face of these challenges. The UVM Health Network has worked hard to do the opposite.
From day one, our mission has been to meet our patients’ needs and keep our facilities open and serving patients. This is especially true at our academic medical center, where we serve the sickest patients of our region, and we have worked to add bed capacity in innovative ways to meet growing demand.
Some of this work wouldn’t have been possible without coordination with partners in the community and state government. For example, the state of Vermont is helping us to discharge patients to skilled nursing facilities when they no longer require hospitalization.
All told, we have added 57 beds to our network (including 16 emergency department beds, 13 mental health beds and five intensive care beds) during the pandemic, and worked with community partners and the state to bring online 46 skilled nursing facility beds. We’ve also worked with the state of Vermont to try to maintain the supply of mental health inpatient beds at the state’s psychiatric hospital and the Brattleboro Retreat.
The skilled nursing facility and mental health beds have made it possible to move patients from inpatient facilities to more appropriate care settings and free up space for other patients.
Our focus on preserving — and, in fact, increasing — capacity for our sickest patients has come, in part, at the price of reduced access to routine ambulatory care, as we have diverted limited resources to maintaining hospital capacity. We’ve also had to postpone non-urgent surgeries at some of our hospitals due to the need for more critical care.
Access to specialty care within our network has been a challenge for some time and has been further limited by the pandemic and the cyberattack we experienced in fall of 2020, causing unacceptably long wait times for patients in some areas.
In October, we launched our Access Action Plan, a multiyear, organization-wide effort aimed at tackling, head-on, the challenges that lead to long wait times. The plan has three core goals:
- Retain our talented workforce and hire successfully amid national staffing shortages.
- Reduce wait times for specialty care.
- Improve hospital inpatient and emergency capacity.
In just two months since our plan was announced, we implemented the second phase of our electronic health record system; launched eConsults in some specialty areas so patients can get expert opinions within a week; and are making significant investments in expanding our patient access service center to improve how we schedule appointments.
But we must also recognize that many of the initiatives we’re embarking on will take time to make a broad impact and are dependent on the pressures of the pandemic reducing. We are continuing to refine and add additional action items to our plan, which we will share as we make progress in the New Year.
Our patients are at the heart of everything we do: Our mission is to provide high-quality health care to everyone we serve, now and into the future. We have brought dedication, creativity and an unwavering commitment to our communities as we work to maintain access to the most critical services needed by our sickest patients.
For example, recently we responded to the state of Vermont’s request — and New York state’s order — to shift more resources to critical care capacity. This would not be possible without our incredible workforce, all of whom continue to face unprecedented challenges in order to keep our communities safe from Covid-19 and as healthy as possible during these trying times.
